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  • Claim Form

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    nishit
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    This document appears to be a claim form for a fraudulent or lost credit card from The New India Assurance Co. It requests basic details about the customer, their account, and the disputed transaction. It asks for information like the date and time of the incident, brief details of what happened, when the card was blocked, if a police report was filed, and bank details for claim settlement. Additionally, it requests details to verify the customer's identity and address and seeks the investigation team's recommendation on whether fraud occurred along with any other helpful details to process the claim.

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    claim form

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    This document appears to be a claim form for a fraudulent or lost credit card from The New India Assurance Co. It requests basic details about the customer, their account, and the disputed transaction. It asks for information like the date and time of the incident, brief details of what happened, when the card was blocked, if a police report was filed, and bank details for claim settlement. Additionally, it requests details to verify the customer's identity and address and seeks the investigation team's recommendation on whether fraud occurred along with any other helpful details to process the claim.

    Copyright:

    © All Rights Reserved
    Scarica in formato PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    46 visualizzazioni2 pagine

    Claim Form

    Caricato da

    nishit
    This document appears to be a claim form for a fraudulent or lost credit card from The New India Assurance Co. It requests basic details about the customer, their account, and the disputed transaction. It asks for information like the date and time of the incident, brief details of what happened, when the card was blocked, if a police report was filed, and bank details for claim settlement. Additionally, it requests details to verify the customer's identity and address and seeks the investigation team's recommendation on whether fraud occurred along with any other helpful details to process the claim.

    Copyright:

    © All Rights Reserved
    Scarica in formato PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    di 2

    The New India Assurance Co.

    Ltd
    LCBO-990000, New India Centre, Ground Floor,
    17/A Cooperage Road, Mumbai- 400 039
    Claim Form for Fraudulent/Lost Card Liability

    Basic Details
    1. Claim No
    2. Customer Name
    3. Account no
    4. Card no
    5. Customer’s relation with the Bank in terms of Years
    6. Card Type
    7. Date and Time of Accident
    8. Place of Accident

    9. Brief details of incident of Fraud

    10. Claim Amount


    11. Date and Time of Request for Hot Listing
    12. Date and Time of Card blocking
    13. No of card issued in account
    14. Misuse card issue date
    15. Maximum Limit of Insurance Provided
    16. Daily Withdrawl Limit
    17. Who blocked the card ?
    18. Did Customer received any SMS alert for the disputed txn
    ?
    19. At the time of disputed txn took place, whether card was
    with Customer ?
    20. How did the Customer realized about the misuse of card
    and on which date?
    21. Is there any delay in blocking the card? If Yes, Specify
    Reason
    22. Is the card in possession with Customer ?
    23. Where Customer used his card last time ?
    24. Did Customer used his card abroad?
    25. Confirm with Customer where he was at the time of
    disputed txn?
    26. Is there any ATM transaction in dispute?
    27. Is Police complaint lodged? If Yes, Date of police
    complaint
    28. Date of Filing for Chargeback
    29. Date of Rejection of Chargeback
    30. Bank Details ( For Claim Settlement) Name:
    Bank Name:
    A/c No:
    IFSC Code:
    Branch Name:

    Customer Profile
    Occupation( if salaried or self employed please mention the
    name of the organisation)

    Designation

    Is there any difference in addresses mentioned in system and


    actual address ( for future communication)

    Additional comments, if any


    Investigation Analytics Team Recommendation
    Confirm Fraud?

    Any other information helpful in processing the claim

    All details are verified from us. Here we confirm that there is no involvement of any bank official/staff in
    this fraudulent act and this is done fully by cloned card and original card is destroyed in front of me.

    Name

    Designation

    Employee No. Signature with seal of Bank official


    (to be provided on all pages)

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