{"id":1148,"title":"CLAIM FORM JEWELLER’S BLOCK INSURANCE POLICY","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/608f80e63da845249bf05b344a51b561.pdf","sha256":"bd50dbe2f6044abde3b68ff228a9525834842840edd884da2a8312391a78dbed","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to report and claim losses under the Jeweller’s Block Insurance Policy.","notes":["Fill the form in block letters.","If any detail is not readily available, send the form without delay and provide particulars later."],"title":"CLAIM FORM JEWELLER’S BLOCK INSURANCE POLICY","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claimant and Loss Details","fields":[{"help":"","type":"text","label":"Policy No:","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":"","type":"text","label":"Claim Number:","options":[],"required":null,"pdf_field":""},{"help":"Select time of loss","type":"choice","label":"Time of Loss A.M. / P.M.","options":["A.M.","P.M."],"required":null,"pdf_field":""},{"help":"Enter full name of claimant or insured","type":"text","label":"Name of Claimant /Insured","options":[],"required":null,"pdf_field":""},{"help":"Describe the nature of business","type":"text","label":"Brief description of business","options":[],"required":null,"pdf_field":""},{"help":"Enter full postal address including City, State, Pin Code","type":"text","label":"Address for correspondence","options":[],"required":null,"pdf_field":""},{"help":"Enter phone number","type":"phone","label":"Phone No:","options":[],"required":null,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E-mail ID:","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile No:","options":[],"required":null,"pdf_field":""},{"help":"Enter date when loss was discovered","type":"date","label":"Date of discovery of loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the loss briefly","type":"text","label":"Brief Description of loss","options":[],"required":null,"pdf_field":""},{"help":"Enter location where loss occurred","type":"text","label":"Location of loss","options":[],"required":null,"pdf_field":""},{"help":"List items affected by the loss","type":"text","label":"Item/s affected by loss","options":[],"required":null,"pdf_field":""},{"help":"Explain cause of the loss","type":"text","label":"Cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Relationship of contact person to insured","type":"text","label":"Relationship with the Insured","options":[],"required":null,"pdf_field":""},{"help":"Phone number of contact person","type":"phone","label":"Phone No:","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of contact person","type":"phone","label":"Mobile No:","options":[],"required":null,"pdf_field":""},{"help":"Email of contact person","type":"email","label":"E-mail ID:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant / insured"},{"title":"Loss and Claim Details","fields":[{"help":"Provide estimated loss amount; attach supporting sheet with breakup","type":"amount","label":"Estimate of loss Rs.","options":[],"required":null,"pdf_field":""},{"help":"Specify policy section applicable for claim","type":"text","label":"Section of the Policy under which the claim is being lodged","options":[],"required":null,"pdf_field":""},{"help":"Enter police station name where FIR was registered","type":"text","label":"Name of the Police Station :","options":[],"required":null,"pdf_field":""},{"help":"Enter FIR number","type":"text","label":"FIR No.","options":[],"required":null,"pdf_field":""},{"help":"Date of FIR","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Were there any witnesses to the loss / accident? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of witness if any","type":"text","label":"If ‘Yes’ Name:","options":[],"required":false,"pdf_field":""},{"help":"Address of witness including City, State, Pin Code","type":"text","label":"Address:","options":[],"required":false,"pdf_field":""},{"help":"Mobile number of witness","type":"phone","label":"Mobile Number:","options":[],"required":false,"pdf_field":""},{"help":"Email of witness","type":"email","label":"E-mail ID:","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Whether any media supporting like CCTV footage/news available for reported incident Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of carrier or authority if applicable","type":"text","label":"Name of the Carrier/Authority in whose custody the loss has taken place (if applicable)","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Has the claim been lodged on the Carrier/Authority Yes No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Details of claim lodged on carrier/authority","type":"text","label":"Provide details if applicable","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Is the loss/damage covered under any other Insurance Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Other insurance policy number","type":"text","label":"If ‘Yes’, specify details and attach a copy of the policy & update: Policy No.:","options":[],"required":false,"pdf_field":""},{"help":"Name of other insurance company","type":"text","label":"Insurance Company:","options":[],"required":false,"pdf_field":""},{"help":"Period of other insurance","type":"date","label":"Period of Insurance: to","options":[],"required":false,"pdf_field":""},{"help":"Sum insured under other policy","type":"amount","label":"Sum Insured (Rs.):","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Is Insured the Sole Owner of the affected property Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other interested person/entity","type":"text","label":"If ‘No’, specify details of other person/entity having interest in property: Name:","options":[],"required":false,"pdf_field":""},{"help":"Nature of interest of other person/entity","type":"text","label":"Nature of interest:","options":[],"required":false,"pdf_field":""},{"help":"Name of other interested person/entity (if multiple)","type":"text","label":"Name:","options":[],"required":false,"pdf_field":""},{"help":"Address of other interested person/entity including City, State, Pin Code","type":"text","label":"Address:","options":[],"required":false,"pdf_field":""},{"help":"Phone number of other interested person/entity","type":"phone","label":"Phone No:","options":[],"required":false,"pdf_field":""},{"help":"Mobile number of other interested person/entity","type":"phone","label":"Mobile Number:","options":[],"required":false,"pdf_field":""},{"help":"Email of other interested person/entity","type":"email","label":"E-mail ID:","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant / insured"},{"title":"Previous Losses and Additional Information","fields":[{"help":"Provide details of previous losses in a table with columns: Date of Loss, Claim Description and Cause of Loss, Value of Loss (Rs.), Insurer","type":"table","label":"Details of previous losses in past three years (if any) Date of Loss, Claim Description and Cause of Loss, Value of Loss (Rs.), Insurer","options":[],"required":false,"pdf_field":""},{"help":"Additional information relevant to the claim","type":"text","label":"Any other information which you wish to provide","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant / insured"},{"title":"Declaration and Signature","fields":[{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Insured/Claimant","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Print name of insured/claimant","type":"text","label":"Name of Insured/Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured / claimant"}],"deadlines":[],"applies_to":"Jeweller’s Block Insurance Policy claims","attachments":["Supporting sheet with breakup of estimate of loss","Original or certified copy of FIR","Copy of other insurance policy if loss covered under other insurance"],"declarations":["The statements/information given in this claim form are true, correct and complete.","All persons having an interest in the property are disclosed as per the proposal form or policy endorsement.","No similar claim has been made with any other insurance company except as disclosed.","No material information relevant to the claim has been withheld or not disclosed.","If any false or fraudulent information is given, the policy shall be null and void and claims forfeited.","Receipt of this claim form or documents does not constitute admission of liability and the company may require further information."],"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/1148-claim-form-jewellers-block-insurance-policy"}