{"id":1165,"title":"AGRICULTURE PUMPSET INSURANCE POLICY CLAIM FORM","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/a68d6440b48e41638604b5cfe0f521f9.pdf","sha256":"40bbbedafa431464a732e6ae4aa4a042c208d25237e1acd04d4d2a0e3159319b","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 an agriculture pumpset insured under the policy.","notes":["If any detail is not readily available, do not delay dispatching the form; send such particulars later.","Issue of this claim form is not an admission of liability."],"title":"AGRICULTURE PUMPSET INSURANCE POLICY CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"DETAILS OF INSURED/CLAIMANT","fields":[{"help":"Enter your policy number","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","options":[],"required":null,"pdf_field":""},{"help":"Enter claim number if available","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 address including city, state, and pin code","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Enter phone number","type":"phone","label":"Contact Details  Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile 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":""},{"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","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Enter time of loss with AM or PM","type":"text","label":"Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Enter full address of loss location including city, state, and pin code","type":"text","label":"Loss Location Address","options":[],"required":null,"pdf_field":""},{"help":"Enter 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 the Insured","options":[],"required":null,"pdf_field":""},{"help":"Enter phone number of contact person","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile number of contact person","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Enter email ID of contact person","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause of loss or damage in detail","type":"text","label":"Describe Cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated loss amount","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Provide serial number and type of damaged pump set","type":"text","label":"Serial No. and type of Pump Set damaged","options":[],"required":null,"pdf_field":""},{"help":"Provide manufacturer name and year of manufacture","type":"text","label":"Makers’ name and year of make","options":[],"required":null,"pdf_field":""},{"help":"Select the nature of damage","type":"choice","label":"Nature of damage Fire/Theft/Electrical and/ or Mechanical Breakdown","options":["Fire","Theft","Electrical Breakdown","Mechanical Breakdown"],"required":null,"pdf_field":""},{"help":"Specify if item is totally lost or partially damaged and details","type":"text","label":"Is the item totally destroyed/lost? If not, what items are damaged?","options":[],"required":null,"pdf_field":""},{"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":"If not reported, provide reason","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":"Provide name of authority","type":"text","label":"Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Provide 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":"DETAILS OF OTHER INSURANCE","fields":[{"help":"Indicate if loss is covered by other insurance","type":"yes-no","label":"Is the loss/damage covered under any other Insurance","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide name of other insurer","type":"text","label":"Name of Insurer","options":[],"required":null,"pdf_field":""},{"help":"Provide address of other insurer","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Provide phone number of other insurer","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Provide mobile number of other insurer","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Provide email ID of other insurer","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Provide policy number of other insurance","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Provide period of insurance of other policy","type":"date","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Provide 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":"Indicate if insured is sole owner","type":"yes-no","label":"Is the Insured the Sole Owner of the property?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If not sole owner, specify nature of interest","type":"text","label":"Nature of Interest","options":[],"required":null,"pdf_field":""},{"help":"Provide names of other interested persons","type":"text","label":"Person/s who has/have interest on property","options":[],"required":null,"pdf_field":""},{"help":"Provide address of other interested persons","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Provide phone number of other interested persons","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Provide mobile number of other interested persons","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Provide email ID of other interested persons","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":"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":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter your full name","type":"text","label":"Name of Insured/Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured/claimant"}],"deadlines":[],"applies_to":"Agriculture Pumpset Insurance Policy claims","attachments":["Copy of other insurance policy if loss is covered under any other insurance"],"declarations":["The statements/information given in this claim form are true, correct and complete.","All persons having interest in the property are disclosed as per the proposal form or policy endorsement and no similar claim has been made to any other insurer.","No material information relevant to the claim has been withheld or undisclosed.","If any false or fraudulent information is given, the policy shall be void and claims forfeited.","Receipt of this claim form or documents does not mean acceptance of the claim; the company may require further information or reject the claim."],"dropped_labels":10},"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/1165-agriculture-pumpset-insurance-policy-claim-form"}