{"id":1153,"title":"CLAIM FORM -DIRECTORS & OFFICERS LIABILITY INSURANCE (D & O)","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/8328d5a900bc4b8187bf3cb8355063fc.pdf","sha256":"a8d82b06a860443e9028c07bb46433ec3013e6229bf0eba3b4b85fb12c423202","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by insured companies or their directors/officers to notify and claim under Directors and Officers Liability Insurance for claims or circumstances that may give rise to a claim.","notes":["Please read the claim form fully before answering the questions.","All questions must be answered as fully as possible; use additional sheets if necessary.","Appointment of legal representatives should not occur without prior consent of the insurer."],"title":"CLAIM FORM -DIRECTORS & OFFICERS LIABILITY INSURANCE (D & O)","submit":{"to":"the insurance company as soon as possible","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured/Claimant","fields":[{"help":"","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":"","type":"text","label":"Claim Number","options":[],"required":null,"pdf_field":""},{"help":"Name of the insured company notifying the claim","type":"text","label":"Full name of the Insured Company giving notification","options":[],"required":null,"pdf_field":""},{"help":"Names and positions of directors/officers notifying the claim","type":"text","label":"Full name & position of the directors/officers giving notification","options":[],"required":null,"pdf_field":""},{"help":"Complete address including city, state, and pin code","type":"text","label":"Address of the Insured Company or directors/officers giving notification","options":[],"required":null,"pdf_field":""},{"help":"Contact mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""}],"filled_by":"insured company or directors/officers"},{"title":"Details Of The Relevant Insured Person(s)","fields":[{"help":"Names and positions of insured persons involved in the claim","type":"text","label":"Full name and position of the Insured Person(s) who is/are the subject of the claim or circumstance","options":[],"required":null,"pdf_field":""},{"help":"Name of the entity if different from the insured company","type":"text","label":"Name of the Insured entity of which such Insured Person(s) is/are a director/officer or employee, if not the Insured Company","options":[],"required":null,"pdf_field":""}],"filled_by":"insured company or directors/officers"},{"title":"Details Of Claimant","fields":[{"help":"Name of the claimant or potential claimant","type":"text","label":"Full name of the claimant or potential claimant (i.e. the party making the claim or potential claim upon the Insured)","options":[],"required":null,"pdf_field":""},{"help":"Complete address of the claimant","type":"text","label":"Address of the claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured company or directors/officers"},{"title":"Details Of The Subject Activity","fields":[{"help":"Describe the activity that gave rise to the claim","type":"text","label":"From what activity on the part of the Insured does the claim or circumstance arise?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if there is written evidence and attach if yes","type":"yes-no","label":"Was the performance or undertaking of such activity evidenced in writing? If so, please attach a copy. If not, please provide relevant information.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date or period when the activity was performed","type":"date","label":"When was the activity from which the claim arises or may arise performed or undertaken?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured company or directors/officers"},{"title":"Details of Claim or Circumstance","fields":[{"help":"Describe the claim or circumstance in detail","type":"text","label":"What is the precise nature of the claim (i.e. the claimant’s allegations) or the fact or circumstance that might give rise to a claim?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if legal proceedings have started and attach documents if yes","type":"yes-no","label":"Have proceedings been commenced? If so, please attach a copy of the court documents.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date of first awareness of the claim or circumstance","type":"date","label":"On what date did you first become aware of the claim or of the fact or circumstance?","options":[],"required":null,"pdf_field":""},{"help":"Date when the claim was first notified","type":"date","label":"On what date was the claim or the intimation of a claim first made to you?","options":[],"required":null,"pdf_field":""},{"help":"Specify how the claim was first intimated and provide details or attach copy","type":"choice","label":"Was the first intimation of a claim oral or in writing? If in writing please attach a copy. If oral, please give a “first person” account of the conversation, (i.e. “I said”, “He said”).","options":["Oral","In writing"],"required":null,"pdf_field":""},{"help":"Claimed amount and its components if known","type":"amount","label":"What amount, if any, is claimed? If known, what does that amount comprise?","options":[],"required":null,"pdf_field":""},{"help":"Your response or comments regarding the claim or circumstance","type":"text","label":"What are your comments in response to the claim or the fact or circumstance that might give rise to a claim?","options":[],"required":null,"pdf_field":""},{"help":"Comments on claim amount and estimated liability","type":"text","label":"What are your comments on the quantum of the claim and what is your estimate of your potential monetary liability, if any, to the claimant?","options":[],"required":null,"pdf_field":""},{"help":"Details of legal representation if appointed","type":"text","label":"Have you appointed a solicitor or other lawyer to act for you? If so, what is the lawyers name, Firm, address and charge out rates?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured company or directors/officers"},{"title":"Witness Details","fields":[{"help":"Indicate if witnesses exist","type":"yes-no","label":"Were there any witnesses to the loss / accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Names of witnesses if any","type":"text","label":"Name of Person/s","options":[],"required":null,"pdf_field":""},{"help":"Address of witnesses","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"City of witnesses","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of witnesses","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Pin code of witnesses","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of witnesses","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of witnesses","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email address of witnesses","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured company or directors/officers"},{"title":"Information to Statutory Authority","fields":[{"help":"Indicate if loss was reported to any authority","type":"yes-no","label":"Has the loss been reported to an Authority","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of the authority if reported","type":"text","label":"Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Reference number given by the authority","type":"text","label":"Authority Reference No.","options":[],"required":null,"pdf_field":""},{"help":"Contact person at the authority","type":"text","label":"Contact Person/s","options":[],"required":null,"pdf_field":""},{"help":"Address of the authority","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"City of the authority","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of the authority","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Pin code of the authority","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of the authority","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of the authority","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email address of the authority","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured company or directors/officers"},{"title":"Details of Other Insurance/Interest","fields":[{"help":"Attach copy of other insurance policy if applicable","type":"attachment","label":"Copy of the policy","options":[],"required":null,"pdf_field":""},{"help":"Address related to other insurance or interest","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Period of other insurance","type":"date","label":"to","options":[],"required":null,"pdf_field":""}],"filled_by":"insured company or directors/officers"},{"title":"Details of Previous Losses","fields":[{"help":"Date when previous loss occurred","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Description and cause of previous loss","type":"text","label":"Claim Description and Cause of Loss","options":[],"required":null,"pdf_field":""},{"help":"Value of previous loss in rupees","type":"amount","label":"Value of Loss (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Name of insurer for previous loss","type":"text","label":"Insurer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured company or directors/officers"},{"title":"Declaration and Signature","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of insured with company seal","type":"signature","label":"Insured’s Signature with Company Seal","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"insured company or directors/officers"}],"deadlines":["Please send the completed claim form, as soon as possible to us"],"applies_to":"Directors & Officers Liability Insurance claims","attachments":["copies of relevant documentation","copy of the activity evidence in writing if available","copy of court documents if proceedings commenced","copy of first intimation in writing if applicable","copy of other insurance policy if applicable"],"declarations":["The insured warrants the truth of the statements 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 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/1153-claim-form-directors-and-officers-liability-insurance-d-and-o"}