-------------------------------------------------- DRAFT FOR ATTORNEY REVIEW ONLY — NOT LEGAL ADVICE This Insurance Claim Letter draft is a structured preparation document only. All damage figures and estimates stated in this letter are the Claimant's own assessment and do not constitute professional insurance valuation. A qualified Indian insurance attorney must review this letter before it is sent. The Claimant should retain copies of all supporting documents listed. -------------------------------------------------- Amit Sharma [Full address], Mumbai Maharashtra India [Phone] | [Email] Date: June 1 2026 The Claims Manager Bajaj Allianz General Insurance Co Ltd Mumbai Branch [Branch address], Mumbai Maharashtra India SUBJECT: FORMAL INSURANCE CLAIM — POLICY NO. BAJ-HOM-2024-789456 — FIRE AND ALLIED PERILS — LOSS DATE MARCH 15 2026 Dear Sir/Madam, 1. OPENING AND CLAIM STATEMENT I write to formally notify Bajaj Allianz General Insurance Co Ltd of my claim under Home Insurance Policy Number BAJ-HOM-2024-789456 for loss and damage arising from a fire at my insured residential apartment on March 15 2026. This claim is made under the Fire and Allied Perils coverage section of the above policy. I request Bajaj Allianz General Insurance Co Ltd to acknowledge this claim, appoint a licensed surveyor or loss assessor, and process my claim promptly and in full in accordance with the policy terms and applicable IRDAI regulations. 2. LOSS EVENT DESCRIPTION 2.1 Date and Time of Loss: March 15 2026 at approximately 2:30 PM. 2.2 Location: My insured residential apartment at [full address], Mumbai Maharashtra India. 2.3 Cause of Loss: A fire originated in the kitchen of my apartment caused by an electrical short circuit in the kitchen wiring. The fire caused direct damage to the kitchen and indirect water damage to the living room ceiling from firefighting operations conducted by the Mumbai Fire Brigade. 2.4 The fire was extinguished by the Mumbai Fire Brigade. A police FIR was lodged and a fire brigade report has been obtained. The electricity board conducted an inspection confirming the electrical short circuit cause. 3. POLICY COVERAGE REFERENCE 3.1 Policy Number: BAJ-HOM-2024-789456 3.2 Coverage Section Claimed: Fire and Allied Perils — Building and Contents 3.3 Sum Insured: INR 35,00,000 building and INR 10,00,000 contents as per the policy schedule. 3.4 Deductible: As stated in the policy schedule — amount to be confirmed by Bajaj Allianz General Insurance Co Ltd. 3.5 I am a regular premium-paying policyholder and confirm the policy is in full force and effect with all premiums paid to date. 4. ITEMIZED SCHEDULE OF LOSS AND DAMAGES I set out below my itemized assessment of the loss and damage sustained: 4.1 Building Damage — Kitchen: Kitchen cabinets — fire destroyed and smoke damaged: INR 1,20,000 Kitchen flooring — fire and water damage: INR 65,000 Kitchen ceiling — fire damage: INR 45,000 Kitchen electrical wiring and fittings: INR 55,000 Kitchen wall plastering and painting: INR 35,000 Sub-total building kitchen: INR 3,20,000 4.2 Building Damage — Living Room: Living room ceiling — water damage from firefighting: INR 55,000 Living room wall repainting: INR 25,000 Sub-total building living room: INR 80,000 4.3 Contents Damage: Refrigerator — 3 years old Samsung: INR 45,000 Microwave oven — 2 years old LG: INR 18,000 Kitchen chimney — 4 years old: INR 22,000 Kitchen utensils and crockery: INR 15,000 Sub-total contents: INR 1,00,000 4.4 Temporary Accommodation: Hotel accommodation for 15 days at INR 3,000 per night while apartment uninhabitable: INR 45,000 [Subject to policy coverage for alternative accommodation costs] TOTAL CLAIM: INR 5,45,000 All figures are based on contractor estimates and original purchase receipts where available. I submit these as my good-faith assessment of the loss. 5. DUTY TO MITIGATE 5.1 I confirm that I have taken the following immediate steps to prevent further loss: 1. I immediately arranged for the damaged kitchen wiring to be made safe by a licensed electrician within 24 hours of the fire to prevent any further electrical hazard. 2. I covered exposed areas of the ceiling with temporary sheeting to prevent further water ingress or structural deterioration. 3. I removed undamaged contents from the apartment to secure storage. 5.2 I have deliberately not commenced any permanent repair work pending the insurer's surveyor inspection so that the loss can be properly assessed in its current state. 6. PROFESSIONAL ESTIMATES AND EVIDENCE I enclose the following supporting documents with this letter: 1. Copy of Police FIR lodged on March 15 2026. 2. Mumbai Fire Brigade fire report confirming the fire incident and cause. 3. Maharashtra State Electricity Board short circuit inspection report. 4. Three independent contractor repair estimates from licensed contractors. 5. Photographs of all damage areas taken on March 15 and 16 2026. 6. Original purchase receipts for refrigerator, microwave, and kitchen chimney. 7. Hotel bills for temporary accommodation from March 16 to March 30 2026. 7. CLAIM QUANTUM AND AMOUNT DEMANDED I formally claim the total sum of INR 5,45,000 from Bajaj Allianz General Insurance Co Ltd under Policy Number BAJ-HOM-2024-789456, broken down as follows: Building damage — kitchen: INR 3,20,000 Building damage — living room: INR 80,000 Contents damage: INR 1,00,000 Temporary accommodation: INR 45,000 TOTAL: INR 5,45,000 I request Bajaj Allianz General Insurance Co Ltd to honor its full policy obligations and process this claim for payment without delay. 8. INSURER RESPONSE DEADLINE I respectfully request Bajaj Allianz General Insurance Co Ltd to: 1. Formally acknowledge receipt of this claim letter in writing within 15 days of the date of this letter. 2. Appoint a licensed surveyor or loss assessor to inspect the damage within a reasonable period. 3. Provide a written claim decision within 30 days of the surveyor's inspection report. Note: IRDAI regulations impose obligations on insurers regarding claim acknowledgment and processing timeframes. The applicable IRDAI regulatory timeline requirements for this claim must be confirmed with a qualified Indian insurance attorney. 9. RESERVATION OF RIGHTS I expressly reserve all of my legal rights as a policyholder under Policy Number BAJ-HOM-2024-789456, the Insurance Act 1938 India, and applicable IRDAI regulations including: 1. The right to obtain further independent professional valuations of the damage. 2. The right to add supplemental items of loss discovered after this letter. 3. The right to pursue all available legal and regulatory remedies if the claim is unreasonably delayed or wrongfully denied. Nothing in this letter constitutes a waiver of any of my rights as a policyholder. 10. ESCALATION WARNING I sincerely hope Bajaj Allianz General Insurance Co Ltd will process this claim promptly and fairly. However, if the claim is not acknowledged within 15 days, is unreasonably delayed beyond the IRDAI-prescribed timelines, or is wrongfully denied without valid grounds, I will not hesitate to: 1. Lodge a formal grievance under the IRDAI Integrated Grievance Management System IGMS. 2. File a complaint before the Insurance Ombudsman under the Insurance Ombudsman Rules 2017 India. 3. File a consumer complaint before the Consumer Disputes Redressal Forum in Mumbai under the Consumer Protection Act 2019 India. 4. Seek independent legal advice and pursue all other available remedies. 11. CLOSING AND CONTACT I am fully available and willing to cooperate with Bajaj Allianz General Insurance Co Ltd's appointed surveyor or loss assessor for a site inspection of the damaged apartment at a mutually convenient time. Please contact me at: Phone: [phone number] Email: [email address] I request written acknowledgment of this claim letter at your earliest convenience. I look forward to your prompt response. Yours faithfully, Amit Sharma Date: June 1 2026 Signature: ________________ Enclosures: As listed in Section 6 above. -------------------------------------------------- This Insurance Claim Letter draft was generated by an AI drafting tool as a structured preparation and documentation aid only. It does not constitute legal advice, does not guarantee any claim outcome, and is not a substitute for professional guidance from a qualified attorney. Insurance Act 1938 India and IRDAI regulatory timelines must be confirmed with a qualified Indian insurance attorney before sending. --------------------------------------------------