Policy & Account Details
Client
*
Select Client
Branch
*
Select Branch
Policy
Select Policy
Insurer
Policy Type
Policy No
Policy Start Date
Policy Expiry Date
Account Manager
*
Select ACM
Insured Contact Details
Contact Name
*
Min 3 chars. Only letters, numbers, spaces, hyphens, underscores.
Contact Number
*
Required. 10-15 digits, numeric only.
Contact Email
Invalid email format.
Loss / Incident Details
Nature of Loss
*
Required. Min 3 characters.
Loss Location
*
Loss Location is required.
Loss Date
*
Loss Date is required.
Loss Estimate
Must be a valid number.
Loss Description
Loss Description is required when uploading an asset file.
Intimation & Claim Reference
Intimation Recd Date
Intimated to Insurer Date
Nhance Claim Ref No
Max 100 characters.
Claim Number (Insurer)
Only letters, numbers, /, - allowed.
Status & Tracking
Status
*
Surveyor File Ref No
Priority
Select Priority
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Closure Remark
Asset Details
Asset ID/Code
Serial No
Vehicle No
Description
Add More Asset
OR
Upload Asset File
(Excel or PDF)
Only Excel (.xlsx, .xls, .csv) or PDF (.pdf) files allowed.
Please fill at least one asset row or upload an asset file.
Surveyor Details
Surveyor Name
Contact Person
Contact Number
10-15 digits, numeric only.
Email
Invalid email format.
LOR
Surveyor Remarks
Documents & Attachments
Google Drive Links
Documents Required
Documents Submitted
Pending Documents
ETA for Documents
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Settlement Details
Loss Assessed Value
Must be a valid number.
Settled Amount
Must be a valid number.
Settlement UTR
Max 100 characters.
Create Claim