Ā Ȁ̀ЀԀĀ؀܀ࠀऀЀ਀܀଀ԀĀ ఀഀ਀̀฀ĀȀༀЀ฀ Ѐ ကᄀ ؀ሀጀ᐀ᔀᘀᜀĀᜀᘀ᠀ᤀ؀ᨓ ᬀ᐀ ᔀࠀሀԀᘓЀᰀ܀ఀ฀̀଀ᴀ ḀሀༀԀఀЀᰀ܀ఀ฀̀଀ᴀ ἀ᐀ ℀᐀ ᰀༀఀ̀ᴀ ∀᐀ ᠀ᄀᄀ଀̀؆ᴀЀ ⌀

 

Claims / Claim Form Fire Insurance/ Ver 1. 0/ 1st June 2006 Claim Form Fire Insurance The Issue Of This Form Is Not To Be Taken As An Admission.

 

Ā Ȁ̀ЀԀĀ؀܀ࠀऀЀ਀܀଀ԀĀ ఀഀ਀̀฀ĀȀༀЀ฀ Ѐ ကᄀ ؀ሀጀ᐀ᔀᘀᜀĀᜀᘀ᠀ᤀ؀ᨓ ᬀ᐀ ᔀࠀሀԀᘓЀᰀ܀ఀ฀̀଀ᴀ ḀሀༀԀఀЀᰀ܀ఀ฀̀଀ᴀ ἀ᐀ ℀᐀ ᰀༀఀ̀ᴀ ∀᐀ ᠀ᄀᄀ଀̀؆ᴀЀ ⌀᐀ Ḁࠀഀ਀ༀᘊЀᰀ܀ఀ฀̀଀ᴀ ␀ༀഀᄀሀԀഀ̀ᴀ─Ѐ ☀ࠀ฀Ԁሀ̀ᴀ─Ѐ ✀᐀ ⠀─ఀༀԀሀᴀ ᬀᄀ ᜀᘀ᠀ᤀ؀ᨓĀᰀȁ᨜ጀጀᴀ ᬀ᐀ ἀ᐀ ℀᐀ ∀᐀ Ḁᄀ ጀЀᄀ ᜀ਀℀ԀĀ༢Āᨏࠀࠀ ᤀ฀ༀइ℀Ā༢Āᨏࠀࠀ ᬀ᐀ ἀ᐀ ─ᄀ Ā.

 

Toll Free Number 1800-209-5846 1800-209-LTIN www. ltinsurance. com is the brand of L T General Insurance Company Limited Registered Office: L T House, N. M. Marg, Ballard.

 

10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002 Easy Health ClaimForm1PART A TO BE FILLED IN BY THE INSURED The issue of this.

 

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Consolidated Hallmark Consolidated Hallmark InsurancePlc RC: 168762 33D, Bishop Aboyade Cole Street, V. I. , Lagos Tel: 234-1-4618222, Fax: 234-1-468380.

 

IFFCO-TOKIO GENERAL INSURANCE COMPANY LIMITED REGISTERED OFFICE: 34, NEHRU PLACE, NEW DELHI – 110019 Claim No. : _____________ Date of Issue: __________.

 

IFFCO-TOKIO GENERAL INSURANCE COMPANY LIMITED REGISTERED OFFICE: 34, NEHRU PLACE, NEW DELHI – 110019 Claim No. : _____________ Date of Issue: __________.

 

As soon as Loss or Damage has become known the Company must be notified without delay. If any detail or information is not readily available please do not delay.

 

THE FOLLOWING ITEMS MUST BE INCLUDED WITH THIS CLAIM 1. The Original if a refund is not obtainable. 2. Doctor Õ s/Hospital Certificate specifying exact nature.

 

Downloaded from www. insureatclick. com - Broker : Loyal Insurance Brokers Ltd. Downloaded from www. insureatclick. com - Broker : Loyal Insurance Brokers Ltd.

 

Downloaded from www. insureatclick. com - Broker : Loyal Insurance Brokers Ltd. The Issue of This Form Is Not To Be Taken As Admission Of Liability As soon as Loss or Damage.

 

Downloaded from www. insureatclick. com - Broker : Loyal Insurance Brokers Ltd. The Issue of This Form Is Not To Be Taken As Admission Of Liability As soon as Loss or Damage.

 

Claims / Claim Form Fire Insurance/ Ver 1. 0/ 1st June 2006 Claim Form Fire Insurance The Issue Of This Form Is Not To Be Taken As An Admission.

 

Downloaded from www. insureatclick. com - Broker : Loyal Insurance Brokers Ltd. T h e N e w I n d i a A s s u r a n c e C o m p a n y L i m i t e d H e a d O f f i c e : 8 7 , M G R o a d , F o r t , M u m b a i - 4 0 0 0 0 1 F i r e I n s u r a n c e C l

 

Downloaded from www. insureatclick. com - Broker : Loyal Insurance Brokers Ltd.

 

Downloaded from www. insureatclick. com - Broker : Loyal Insurance Brokers Ltd.

 

Downloaded from www. insureatclick. com - Broker : Loyal Insurance Brokers Ltd. T h e N e w I n d i a A s s u r a n c e C o m p a n y L i m i t e d H e a d O f f i c e : 8 7 , M G R o a d , F o r t , M u m b a i - 4 0 0 0 0 1 F i r e I n s u r a n c e C l

 

༈ ༰ࠀ̀ᄁऀ᐀∀ሀऀഀ̀Ā༗ጀ ࠀ ࠀ ༰Ȁጀࠀ̀ḐⰀࠀ ᄏऀ㐀ࠀ᐀̀༉ሀࠀሀ✀ ἀ ༰ࠀ̀㨀ⰀȀĀࠀĀ̀Ā༗ጀࠀ ∀ ̀ ḏऀఀȀ༈ ༰ࠀ̀ᄁऀ᐀∀ሀऀഀ̀Ā༗ጀ ࠀ ̀ ᔏ̀̀̀က✀Ā⌀〈〃ᄁ ऀ ̀

 

Ā Ȁ̀ЀԀĀ؀܀ࠀऀЀ਀܀଀ԀĀ ఀഀ਀̀฀ĀȀༀЀ฀ Ѐ ကᄀ ؀ሀጀ᐀ᔀᘀᜀĀᜀᘀ᠀ᤀ؀ᨓ ᬀ᐀ ᔀࠀሀԀᘓЀᰀ܀ఀ฀̀଀ᴀ ḀሀༀԀఀЀᰀ܀ఀ฀̀଀ᴀ ἀ᐀ ℀᐀ ᰀༀఀ̀ᴀ ∀᐀ ᠀ᄀᄀ଀̀؆ᴀЀ ⌀

 

Downloaded from www. insureatclick. com - IMD Code : 10000006.

 

Policy No: Claim no: 1. Name 2. Address _ _ City: 3. Name of Contact 4. Contact No s: 5. Date Time of. 6. Place of 7. Purpose for which the premises being used.

 

Claims / Claim Form Fire Insurance/ Ver 1. 0/ 1st June 2006 Claim Form Fire Insurance The Issue Of This Form Is Not To Be Taken As An Admission.

 

As soon as Loss or Damage has become known, th e Company must be notified without delay. If any detail or information is not readily available, please do not delay.

 

1 IFFCO-TOKIO GENERAL INSURANCE COMPANY LIMITED REGISTERED OFFICE: IFFCO Sadan, C – 1, District Centre, Saket, New Delhi 110017 Claim No. : _____________.

 

Machinery Breakdown Insurance D D M M Y Y Y Y D D M M Y Y Y Y Toll Free Number 1800-209-5846 1800-209-LTIN www. ltinsurance. com SMS ‘LTI’ to 5607058 56070LT Intermediary Name: FOR OFFICE USE ONLY.

 

Contractor’s All Risks Insurance 1/2.

 

Ā ĀĀĀĀ Ѐ ĀĀ ᤀጀ ᨀ฀ఀ̀ᬀ ᰀጀ ᘀༀༀ଀̀؆ᬀЀ Ѐ ᴀጀ Ḁᔕ܀᠀฀਀Ԁࠀഀᬀ ἀጀ  ጀ ∀ጀ ⌀ࠀഀ਀฀ᔀ਀Ѐᨀ܀ఀᄀ̀଀ᬀ Ā ✀ጀ ⠀─ఀ฀Ԁကᬀ ⤀ጀ ЀЀЀЀЀЀЀЀЀЀ Ⰰጀ Ѐ ᤀጀ 　

 

RGI-MI-04 19 Money Insurance Claim Form Issuance of this form does not imply acceptance of the liability Please return the form completed.

 

Personal Accident Micro Insurance 1800-209-5846 1800-209-LTIN www. ltinsurance. com.

 

1 IFFCO-TOKIO GENERAL INSURANCE COMPANY LIMITED REGISTERED OFFICE: IFFCO Sadan, C – 1, District Centre, Saket, New Delhi 110017 Claim No. : _____________.

 

Ā ĀĀĀĀ Ѐ ĀĀ ᤀጀ ᨀ฀ఀ̀ᬀ ᰀጀ ᘀༀༀ଀̀؆ᬀЀ Ѐ ᴀጀ Ḁᔕ܀᠀฀਀Ԁࠀഀᬀ ἀጀ  ጀ ∀ጀ ⌀ࠀഀ਀฀ᔀ਀Ѐᨀ܀ఀᄀ̀଀ᬀ Ā ✀ጀ ⠀─ఀ฀Ԁကᬀ ⤀ጀ ЀЀЀЀЀЀЀЀЀЀ Ⰰጀ Ѐ ᤀጀ 　

 

1 IFFCO-TOKIO GENERAL INSURANCE COMPANY LIMITED REGISTERED OFFICE: IFFCO Sadan, C – 1, District Centre, Saket, New Delhi 110017 Claim No. : _____________.

 

PolicyNo Date of registration Area Office Code/Service Centre Code Broker/Agent Name code Code 1 A. Name B. CustomerID. Plot No. / DoorNo.

 

Ā ਀਀฀ᔂЀᜀ̀᠀฀଀฀਀̀ Ѐ Ă ؀ሀጀ᐀ᔀᘀᜀĀᜀఀЀ਀ༀ฀ࠀ ᤀက฀ԀఀЀᨀ܀ఀᄀ̀଀ᬀ ᐀ࠀကԀᔒЀᨀ܀ఀᄀ̀଀ᬀ ᰀഀ؀܀଀̀ༀᬀ ăက̀᠀Ȁࠀഀ̀ Ѐᨀ܀ఀᄀ̀଀ᬀ ᴀ ฀ഀༀကԀഀ̀ἀ

 

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Fidelity Guarantee Insurance ClaimForm Issuance of this form does not imply acceptance of the liability Please return the form duly completed.

 

Blue Cross Asia-Pacific Insurance Limited ME041/12. 2007 藍十字 亞太 29/F, BEA Tower, Millennium City 5, 418 Kwun Tong Road,.