{"id":1098,"title":"Claim Form Private Car Long Term Package Policy","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/4b3f9e011cf84b64931ebbad405336c2.pdf","sha256":"f0e720095eb6df283461199a31f0f690be7a8a88d844fe10844dee4e7dbc8804","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the policyholder or claimant to file a claim under the Private Car Long Term Package Policy for vehicle damage or loss.","notes":["Please do not dismantle the vehicle before survey","Attach a cancelled cheque leaf along with the Claim Form for Direct Fund Transfer/EFT Mandate (Mandatory)","If any detail or information is not readily available, do not delay dispatch of this form; such particulars may be sent later","The issue and acceptance of this form cannot be taken as an admission of liability","Use original documents for verification where specified","Additional documents may be requested as needed"],"title":"Claim Form Private Car Long Term Package Policy","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy Holder/Claimant Details","fields":[{"help":"","type":"text","label":"Claimant Name :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name as per Policy :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address :","options":[],"required":null,"pdf_field":""},{"help":"Enter the postal code","type":"number","label":"Pin code :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State :","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email :","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Phone No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Fax No. :","options":[],"required":false,"pdf_field":""},{"help":"Specify your relationship to the insured vehicle owner","type":"text","label":"Relationship with Insured :","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Vehicle Details","fields":[{"help":"Vehicle registration number","type":"text","label":"Registration No. :","options":[],"required":null,"pdf_field":""},{"help":"Vehicle chassis number","type":"text","label":"Chassis No. :","options":[],"required":null,"pdf_field":""},{"help":"Date when vehicle was registered","type":"date","label":"Date of Registration :","options":[],"required":null,"pdf_field":""},{"help":"Select the class of your vehicle","type":"choice","label":"Class of vehicle","options":["Private","Commercial","Two Wheeler"],"required":null,"pdf_field":""},{"help":"Vehicle manufacturer","type":"text","label":"Make :","options":[],"required":null,"pdf_field":""},{"help":"Vehicle model","type":"text","label":"Model :","options":[],"required":null,"pdf_field":""},{"help":"Engine number of the vehicle","type":"text","label":"Engine No. :","options":[],"required":null,"pdf_field":""},{"help":"Insurance start date","type":"date","label":"Period of Insurance : From:","options":[],"required":null,"pdf_field":""},{"help":"Insurance end date","type":"date","label":"To","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Loss Details","fields":[{"help":"Date when the loss or accident occurred","type":"date","label":"Date of Occurrence:","options":[],"required":null,"pdf_field":""},{"help":"Time of the incident","type":"text","label":"Time of Occurrence : A.M. / P.M","options":["A.M.","P.M."],"required":null,"pdf_field":""},{"help":"Where the vehicle is currently located","type":"text","label":"Current location :","options":[],"required":null,"pdf_field":""},{"help":"If fire brigade was involved, name the fire station","type":"text","label":"Fire Station :","options":[],"required":false,"pdf_field":""},{"help":"Reference number if any","type":"text","label":"Reference No. :","options":[],"required":false,"pdf_field":""},{"help":"Applicable only for commercial vehicles","type":"text","label":"Nature & weight of goods carried at the time of accident (Commercial Vehicle):","options":[],"required":false,"pdf_field":""},{"help":"Briefly describe the loss or damage","type":"text","label":"Short description of loss : (please attach separate sheet if needed)","options":[],"required":null,"pdf_field":""},{"help":"Number of occupants in the vehicle during the incident","type":"number","label":"No. of people travelling in the insured vehicle at the time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Reason for vehicle use at time of loss","type":"text","label":"Purpose for which vehicle was: being used at the time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Indicate if police were informed","type":"yes-no","label":"Is loss reported to Police?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of police station where reported","type":"text","label":"Police Station :","options":[],"required":false,"pdf_field":""},{"help":"FIR or diary number if applicable","type":"text","label":"Diary / FIR No. :","options":[],"required":false,"pdf_field":""},{"help":"Indicate if fire brigade was informed","type":"yes-no","label":"Is loss reported to Fire Brigade?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Location where the incident happened","type":"text","label":"Place of Occurrence:","options":[],"required":null,"pdf_field":""},{"help":"Speed of vehicle at time of accident (Km/Hr.)","type":"number","label":"Speed:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Details Of Driver At The Material Time Of Accident","fields":[{"help":"Full name of the driver at time of accident","type":"text","label":"Name of Driver :","options":[],"required":null,"pdf_field":""},{"help":"Driver's contact number","type":"phone","label":"Contact No.:","options":[],"required":false,"pdf_field":""},{"help":"Driver's license number","type":"text","label":"Driving License No.:","options":[],"required":null,"pdf_field":""},{"help":"Regional Transport Office that issued the license","type":"text","label":"Issuing RTO :","options":[],"required":false,"pdf_field":""},{"help":"Select license type","type":"choice","label":"License Type:","options":["Permanent","Learner"],"required":null,"pdf_field":""},{"help":"Vehicle class driver is authorized for","type":"text","label":"Class of Vehicle authorized to drive:","options":[],"required":false,"pdf_field":""},{"help":"License issue date","type":"date","label":"Issue Date :","options":[],"required":false,"pdf_field":""},{"help":"License expiry date","type":"date","label":"Expiry Date :","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Direct Fund Transfer/EFT Mandate Form","fields":[{"help":"Name of your bank","type":"text","label":"Bank Name :","options":[],"required":true,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch :","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code :","options":[],"required":true,"pdf_field":""},{"help":"Bank MICR code","type":"text","label":"MICR code :","options":[],"required":false,"pdf_field":""},{"help":"Name of account holder","type":"text","label":"Name of Payee :","options":[],"required":true,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Payee Account No. :","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Garage / Workshop Details","fields":[{"help":"Name of the garage where vehicle will be repaired","type":"text","label":"Name of Garage/Workshop :","options":[],"required":null,"pdf_field":""},{"help":"Contact person at the garage","type":"text","label":"Contact Person :","options":[],"required":false,"pdf_field":""},{"help":"Garage address","type":"text","label":"Address :","options":[],"required":false,"pdf_field":""},{"help":"Garage phone number","type":"phone","label":"Contact No.:","options":[],"required":false,"pdf_field":""},{"help":"Estimated repair cost","type":"amount","label":"Estimated Loss Amount :","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Other Insurance Details","fields":[{"help":"Indicate if you have other insurance covering this loss","type":"yes-no","label":"If there is any other insurance policy indemnifying you in respect this accident? YES NO","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Name of other insurer if applicable","type":"text","label":"Name of Insurer :","options":[],"required":false,"pdf_field":""},{"help":"Other insurance policy number","type":"text","label":"Policy No :","options":[],"required":false,"pdf_field":""},{"help":"Period of other insurance","type":"text","label":"Period of Insurance :","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder or claimant"},{"title":"Declaration","fields":[{"help":"Sign to declare the truthfulness of information","type":"signature","label":"Signature of Insured/Claimant","options":[],"required":true,"pdf_field":""},{"help":"Location where form is signed","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder or claimant"}],"deadlines":[],"applies_to":"Private Car Long Term Package Policy claims","attachments":["Duly filled and signed claim form","Copy of Registration Book (Please furnish original for verification)","Copy of Motor Driving License of the person driving the vehicle at the time of accident (Please furnish original for verification)","Police Panchnama/FIR (In case of Third Party property damage / Death / Body Injury / Fire / Malicious Damage Claims)","Original Policy document","Original Registration Book / Certificate, Permit, Fitness Certificate, Tax Certificate & Load Challan","Police Panchnama / FIR","Estimate for repairs from repairer where vehicle is to be repaired","Repair Bills/Invoices after the job is completed","Payment receipts after the job is completed","KYC/AML for losses above 1 Lakh","Additional documents in case commercial vehicle Permit, Fitness Certificate, Tax Certificate & Load Challan (Please furnish original for verification)","Final Investigation Report from the magistrate’s court under section 173 Cr. P C / Non Traceable Report","All the sets of Keys / Service Booklet / Warranty Card / Original purchase invoice","Acknowledged copy of letter addressed to RTO intimating theft and informing \"NON-USE\" of vehicle","Form 28, 29 and 30 signed by the insured and Form 35 signed by the Financer, as the case may be, undated and blank","Letter of Undertaking, Subrogation & Discharge Voucher","Consent towards agreed claim settlement value from yourself and Financier","NOC from the Financer if claim is to be settled in your favour"],"declarations":["The information provided is true and complete to the best of my knowledge","False or fraudulent statements or concealment of facts will lead to policy cancellation and claim forfeiture","I have received and understood the list of required documents and agree to provide additional information if needed","I consent to sharing my personal data with State Bank Group entities for availing their services unless I strike this clause"],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"customer.care@sbigeneral.in","label":"Motor Claims Email","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.sbigeneral.in/claim/motor","quote":"m\nRegister or Track Claim Status with one simple click\nIntimate Claim\nCheck Claim Status\n1800 102 1111\n(Available 24/7)\ncustomer.care@sbigeneral.in\nMail ID\nSmooth rides, smoother claims\nBecause you deserve worry-free journeys, always\nDownload SBIG App\nRegister or Tra","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"sbig.health@sbigeneral.in","label":"Health Claims Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"ailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office:\nSBI General Insurance Company Limited,\n9th Floor, Westport, Pan Card","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"seniorcitizen.health@sbigeneral.in","label":"Senior Citizen Health Claims Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office:\nSBI General Insurance Company Limited,\n9th","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 102 1111","label":"Motor Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"motor","source_url":"https://www.sbigeneral.in/claim/motor","quote":"e Claim\nFAQs\nDownload Claim Form\nRegister or Track Claim Status with one simple click\nIntimate Claim\nCheck Claim Status\n1800 102 1111\n(Available 24/7)\ncustomer.care@sbigeneral.in\nMail ID\nSmooth rides, smoother claims\nBecause you deserve worry-free journ","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 210 3366","label":"Health Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"e simple click\nCheck Claim Status\nIntimate Claim\nFor any Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 210 6366","label":"Health Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"heck Claim Status\nIntimate Claim\nFor any Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"sms","value":"561612","label":"Health Claims SMS 'HEALTHCLAIM'","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"y Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/sbi-general-insurance/1098-claim-form-private-car-long-term-package-policy"}