{"id":1115,"title":"INDEMNITY CUM UNDERTAKING","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/14ef7eac69814aa3a311457fd1ffcf11.pdf","sha256":"13fdf53d07f41cf26d253a34573ab197f8ad36895948fa110ff1dffb85d26e39","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is an indemnity bond to be filled by the legal heir of a deceased or injured passenger insured under an IRCTC insurance policy when no nominee is declared. It is used to claim insurance benefits from SBI General Insurance Company Limited.","notes":[],"title":"INDEMNITY CUM UNDERTAKING","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Deponent and Passenger Details","fields":[{"help":"Fill the date and place where the undertaking is made","type":"date","label":"This Indemnity cum Undertaking is made on this ____________day of ______________________ 2023 at ____________, in the presence of the witness below mentioned.","options":[],"required":null,"pdf_field":""},{"help":"Enter full name, father's/husband's name, and residential address of the Deponent","type":"text","label":"Mr/Mrs. _______________________________ s/o _____________ r/o ______________________ (hereinafter referred to as ‘Deponent’)","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of the Passenger","type":"text","label":"Mr./Mrs.________________________________________ (hereinafter referred to as ‘Passenger’)","options":[],"required":null,"pdf_field":""},{"help":"Enter train number, boarding station, destination station, and PNR number","type":"text","label":"Train no. ___________ on 2nd June 2023 from ________________________ to ____________________________ vide PNR No. _____________________","options":[],"required":null,"pdf_field":""},{"help":"Enter the insurance policy number issued by SBI General Insurance Company Limited","type":"text","label":"IRCTC insurance Policy No. ______________________________","options":[],"required":null,"pdf_field":""}],"filled_by":"legal heir (Deponent)"},{"title":"Declarations and Undertakings","fields":[{"help":"Confirm legal heir status and claim rights","type":"checkbox","label":"Deponent declares that he/she is the legal heir of Passenger and has right over claim of the Passenger.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Acknowledge full and final settlement","type":"checkbox","label":"Deponent agrees that amount paid by SBIG is towards full and final settlement and is in complete discharge of the future claims of Passenger under the Policy.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Accept indemnity responsibility","type":"checkbox","label":"Deponent agrees and undertakes to keep SBIG indemnified from and against any claim that may be made or brought or commenced against SBIG if the issue of legal heir is disputed and/or called in question in any manner whatsoever regarding the claim of the Passenger for above mentioned accident.","options":["Agree"],"required":true,"pdf_field":""}],"filled_by":"legal heir (Deponent)"},{"title":"Signatures","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"legal heir (Deponent) and witness"}],"deadlines":[],"applies_to":"Claims under IRCTC insurance policy where no nominee is declared","attachments":[],"declarations":["Deponent declares he/she is the legal heir and has claim rights over the Passenger.","Deponent agrees that amount paid by SBIG is full and final settlement of claims.","Deponent undertakes to indemnify SBIG against any future claims if legal heir status is disputed."],"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/1115-indemnity-cum-undertaking"}