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Erection All Risk

The document is an Erection All Risk Insurance Claim Form issued by IFFCO Tokio General Insurance Co. Ltd., requiring detailed information about the claim, including loss description, cause, and estimated repair costs. It emphasizes that the issuance of the form does not imply admission of liability and must be submitted within 15 days of the incident. The form also includes a declaration statement to be signed by the claimant, affirming the truthfulness of the provided information.

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3 views1 page

Erection All Risk

The document is an Erection All Risk Insurance Claim Form issued by IFFCO Tokio General Insurance Co. Ltd., requiring detailed information about the claim, including loss description, cause, and estimated repair costs. It emphasizes that the issuance of the form does not imply admission of liability and must be submitted within 15 days of the incident. The form also includes a declaration statement to be signed by the claimant, affirming the truthfulness of the provided information.

Uploaded by

khodiyarconsultancy75
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

IFFCO TOKIO GENERAL INSURANCE CO. LTD.

Regd. Office: IFFCO Sadan, C-1, Distt. Centre, Saket, New Delhi 110 017

Erection All Risk Insurance Claim Form


Claim No. _______________ Date of Issue: ________________

• Please note that this Claim Form is issued without prejudice to the terms and conditions of the policy and issuance of this form
should not be construed as admission of Liability.
• Please fill in all the blanks and give complete details of information asked for. In case space provided is found insufficient, a
separate sheet may kindly be annexed.
• Please submit this form, duly filled & signed, within 15 days, from the date of occurrence.
Policy No.
Insured:
Address:
Site of Erection:
1. Description and value of items lost or damaged.
(If Declaration Policy, quote reference number of Declaration)
2. When did the item in question arrive at site?
3. Date, time and place of loss or damage.
4. Cause of loss or damage.
5. By whom was the accident witnessed?
6. Nature of damage sustained with full description.
7. Specify the nature of Guarantee from the Supplier or the
manufacturer of the damaged equipment. Are there any changes of
the Supplier or Manufacturer indemnify the loss? If not state
precisely the reasons.
8. If damage occurred during testing, when did testing commence?
9. State what repairs or replacements are required and estimated
cost thereof.
NOTE: Every effort should be made to give a Preliminary figure,
it being understood that the eventual claim will not necessarily be
limited to his estimate.
10. Salvage or scrap value of damaged parts.
11. Will it be necessary to:
(a) Work overtime or on Sundays/Holidays in order to effect
repairs?
(b) Dispatch replacement parts by “Express Delivery”?
12. State where damaged item can be Inspected should the
company so desire.
13. Was the loss or damage caused by a Third Party? If so give
name and address of Third Party concerned.
14. Are there any rights of recovery from Contractors/Sub-
Contractors Suppliers/ Manufactures?
15. Give details of any other Insurance under which you are
entitled to recover in respect of this loss or damage.
16. Please give any other particular relevant to the Loss / damage.

I / We hereby declare that the statements made by us in the claim form are true to the best of our knowledge and belief and that
we have not withheld any material information which has a bearing upon the claim.

Name: Designation: Signature:


Date: Place:

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