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

 

MACHINERY BREAKDOWN POLICY CLAIM FORM Please note that the issue of this claim form is not to be taken as an admission of liability DETAILS.

 

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

 

I MACHINERY BREAKDOWN POLICY CLAIM FORM Please note that the issue of this claim form is not to be taken as an admission of liability 1 Name:.

 

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

 

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

 

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.

 

INSURANCE CLAIMFORM Are you registeredfor GST purposes Yes ‰ No ‰ What is yourABN Have you claimed, or intend to claim an input tax credit on the GST comp onent of the premium applicable.

 

INSURANCE CLAIMFORM Are you registeredfor GST purposes Yes ‰ No ‰ What is yourABN Have you claimed, or intend to claim an input tax credit on the GST comp onent of the premium applicable.

 

! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! , ! - ! , ! - !. / ! ! ! 0 ! 1 ! ! 2 2 3 2 ! 3 , 4 ! 5 , ! ! ! ! ! 5 6 7 ! ! ! ! 8 ! - 8 , ! ! 9: ; , ! ! 3 ! ! ! 1 3 ! ! ! ! ! ! 3 ! ! ! 3 ! ! ! ! ! ! ! 3 2 !! ! ! ! , 0 ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

 

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.

 

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.

 

᐀37 2/ 06 4. ;. ; 884A ,78 A 7/7:2026 48 :,1 ;. 2672,. /7: 6A. 9 285. 6 47; 6- 6. ;25. /7: 2 ; :. 84 ,. 5. 6 A. 9 285. 6 7 ;2524 : ;8. ,2/2, 276؀ 1. :. - 5 0. 1 ;. 6 ; ; 26. -Ѐ -. ;,:2. - 5 0. 6- 8:7 2-. 6. ;25. /7: :. 8 2:؀ᜀ7 A7 7 6 1. 9 285. 6 ጀ. ; Ԁᘀᰀ

 

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: __________.

 

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

 

,x “Ьh Ааc JД A ю„т Kз Й ў JГЗ ’я9эК.

 

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.

 

Ā ĀĀĀĀ ĀĀĀ Ѐ ᤀጀ ᨀ฀ఀ̀ᬀ ᰀጀ ᘀༀༀ଀̀؆ᬀЀ Ѐ ᴀጀ Ḁᔕ܀᠀฀਀Ԁࠀഀᬀ ἀጀ  ጀ ⌀ጀ ␀ࠀഀ਀฀ᔀ਀Ѐᨀ܀ఀᄀ̀଀ᬀ ⠀ጀ ⤀☀ఀ฀Ԁကᬀ ⨀ጀ ЀЀЀЀЀЀЀЀЀЀ ⴀጀ Ѐ ᤀጀ ㄀฀

 

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

 

Ā ĀĀĀĀ Ā က܀ᄀሀऀ̀܀Ѐࠀ Āጀ᐀̀؀ᔀĀᘀ฀ऀᔀ Ѐ Ā ᴀሀༀԀఀЀᬀ܀ఀ฀̀଀ᰀ Ѐ ᬀༀఀ̀ᰀ Ѐ ᠀ᄀᄀ଀̀؆ᰀЀ Ѐ ᴀࠀഀ਀ༀᘊЀᬀ܀ఀ฀̀଀ᰀ ⌀℀ఀༀԀሀᰀ Ā ☀ Ѐ ⴀ᐀ Ѐ Ѐ Ѐ ᨀ଀̀✀

 

THE APPLIANCE OR MOTOR Type of appliance Motor, etc Maker’s name Model Serial No. KW watts Voltage RPM Open/Sealed Appliance purchased from Date.

 

Saudi United Coooperative Insurance Company Wala a required Saudi United Coooperative Insurance Company Wala a.

 

Saudi United Coooperative Insurance Company Wala a required Saudi United Coooperative Insurance Company Wala a.

 

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

 

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

 

INSURANCE CLAIMFORM Are you registeredfor GST purposes Yes ‰ No ‰ What is yourABN Have you claimed, or intend to claim an input tax credit on the GST comp onent of the premium applicable.

 

! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! , ! - ! , ! - !. / ! ! ! 0 ! 1 ! ! 2 2 3 2 ! 3 , 4 ! 5 , ! ! ! ! ! 5 6 7 ! ! ! ! 8 ! - 8 , ! ! 9: ; , ! ! 3 ! ! ! 1 3 ! ! ! ! ! ! 3 ! ! ! 3 ! ! ! ! ! ! ! 3 2 !! ! ! ! , 0 ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

 

! ! ! !.

 

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,.

 

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. : _____________.

 

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.

 

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

 

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. : _____________.