{"id":1126,"title":"MACHINERY BREAKDOWN INSURANCE (MB) CLAIM FORM","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/9504fb9cf07140618ae44d2a6fe4c7d6.pdf","sha256":"4311cfe60203ab94305f7e95a686fdd8e82a00bacd2c8eac519769cb098f560d","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to report and claim for machinery breakdown losses under their insurance policy.","notes":["Issue of this claim form is not to be taken as an admission of liability."],"title":"MACHINERY BREAKDOWN INSURANCE (MB) CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"A. DETAILS OF INSURED/CLAIMANT","fields":[{"help":"Enter your insurance policy number","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Enter start and end dates of the insurance period","type":"date","label":"Period of Insurance to","options":[],"required":null,"pdf_field":""},{"help":"Enter claim number if already assigned","type":"text","label":"Claim Number","options":[],"required":null,"pdf_field":""},{"help":"Enter the name exactly as on the policy","type":"text","label":"Name as per  policy","options":[],"required":null,"pdf_field":""},{"help":"Enter full address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Enter city name","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"Enter state name","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter postal pin code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Enter landline phone number","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Describe your business or occupation briefly","type":"text","label":"Brief Description of Business /Office/Industry/Occupation","options":[],"required":null,"pdf_field":""},{"help":"Enter the indemnity limit as per policy","type":"amount","label":"Limits of Indemnity under the Policy (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"B. DETAILS OF LOSS/DAMAGE","fields":[{"help":"Enter the date when loss occurred","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Enter time and select A.M. or P.M.","type":"text","label":"Time of Loss","options":["A.M.","P.M."],"required":null,"pdf_field":""},{"help":"Enter full address where loss occurred","type":"text","label":"Loss Location Address","options":[],"required":null,"pdf_field":""},{"help":"Enter city of loss location","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"Enter state of loss location","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter pin code of loss location","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Name of contact person at loss location","type":"text","label":"Contact Details of person/s at Loss Location - Name","options":[],"required":null,"pdf_field":""},{"help":"Specify relationship to insured","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"Phone number of contact person","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of contact person","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email of contact person","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Describe what caused the loss or damage","type":"text","label":"Describe Cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Estimate the monetary loss","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"WITNESS DETAILS / INFORMATION TO AUTHORITY","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Were there any witnesses to the loss / damage?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes, provide witness names","type":"text","label":"Name of Person/s","options":[],"required":null,"pdf_field":""},{"help":"Witness address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"City of witness","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of witness","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Pin code of witness","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of witness","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of witness","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email of witness","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has the loss been reported to an Authority","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain why not reported if No","type":"text","label":"If ‘No’, reason for not reporting","options":[],"required":null,"pdf_field":""},{"help":"Select the authority to which loss was reported","type":"choice","label":"If “Yes”, provide details - Fire / Police / Municipality / Other","options":["Fire","Police","Municipality","Other"],"required":null,"pdf_field":""},{"help":"Name of reporting authority","type":"text","label":"Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Provide report or reference number and date","type":"text","label":"Information Report No./Authority Reference No. and Date","options":[],"required":null,"pdf_field":""},{"help":"Contact person at authority","type":"text","label":"Contact Person/s","options":[],"required":null,"pdf_field":""},{"help":"Address of authority","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"City of authority","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of authority","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Pin code of authority","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of authority","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of authority","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email of authority","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"C. DETAILS OF OTHER INSURANCE","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Is the loss/damage covered under any other Insurance","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other insurer if applicable","type":"text","label":"Name of Insurer","options":[],"required":null,"pdf_field":""},{"help":"Address of other insurer","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"City of other insurer","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of other insurer","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Pin code of other insurer","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of other insurer","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of other insurer","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email of other insurer","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Start and end dates of other insurance","type":"date","label":"Period of Insurance to","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other policy","type":"amount","label":"Sum Insured (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"D. DETAILS OF OTHER INTEREST","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Is the Insured the Sole Owner of the property?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If No, specify nature of interest","type":"text","label":"Nature of Interest","options":[],"required":null,"pdf_field":""},{"help":"Name persons with interest","type":"text","label":"Person/s who has/have interest on property","options":[],"required":null,"pdf_field":""},{"help":"Address of interested persons","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"City of interested persons","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of interested persons","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Pin code of interested persons","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of interested persons","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of interested persons","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email of interested persons","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"E. DETAILS OF ITEMS AFFECTED","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Has the affected equipment undergone any repairs previously?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of previous repairs in columns: Date, Nature, Parts affected, Cost","type":"table","label":"If “Yes”, the nature of such repairs - Date of Repair, Nature of Repair, Parts affected, Cost of Repair(Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Serial number of equipment","type":"number","label":"Sl. No.","options":[],"required":null,"pdf_field":""},{"help":"Describe the equipment","type":"text","label":"Description of Equipment","options":[],"required":null,"pdf_field":""},{"help":"Name of manufacturer","type":"text","label":"Manufacturer","options":[],"required":null,"pdf_field":""},{"help":"Year equipment was made","type":"number","label":"Year of Manufacture","options":[],"required":null,"pdf_field":""},{"help":"Serial or machine number","type":"text","label":"Identification/ Machine/Serial No.","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for this equipment","type":"amount","label":"Sum Insured (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Last maintenance date","type":"date","label":"Date of Last Maintenance","options":[],"required":null,"pdf_field":""},{"help":"Expiry date of AMC or warranty","type":"date","label":"Date of Expiry of AMC/Warranty","options":[],"required":null,"pdf_field":""},{"help":"Estimated cost of repair or replacement","type":"amount","label":"Cost of Repair/Replacement (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"F. DETAILS OF REPAIR/REPAIRER","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Is the repair being carried out in house?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe in-house repair details and attach estimates and invoices","type":"text","label":"If ‘Yes’, specify and submit Job-Work estimates along with Pro-forma Invoices of Spare Parts to be replaced","options":[],"required":null,"pdf_field":""},{"help":"Name of external repairer","type":"text","label":"If “No” specify following details - Name of the Repairer","options":[],"required":null,"pdf_field":""},{"help":"Contact person at repairer","type":"text","label":"Name of contact person/s","options":[],"required":null,"pdf_field":""},{"help":"Address of repairer","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"City of repairer","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of repairer","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Pin code of repairer","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of repairer","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of repairer","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email of repairer","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"G. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"List previous losses with date, description, value and insurer","type":"table","label":"Losses during the 3 preceding years - Date of Loss, Claim Description and Cause of Loss, Value of Loss (Rs.), Insurer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"H. DETAILS OF OTHER INFORMATION","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Do you wish to provide any other information?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide any additional information","type":"text","label":"If ‘Yes’, specify","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Declaration and Signature","fields":[{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Print your name","type":"text","label":"Name of Insured/Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"}],"deadlines":[],"applies_to":"Machinery Breakdown Insurance claims","attachments":["Copy of other insurance policy if loss covered under other insurance","Job-Work estimates and Pro-forma Invoices of Spare Parts if repair is in-house"],"declarations":["The claimant warrants the truth of all statements made in this form to the best of their knowledge and belief.","If any false or fraudulent statement or concealment is made, the claim shall be forfeited and the policy shall be null and void."],"dropped_labels":0},"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/1126-machinery-breakdown-insurance-mb-claim-form"}