{"id":1139,"title":"LOAN INSURANCE POLICY Claim Form","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/81d586bc7b0a48c6b7a9ddc3e3a9c937.pdf","sha256":"369c6fbe78692956119888d76e0f0e4d252f885433f3d3fd233767a975350570","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to file a claim under the loan insurance policy for critical illness, personal accident, or loss of job. The claimant or insured person fills it.","notes":["Issuance of this form does not admit liability or waive policy terms.","If any claim is dishonest or fraudulent, the policy shall be void and benefits forfeited.","If nominee is minor, legal guardian details must be provided."],"title":"LOAN INSURANCE POLICY Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured/Claimant","fields":[{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Claimant","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Hospitalized Person","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender Male Female","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address Plot No/Door No. Building Name Road Area City Pincode State","options":[],"required":null,"pdf_field":""},{"help":"Provide phone numbers and email","type":"text","label":"Contact Details Phone No. Mobile E-mail Id","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Start and end date of policy coverage","type":"date","label":"Period of Insurance From To","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Section I – Critical Illness","fields":[{"help":"Describe symptoms","type":"text","label":"Signs and symptoms of illness","options":[],"required":null,"pdf_field":""},{"help":"Select the diagnosed illness","type":"choice","label":"Diagnosis of illness","options":["Cancer","Coma","Aorta Surgery","Coronary Artery Bypass Grafting","Heart Valve Replacement","Stroke","Major Organ Transplant","Myocardial Infarction (First Heart Attack)","Aorta Graft Surgery","Multiple Sclerosis","Kidney Failure (End Stage Renal Failure)","Third Degree Burns","Total Blindness"],"required":null,"pdf_field":""},{"help":"Provide investigation name and results","type":"text","label":"Name of the investigation with the results confirming diagnosis","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of disease first detected","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you ever had the similar conditions in past? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if answered Yes above","type":"text","label":"If ‘Yes’, provide details","options":[],"required":false,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of first visit to Hospital","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of last visit in this regard","options":[],"required":null,"pdf_field":""},{"help":"Select frequency of hospital visits","type":"choice","label":"Frequency of visits Weekly Monthly Other","options":["Weekly","Monthly","Other"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Hospital","options":[],"required":null,"pdf_field":""},{"help":"Hospital contact details","type":"text","label":"Contact Details Phone No. Mobile E-mail Id","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Treating Doctor","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Qualification of Treating Doctor","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Treating Doctors Registration No.","options":[],"required":null,"pdf_field":""},{"help":"Doctor's contact details","type":"text","label":"Contact Details Phone No. Mobile E-mail Id","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"OP No. / Hospital No. / Indoor Patient No.","options":[],"required":null,"pdf_field":""},{"help":"Select patient's progress","type":"choice","label":"Progress Recovered Improved Unimproved Retrogressed","options":["Recovered","Improved","Unimproved","Retrogressed"],"required":null,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Section II – Personal Accident","fields":[{"help":"DD MM YYYY format","type":"date","label":"Date of Accident/Incidence","options":[],"required":null,"pdf_field":""},{"help":"Provide time and specify AM or PM","type":"text","label":"Time of Accident/Incidence","options":[],"required":null,"pdf_field":""},{"help":"Describe cause","type":"text","label":"Cause of Accident/Incidence","options":[],"required":null,"pdf_field":""},{"help":"Describe details","type":"text","label":"Details of Accident/Incidence","options":[],"required":null,"pdf_field":""},{"help":"Contact details of accident location or related person","type":"text","label":"Contact Details Phone No. Mobile E-mail Id","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were there any witness to the Accident/Incidence? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Witness address","type":"text","label":"Address Plot No/Door No. Building Name Road Area City Pincode State","options":[],"required":false,"pdf_field":""},{"help":"Witness contact details","type":"text","label":"Contact Details Phone No. Mobile E-mail Id","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the person moved to hospital immediately after the accident? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Hospital details if moved immediately","type":"text","label":"If 'Yes', Name of Hospital Plot No/Door No. Building Name Road Area City Pincode State","options":[],"required":false,"pdf_field":""},{"help":"Hospital contact details","type":"text","label":"Contact Details Phone No. Mobile E-mail Id","options":[],"required":false,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of Admission","options":[],"required":false,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of Discharge","options":[],"required":false,"pdf_field":""},{"help":"Hospital address","type":"text","label":"Address of Hospital","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Section III – Loss of Job/Employment","fields":[{"help":"","type":"text","label":"Name of Bank / Financial Institution","options":[],"required":null,"pdf_field":""},{"help":"Bank or financial institution address","type":"text","label":"Address Plot No/Door No. Building Name Road Area City Pincode State","options":[],"required":null,"pdf_field":""},{"help":"Bank contact details","type":"text","label":"Contact Details Phone No. Mobile E-mail Id","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Loan Account No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Loan Type","options":[],"required":null,"pdf_field":""},{"help":"Loan amount in rupees","type":"amount","label":"Amount of Loan Rs.","options":[],"required":null,"pdf_field":""},{"help":"EMI amount in rupees","type":"amount","label":"EMI Rs.","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of Loan Disbursement","options":[],"required":null,"pdf_field":""},{"help":"Loan tenure in months","type":"number","label":"Tenure of Loan Months","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of last EMI paid","options":[],"required":null,"pdf_field":""},{"help":"Amount in rupees","type":"amount","label":"Amount of last EMI paid","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Employer","options":[],"required":null,"pdf_field":""},{"help":"Employer address","type":"text","label":"Address Plot No/Door No. Building Name Road Area City Pincode State","options":[],"required":null,"pdf_field":""},{"help":"Employer contact details","type":"text","label":"Contact Details Phone No. Mobile E-mail Id","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of Appointment/Joining","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Designation","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of Termination / Suspension/ Retrenchment","options":[],"required":null,"pdf_field":""},{"help":"Explain reason","type":"text","label":"Reasons for Termination","options":[],"required":null,"pdf_field":""},{"help":"If applicable, DD MM YYYY format","type":"date","label":"Date of Reinstatement (in case of Suspension)","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the loss been reported to an Authority Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain if not reported","type":"text","label":"If 'No', reason for not reporting","options":[],"required":false,"pdf_field":""},{"help":"Select authority type","type":"choice","label":"If 'Yes', provide details Police Other","options":["Police","Other"],"required":false,"pdf_field":""},{"help":"Name of reporting authority","type":"text","label":"Name of Authority","options":[],"required":false,"pdf_field":""},{"help":"FIR number and date","type":"text","label":"First Information Report/ Report Date","options":[],"required":false,"pdf_field":""},{"help":"Medico Legal Case number if applicable","type":"text","label":"MLC No.","options":[],"required":false,"pdf_field":""},{"help":"Name of person reporting or related","type":"text","label":"Name of Person","options":[],"required":false,"pdf_field":""},{"help":"Address of above person","type":"text","label":"Address Plot No/Door No. Building Name Road Area City Pincode State","options":[],"required":false,"pdf_field":""},{"help":"Contact details of above person","type":"text","label":"Contact Details Phone No. Mobile E-mail Id","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Details of Previous Claim","fields":[{"help":"","type":"yes-no","label":"Have you incurred any claim before? Yes No","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Details of Other Insurance/Interest","fields":[{"help":"","type":"yes-no","label":"Is the Accident/Incidence covered under any other Insurance? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide other insurance details if applicable","type":"text","label":"If 'Yes', specify details and attach a copy of the policy Name of Insurer Policy No. Sum Insured Rs. Period of Insurance From To Policy issuance office location","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Details of Other Information","fields":[{"help":"","type":"yes-no","label":"Do you wish to provide any other information? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide any additional information","type":"text","label":"If 'Yes', specify","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Annexure I: To be completed by Nominee in the event of Insured's death","fields":[{"help":"","type":"text","label":"Name of the Nominee","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"DD MM YYYY format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Nominee's address","type":"text","label":"Address Plot No/Door No. Building Name Road Area City Pincode State","options":[],"required":null,"pdf_field":""},{"help":"Nominee contact details","type":"text","label":"Contact Details Phone No. Mobile E-mail Id","options":[],"required":null,"pdf_field":""},{"help":"Provide guardian details if nominee is minor","type":"text","label":"*If nominee is minor, kindly provide the Legal Guardian details Name of Guardian Relationship with Insured Date of Birth Address Plot No/Door No. Building Name Road Area City Pincode State Contact Details Phone No. Mobile E-mail Id","options":[],"required":false,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of nominee or guardian","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name of Nominee/Guardian (in case of minor)","options":[],"required":null,"pdf_field":""}],"filled_by":"nominee or legal guardian"}],"deadlines":[],"applies_to":"loan insurance claims related to critical illness, personal accident, and loss of job","attachments":["Copy of other insurance policy if accident/incidence is covered under any other insurance","Copy of FIR or report if loss reported to authority"],"declarations":["The claimant warrants the truth of all statements and agrees that any false or fraudulent statement will forfeit the claim and policy benefits.","The claimant accepts the amount as full discharge of insurer's obligations and indemnifies insurer against any other claims."],"dropped_labels":6},"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/1139-loan-insurance-policy-claim-form"}