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Zuno Motor Claim Form-Page1

This document contains a claim form for Zuno Motor insurance. It lists requirements for filing a claim, including filling out all fields in capital letters and signing the form. It also notes that the damaged vehicle must be parked safely and the company is not responsible for any subsequent loss or theft. An attached document lists all documents required to expedite the claim processing. The form requests policy and insured details, vehicle details, accident/theft details, and driver details including name, license information, and relationship to the insured.

Uploaded by

Somnath Laha
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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15K views1 page

Zuno Motor Claim Form-Page1

This document contains a claim form for Zuno Motor insurance. It lists requirements for filing a claim, including filling out all fields in capital letters and signing the form. It also notes that the damaged vehicle must be parked safely and the company is not responsible for any subsequent loss or theft. An attached document lists all documents required to expedite the claim processing. The form requests policy and insured details, vehicle details, accident/theft details, and driver details including name, license information, and relationship to the insured.

Uploaded by

Somnath Laha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Toll Free 1800 12000

Need to claim?
We won’t play the claim game!

Zuno Motor
Claim form
(Issuance of this Form does not imply acceptance of the liability)

All fields in the form are mandatory


A. The claim form is to be filled in CAPITAL LETTERS & duly signed by the insured.
B. All facts and statements must be factual, not influenced or biased in any form.
C. The damaged vehicle must be parked at safe place to avoid any subsequent loss/theft. Company will not be
responsible for the same.
D. Please read carefully, the attached list of documents required to speed up processing of your claim.

Policy No:

Claim No:

Insured details
Insured name:
Address:
City: State: Pin code:
Contact No. 1: Contact No. 2: Mail id:

Vehicle details
Vehicle No: Chassis No:
Engine No: Make: Model:
Registration date: D D M M Y Y Y Y

Details of accident/theft
Date: D D M M Y Y Y Y Time: H H M M Place:
No. of occupants excluding driver: Purpose of travel:
Description of accident:

Driver details
Driver name: Mr/Mrs/Miss:
Licence No: Type of vehicle authorised to drive:
Learner licence: Yes No Expiry date: D D M M Y Y Y Y Contact No:
Relationship with insured: Date of birth: D D M M Y Y Y Y
Qualification: Occupation:

1
Product Name I UIN:

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