Get Lombard General Insurance Application Form

Filling out the Lombard General Insurance Application Form online is a straightforward process that ensures accurate and comprehensive information is gathered for your insurance claim. This guide will provide you with clear, step-by-step instructions to complete the form effectively.

Follow the steps to successfully complete the application form.

1. Press the ‘Get Form’ button to access the Lombard General Insurance Application Form and open it in your preferred editor.
2. Begin by entering your policy or cover note number, along with the claim number, at the top of the form.
3. Fill in your name and correspondence address in the designated fields. Ensure all information is accurate and complete.
4. Next, indicate your district and pin code, followed by your residential and office telephone numbers. Include your mobile number and email address for communications.
5. Select your age group from the options provided, and specify your sex.
6. Provide information about your average yearly income and occupation by selecting the appropriate choices.
7. Indicate the number of family members you have and how many of them are above 18 years old.
8. Specify how many of those family members drive the vehicle and how many vehicles you own.
9. Select the average kilometers you drive in a year and specify the primary usage of the vehicle.
10. Respond to questions about previous claims in the last two years and who was driving during the accident.
11. Indicate the age and sex of the driver at the time of the accident, along with any safety devices present in the vehicle.
12. Fill in the details of your vehicle, including registration number, make, model, date of registration, mileage, chassis number, and engine number.
13. Provide the nature of your business and the hypothecation or hire purchase agreement status.
14. Complete the details regarding the driver at the time of the accident, including their correspondence address and employment status.
15. Detail the accident information, including the date, time, exact location, and a brief description of the incident.
16. Conclude by answering whether a third party was responsible for the accident and provide any necessary attachments, such as an FIR.
17. Once all sections are filled out, review your entries for accuracy. Save your changes, download the completed form, and print or share it as needed.

Complete your Lombard General Insurance Application Form online today to ensure a smooth claims process.