{"id":1365,"date":"2019-04-05T11:37:06","date_gmt":"2019-04-05T06:07:06","guid":{"rendered":"http:\/\/myinsurer.in\/?page_id=1365"},"modified":"2019-04-05T15:58:37","modified_gmt":"2019-04-05T10:28:37","slug":"motor-claim-intimation","status":"publish","type":"page","link":"https:\/\/myinsurer.in\/index.php\/home\/forms\/motor-claim-intimation\/","title":{"rendered":"Motor Claim intimation"},"content":{"rendered":"<h2>\n<h1 itemprop=\"headline\">Motor Claim intimation<\/h1>\n<\/h2>\n<p>\t\t<!-- [if gte mso 9]><xml>\n <o:OfficeDocumentSettings>\n  <o:AllowPNG\/>\n <\/o:OfficeDocumentSettings>\n<\/xml><![endif]--><!-- [if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:TrackMoves\/>\n  <w:TrackFormatting\/>\n  <w:PunctuationKerning\/>\n  <w:ValidateAgainstSchemas\/>\n  <w:SaveIfXMLInvalid>false<\/w:SaveIfXMLInvalid>\n  <w:IgnoreMixedContent>false<\/w:IgnoreMixedContent>\n  <w:AlwaysShowPlaceholderText>false<\/w:AlwaysShowPlaceholderText>\n  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All fields are required.<\/p>\n<div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f1371-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1365#wpcf7-f1371-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1371\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.5.3\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1371-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><label> Accident to Vehicle Registration Number<br \/>\n    <span class=\"wpcf7-form-control-wrap Reg-No\"><input type=\"text\" name=\"Reg-No\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Policy Number:<br \/>\n    <span class=\"wpcf7-form-control-wrap Policy-No\"><input type=\"text\" name=\"Policy-No\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Policy Expiry Date:<br \/>\n    <span class=\"wpcf7-form-control-wrap PolExpDt\"><input type=\"date\" name=\"PolExpDt\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"2026-05-30\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Date of Accident:<br \/>\n    <span class=\"wpcf7-form-control-wrap DateOfAccident\"><input type=\"date\" name=\"DateOfAccident\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" max=\"2026-05-30\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> IDV:<br \/>\n    <span class=\"wpcf7-form-control-wrap IDV\"><input type=\"text\" name=\"IDV\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Estimated cost for repaires:<br \/>\n    <span class=\"wpcf7-form-control-wrap Estimate\"><input type=\"text\" name=\"Estimate\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Is it a collision with another Vehicle: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap CollisionVeh\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"CollisionVeh\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"CollisionVeh\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><\/p>\n<p><label> Has the claim includes any other Third Party Damage\/Accident\/Death etc ?: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap TPClaim\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"TPClaim\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"TPClaim\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><\/p>\n<p><label> Has the incident has been reported to the Police?: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap PoliceReport\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"PoliceReport\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"PoliceReport\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><\/p>\n<p><label> Class of Vehicle: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap ClassOfVehicle\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"ClassOfVehicle\" value=\"Two Wheeler\" \/><span class=\"wpcf7-list-item-label\">Two Wheeler<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"ClassOfVehicle\" value=\"Private Car\" \/><span class=\"wpcf7-list-item-label\">Private Car<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"ClassOfVehicle\" value=\"Commercial Vehicle\" \/><span class=\"wpcf7-list-item-label\">Commercial Vehicle<\/span><\/span><\/span><\/span><\/p>\n<p><label> Make\/Variant:<br \/>\n    <span class=\"wpcf7-form-control-wrap MakeVariant\"><input type=\"text\" name=\"MakeVariant\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Now the vehicle is at (Garage Address and Contact Number):<br \/>\n    <span class=\"wpcf7-form-control-wrap VehicleIsAt\"><input type=\"text\" name=\"VehicleIsAt\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Intimated by(Name):<br \/>\n    <span class=\"wpcf7-form-control-wrap IntimatedByName\"><input type=\"text\" name=\"IntimatedByName\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Garage Mobile number: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap MobileNoG\"><input type=\"tel\" name=\"MobileNoG\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/p>\n<p><label> Customer Mobile number: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap MobileNoC\"><input type=\"tel\" name=\"MobileNoC\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/p>\n<p><span class=\"wpcf7-form-control-wrap acceptance-50\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-50\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I understood that this link is only for the customers of SSV\/myinsurer.in to intimate their Motor claims to Office. Intimating through this form is not to be taken as admission of any liability by office. Alternatively Registered Owner should have to submit the signed \u201cMotor accident claim intimation\u201d and \u201cMotor claim form\u201d in the office at the earliest along with required documents.<\/span><\/label><\/span><\/span><\/span><\/p>\n<p><input type=\"submit\" value=\"Intimate Claim\" class=\"wpcf7-form-control has-spinner wpcf7-submit\" \/><\/p>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Motor Claim intimation This is not a Public Link. All fields are required.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1316,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1365","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/pages\/1365","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/comments?post=1365"}],"version-history":[{"count":7,"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/pages\/1365\/revisions"}],"predecessor-version":[{"id":1374,"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/pages\/1365\/revisions\/1374"}],"up":[{"embeddable":true,"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/pages\/1316"}],"wp:attachment":[{"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/media?parent=1365"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}