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Bajaj Allianz Burglary Claim Form

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You must prepare Bajaj Allianz Burglary Claim Form to report a break in and file a claim to the Bajaj Allianz Burglary authorities. This form has 11 parts requiring various particulars about the insurance policy, event of break in, and the property.


Please complete all 11 parts accurately and truthfully. Signature of a neutral adult witness is necessary in order to acknowledge the information and your signature on the burglary claim form. Please provide detailed description of the burglary and/or break in attempt in each part requesting the information for the same. You may choose to type or print this claim form for legibility. However, use only blue or black ink for typing, printing, and signing this form.


Bajaj Allianz Burglary Claim Form

Steps To Prepare Bajaj Allianz Burglary Claim Form

  • Enter the claim number and the insurance policy number in the foremost portion of the burglary claim form.
  • Enter your full name as it reflects in the insurance policy.
  • Enter your address along with PIN code on the next line.
  • Enter your occupation. Please provide specific details of your occupation like if you are salaried or self-employed and name of the company.
  • Enter full address of the premise under the burglary in 4a part of the Bajaj Allianz Burglary Claim Form. Insert the date and time of the burglary in 4b. Specify how the entrance of the property was affected due to the burglary in 4c. Please provide the information on which rooms were entered in 4d.
  • Provide details if the property was occupied during the burglary in 5a part of the burglary claim form. Otherwise, specify the period of vacancy counting from the last due insurance premium in 5b.
  • Enter the name and address of the police station where you have reported the event of burglary. You may choose to provide FIR number and/or enclose a copy of the same along with the Bajaj Allianz Burglary Claim Form.
  • Specify if you are the sole owner of the property or provide the name/s of the co-owner/s on the next line.
  • You must provide the estimated value of all your belongings in the property at the time of the theft. You may choose to enclose listing with detailed description.
  • Please provide the sum assured for fire loss and mention the name of the insurer on the subsequent line.
  • Please enter the name of the insurance company where you have insured the same property for theft/burglary/break in other than Bajaj Allianz. You must provide a detailed description like insurer’s name, insurance policy number, sum assured, and expiration details.
  • Please report any past incidence of burglary or fire at the property descriptively.
  • Enter the time and date of the break in/burglary event on the following line.
  • Then mention the estimated amount of loss due to theft in the space reserved for the same. You may choose to provide a listing for detailed description of the loss under various heads.
  • A witness must enter his/her occupation, address, date, and sign this form.
  • Please enter date, place, and sign the Bajaj Allianz Burglary Claim Form to complete it.

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