‘CHOLAMANDALAM MS GENERAL INSURANCE
CChennal - 600 003.
Registered and Head Office: Dare House, 2nd Floor, No.2, N.C. Bose Road,
‘COMPANY LIMITED
MOTOR INSURANCE CLAIM FORM
{The feeuance of tis form does not Imply admision of ably)
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Was the Acciderifbaf Reported to Pole: Yes/No
Name ofthe Poe Staton:
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Loss Detalls
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Driver Detals
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Whether the esr oer Fi eRe ens spect
Injury to Third Party/Occupants/Driver
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Other insurance Detals:
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Document Encased (Fr Office Use aly)
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Dicom Polley copy (Sebmisea] veer]
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eos ttate [ined vice aries] Vea]Discharge Voucher Please return this receipt duly stamped and signed to enable the company to make payment
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‘CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LIMITED
Registered and Head Office: Dare House, 2nd Floor, No2, N.C. Bose Road,
Chennal - 600 001.
} Chola@Ms
List of Documents required for claim settlement
{To be submites tothe nearby Chlamandaiam MS office / Surveyor / Repairer)
‘Cai for acide damages:
1 Proof of surance - Poy Coverot copy
2. cop of Registration ok, Tax Recep [Pls furs cin forveriatn)
3. Cony of Matr Dring Lane [wth erga ofthe person dng the wve athe mater ine
14, Pole Panchanam/FR {In cat of The Fert property damage [Death Boy nuyMsjor Loss Cais)
5. Estate for repair tom the grag where the vile tobe rene
6. Rept Ble and poymant recap ter the obs completed
7. Canceled cha eat for HEF transfer
18. ese sgn the attached acharge voucher sar conan ofthe ral him arcu.
For assistance Please Call us at our Toll Free No: 1 800 200 55 44Satisfaction Voucher Please return this receipt duly stamped and signed to enable the company to make payment
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‘CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LIMITED
Registered and Head Office: Dare House, 2nd Floor, No.2, N.S. Bose Read,
‘Chennai - 600 002,
Y Chola@Ms
List of Documents required for claim settlement
(Fo be submited to the nearby Cholamandalem MS office / Surveyor / Repairer)
‘lim for aeidetal damages:
tga Poly document
‘ovina Reistrtion Book/Catat and Tox Payment Rept
Fravous insurance des Poy Ho, suring Ofle/Company peti of surance
its of keys/ServesBoolet/Woreanty Crd
Felice Panchanama/ FR and Final kvesigaton Report
Acros coo of leteraderessedt RTO inmate and mang vik
orn 28,29 nd 30 gn bythe insted ad Form 35 sled bythe Finances
lata of Sregton
‘8, Consent toward agreed elm satlersent vale frm you and Finance
10.NOC ofthe Fiancerif enim st be seed in your veut
11. blak and undated Valsts
12.Cnealind geal for NEFT
13 ese sign the attache decree voucher for companstion of the alc amount.
Additonal docbments in spec das shall inmatod separately.
owe
te ein ee
the cave maybe undated sake
For assistance Please Call us at our Toll Free No: 1 800 200 55 44