{"id":1164,"title":"CLAIM FORM GRAMIN SAMRIDDHI BIMA","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/b65594935e2d4461b6865d64e6161d09.pdf","sha256":"bb6549a011baa78595df4508ba7eaba7ac714e7e82f78cf9593ff4be9964362a","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to file a claim under the Gramin Samriddhi Bima insurance policy.","notes":["If any detail or information is not readily available, do not delay dispatch of the form; such particulars may be sent later."],"title":"CLAIM FORM GRAMIN SAMRIDDHI BIMA","submit":{"to":"","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 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":"Enter name exactly as in the policy","type":"text","label":"Name as per policy","options":[],"required":null,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number with STD code","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","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":"DETAILS OF LOSS/ACCIDENT","fields":[{"help":"Enter date of loss in DD/MM/YYYY format","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Specify time and AM or PM","type":"text","label":"Time of Loss A.M. / P.M.","options":[],"required":null,"pdf_field":""},{"help":"Full address where loss occurred","type":"text","label":"Loss Location Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","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":"Relationship of contact person to insured","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"Landline number with STD code","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Explain how the loss or damage happened","type":"text","label":"Describe Cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Approximate value of loss in rupees","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"WITNESS DETAILS AND INFORMATION TO AUTHORITY","fields":[{"help":"Select Yes or No","type":"choice","label":"Were there any witnesses to the loss / accident? (Yes / No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Names of witnesses if any","type":"text","label":"If ‘Yes’, Name of Person /s","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number with STD code","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Has the loss been reported to an Authority? (Yes / No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain why loss was not reported","type":"text","label":"If ‘No’, reason for not reporting","options":[],"required":null,"pdf_field":""},{"help":"Select the authority reported to","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":"Report or reference number and date","type":"text","label":"Information Report No./Authority Reference No. and Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number with STD code","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"DETAILS OF OTHER INSURANCE","fields":[{"help":"Select Yes or No","type":"choice","label":"Is the loss/damage covered under any other Insurance (Yes / No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other insurer","type":"text","label":"If ‘Yes’, specify details and attach a copy of the policy - Name of Insurer","options":[],"required":null,"pdf_field":""},{"help":"Address of other insurer","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number with STD code","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","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":"DETAILS OF OTHER INTEREST","fields":[{"help":"Select Yes or No","type":"choice","label":"Is the Insured the Sole Owner of the property? (Yes / No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe nature of interest if not sole owner","type":"text","label":"If ‘No’, specify Nature of Interest","options":[],"required":null,"pdf_field":""},{"help":"Names of other interested persons","type":"text","label":"Person/s who has/have interest on property","options":[],"required":null,"pdf_field":""},{"help":"Address of other interested persons","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number with STD code","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"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":"DETAILS OF OTHER INFORMATION","fields":[{"help":"Select Yes or No","type":"choice","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":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"DECLARATION AND SIGNATURE","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of insured/claimant","type":"signature","label":"Signature","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Name of person signing","type":"text","label":"Name Insured/Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"ADDITIONAL INFORMATION REQUIRED UNDER SECTION II,III,V & VII (If Loss caused due to Burglary)","fields":[{"help":"Select type of premises","type":"choice","label":"Specify occupancy of premises - Dwelling / Warehouse/Godown","options":["Dwelling","Warehouse/Godown"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is entry or exit from premises affected? (Yes / No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe how entry or exit is affected","type":"text","label":"If Yes specify","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is any portion of the premises damaged? (Yes / No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe damage to premises","type":"text","label":"If Yes specify","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Was the premises being occupied as on date of loss? (Yes / No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date when premises was last occupied","type":"date","label":"If No specify date of last occupancy","options":[],"required":null,"pdf_field":""},{"help":"Total value of property at loss time","type":"amount","label":"State the total value of property upon the premises at the time of loss Rs.","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is the property covered under Standard Fire and Special Perils Policy? (Yes / No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of insurer for fire and special perils policy","type":"text","label":"If Yes specify Name of Insurer","options":[],"required":null,"pdf_field":""},{"help":"Address of insurer","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number with STD code","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Policy number of fire and special perils policy","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Start and end dates of policy","type":"date","label":"Period of Insurance to","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under policy","type":"amount","label":"Sum Insured (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"DETAILS OF ITEMS AFFECTED (Applicable to Section IV)","fields":[{"help":"Select Yes or No","type":"choice","label":"Is the repair being carried out in house? (Yes / No)","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":"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":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number with STD code","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile 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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/1164-claim-form-gramin-samriddhi-bima"}