Dedicated for Andhra Pradesh Floods

policy Number *Please Enter Your policy Number

Insured’s Name *Please Insured’s Name

Insured Contact No *Please Contact No

Alternative Contact No Please Contact No

Email ID *

State *

City *

Date of Loss *

Cause of Loss*Flood and inundation

Damaged Property / Asset / Vehicle detailsPlease Enter Damaged Property / Asset / Vehicle details

Injury / Death DetailsPlease Enter Injury / Death Details

Place of lossPlease Enter Place of loss

Loss location Address

Estimate of LossEstimate of Loss

Other Remarks relevant to your claim with Bank details and CKYC

I / We hereby declare that the foregoing statement / information as provided by me/us are true in all respects. I / We ensure to substantiate my claim by providing all relevant claim documents.

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