{"id":1162,"title":"PORTABLE - ELECTRONIC EQUIPMENT INSURANCE CLAIM FORM","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/faab4dccd5694dfebbcda48c1c9a5b50.pdf","sha256":"36d2a3c0e5ed277027adb19d3decb4ec5abf2d36895d3b8455200ca429ee7320","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to report and claim for loss or damage to portable electronic equipment covered under the insurance policy.","notes":["Issue of this claim form is not an admission of liability.","If any detail or information is not readily available, do not delay dispatch of the form; such particulars may be sent later."],"title":"PORTABLE - ELECTRONIC EQUIPMENT INSURANCE 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 the start and end dates of the insurance coverage","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"If available, enter the claim number","type":"text","label":"Claim Number","options":[],"required":null,"pdf_field":""},{"help":"Enter the name exactly as it appears on the policy","type":"text","label":"Name as per  policy","options":[],"required":null,"pdf_field":""},{"help":"Enter your full address including city, state, and pin code","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":""}],"filled_by":"insured/claimant"},{"title":"B. DETAILS OF LOSS/ACCIDENT","fields":[{"help":"Enter the date when the loss occurred","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Enter the time of loss and specify 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 the loss occurred","type":"text","label":"Loss Location Address","options":[],"required":null,"pdf_field":""},{"help":"Enter city name of loss location","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"Enter state name 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 at loss location","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of contact person at loss location","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email of contact person at loss location","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Describe how the loss or damage happened","type":"text","label":"Describe Cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Estimate the monetary value of the loss","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"WITNESS DETAILS / INFORMATION TO AUTHORITY","fields":[{"help":"Indicate if there were witnesses","type":"yes-no","label":"Were there any witnesses to the loss / accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"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":"Explain why loss was not reported if applicable","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 the authority where loss was reported","type":"text","label":"Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Enter report or reference number and date","type":"text","label":"Information Report No./Authority Reference No. and Date","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"C. DETAILS OF OTHER INSURANCE","fields":[{"help":"Indicate if other insurance covers the loss","type":"yes-no","label":"Is the loss/damage covered under any other Insurance","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other insurance company","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":"text","label":"Period of Insurance","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":"Indicate if you are the sole owner","type":"yes-no","label":"Is the Insured the Sole Owner of the property?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe nature of interest if not sole owner","type":"text","label":"Nature of Interest","options":[],"required":null,"pdf_field":""},{"help":"Name persons with interest in property","type":"text","label":"Person/s who has/have interest on property","options":[],"required":null,"pdf_field":""},{"help":"Address of persons with interest","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"City of persons with interest","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of persons with interest","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Pin code of persons with interest","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of persons with interest","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of persons with interest","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email of persons with interest","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"E. DETAILS OF ITEMS AFFECTED","fields":[{"help":"Indicate if equipment was repaired before","type":"yes-no","label":"Has the affected equipment undergone any repairs previously?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide Date of Repair, Nature of Repair, Parts affected, Cost of Repair (Rs.) in table format","type":"table","label":"If “Yes”, the nature of such repairs","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"F. DETAILS OF REPAIR/REPAIRER","fields":[{"help":"Indicate if repair is in-house","type":"yes-no","label":"Is the repair being carried out in house?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide 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":"Provide Date of Loss, Claim Description and Cause of Loss, Value of Loss (Rs.), Insurer","type":"table","label":"Losses during the 3 preceding years","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"H. DETAILS OF OTHER INFORMATION","fields":[{"help":"Indicate if you want to provide additional information","type":"yes-no","label":"Do you wish to provide any other information?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide any other relevant 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":"Enter 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":"Portable Electronic Equipment Insurance claims","attachments":["Copy of other insurance policy if loss is covered under any other insurance","Job-Work estimates and Pro-forma Invoices of Spare Parts if repair is in-house"],"declarations":["The insured warrants the truth of the statements made in the 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 null and void."],"dropped_labels":17},"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/1162-portable-electronic-equipment-insurance-claim-form"}