{"id":1171,"title":"FORM OF APPLICATION FOR COMPENSATION","purpose":"claim","insurer":{"slug":"shriram-general-insurance","name":"Shriram General Insurance Company Limited"},"source_pdf":"https://cdn.shriramgi.com/webassets/download/claim/PUBLIC-LIABILITY-NON-INDUSTRIAL-Claim-Form.pdf","sha256":"18f3068ff04ecd0fa6d5e65cb471723250cf6c42daf0e42922c5f3d2da2c7a3f","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for filing a claim for compensation under the Public Liability (Non-Industrial) Insurance Policy. It is filled by the claimant who is related to the injured or deceased person.","notes":[],"title":"FORM OF APPLICATION FOR COMPENSATION","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Bodily Injury","fields":[{"help":"","type":"text","label":"Name and father's name of person injured/dead (husband's name in case of married woman of widow)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the person injured/dead","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of birth","options":[],"required":null,"pdf_field":""},{"help":"Specify Male/Female/Other","type":"text","label":"Sex of the person injured/dead","options":[],"required":null,"pdf_field":""},{"help":"Include location, date and time","type":"text","label":"Place, date and time of the accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation of the person injured/dead","options":[],"required":null,"pdf_field":""},{"help":"Describe injuries","type":"text","label":"Nature of injuries sustained","options":[],"required":null,"pdf_field":""},{"help":"Provide full name and address","type":"text","label":"Name and address of Police Station in whose jurisdiction accident took place or was registered","options":[],"required":null,"pdf_field":""},{"help":"Provide full name and address","type":"text","label":"Name and address of the Medical Officer/Practitioner who attended on the injured/dead","options":[],"required":null,"pdf_field":""},{"help":"Provide full name(s) and address(es)","type":"text","label":"Name/s and address/es of the claimant/claimants","options":[],"required":null,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship with the deceased","options":[],"required":null,"pdf_field":""},{"help":"Optional additional details","type":"text","label":"Any other information that may be considered necessary or helpful in the disposal of the claim","options":[],"required":false,"pdf_field":""}],"filled_by":"claimant"},{"title":"Property Damage","fields":[{"help":"Enter amount of loss","type":"amount","label":"Quantum of Loss reported","options":[],"required":null,"pdf_field":""},{"help":"Describe cause","type":"text","label":"Cause of Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe property damaged","type":"text","label":"Type of Property Damaged (please furnish details)","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration and Signature","fields":[{"help":"Sign to affirm the truth of the information provided","type":"signature","label":"SIGNATURE OF THE CLAIMANT","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant"}],"deadlines":[],"applies_to":"Public Liability (Non-Industrial) Insurance claims","attachments":[],"declarations":["The claimant swears and affirms that all the facts noted above are true to the best of their knowledge and belief."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"chd@shriramgi.com","label":"Help Desk Email ID for claim intimation","level":null,"hours":null,"applies_to":"all","source_url":"https://www.shriramgi.com/claims","quote":"ase download the CLAIM INTIMATION SHEET, fill it and send it to our Help\n                            Desk via Email ID (chd@shriramgi.com)\nNote:\nPlease ensure that the following information is ready with you at the time of\n                            claim","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-300-30000","label":"Customer Help Desk Toll Free","level":null,"hours":"7 Days in week 4:00 AM to Midnight 12:00","applies_to":"all","source_url":"https://www.shriramgi.com/claims","quote":"Option 1:\nIntimate a claim online on Shriram General Insurance website or over the\n                            phone at 1800-300-30000/1800-103-3009 or through the MYSGI App\nOption 2:\nPlease download the CLAIM INTIMATION SHEET, fill it and send it to our","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-103-3009","label":"Customer Help Desk Toll Free","level":null,"hours":"7 Days in week 9:30 am to 5:30 pm","applies_to":"all","source_url":"https://www.shriramgi.com/claims","quote":"ate a claim online on Shriram General Insurance website or over the\n                            phone at 1800-300-30000/1800-103-3009 or through the MYSGI App\nOption 2:\nPlease download the CLAIM INTIMATION SHEET, fill it and send it to our Help","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/shriram-general-insurance/1171-form-of-application-for-compensation"}