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Company

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Claims

Resources

Support

Contact

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Claim Center

Claim Procedures

Motor Insurance Claim Form

Claims are an integral part of insurance business. Claims are paid out of the insurance fund of the insurers.

Download Claim Form

Claims

Claims Outstanding

Claims Statement

Largest Claim Settled

Download Claim Forms

Claims Procedures

Start your claim

Claim No:

Date:

INSTRUCTIONS FOR COMPLETION OF THIS FORM

Claim Form is to be filled in properly & signed by the insured,
Please do not leave any column unanswered.
All facts and Statements must be factual not influenced or biased in any form.
The damaged vehicle must be parked at safe place to avoid any subsequent loss/theft. Company will not be responsible for the same.
Please read carefully and attach the documents required for speed up procession of your claim.

Policy Holder Details:

Period:

Phone & Address

Vehicle Details:

What were the risks covered under the Policy ?

Date of Transfer

Details of the Person Driving

Full Name:

Age:

Driver is:

Owner

Paid Driver

Relative/Friend

Make (√) Whichever is applicable.

Address:

Driving License No:

Issue Date:

Expiry Date:

Loss Details: Accident / Theft

Date of Loss:

Exact Place where loss occurred:

Place to which the vehicle was heading for before accident:

What was the construction of the affected premises at the time?

Walls

Roof

Purpose for which vehicle was being used at the time of accident:

Nature of goods carried at the time of accident?

No of People traveling and in what capacity at time of accident :

Is reported to the Police ?

Yes

No

Name of the Police Station :

Diary/FIR No :

If any third party was responsible for the Accident, give name and address:

Extent of Damage

Brief details of Accident:

If any third party was responsible for the Accident, give name and address:

Estimate cost of repair:

Where can the vehicle be inspected?

Has the accident caused injury to any person or property?

Has any claim be made upon you by any Third Party?

Give particulars of other insurance on the vehicle, if any:

I/We do hereby confirm that to the best of my/our knowledge the aforesaid statements are true. I/We also agree that if any false or fraudulent statement or any suppression or concealment of material fact is made in respect of the said accident the Policy shall be void and all rights to recover there under shall be forfeited.

Download Sheet

Download

Attach Sheet:

Upload filled sheet. (Photo or Scanned copy link)

Date :

Signature of Insured:

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Important

Insurance Development &

Regulatory Authority (IDRA)

Securities & Exchange Commission

Dhaka Stock Exchange

Chittagong Stock Exchange

Financial Reports

Company

Management Information

Reinsurance Arrangements

Our Brokers

Media & News

Claims

Largest Claim Settled

Download Claim Forms

Downloads

Headoffice

Rangs Babylonia (5th Floor),
246 Bir Uttam Mir

Shawkat Sarak,

Tejgaon, Dhaka-1208,

Contact

T: 8878901(Hunt)

F: 8878913, 8878914

M: piclho@gmail.com

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The information on this website is for general purposes only and is not a substitute for professional advice. Pioneer Insurance PLC (“Pioneer Insurance”) strives for accuracy but does not guarantee the completeness or reliability of the content. Insurance products and services are subject to specific terms, conditions, and eligibility requirements, which may vary. All applications for insurance are subject to underwriting approval. We are not responsible for third-party websites linked to this site. By using this website, you agree to the terms and conditions, and any disputes will be governed by the laws of Bangladesh.