{"id":1173,"title":"Electronic Equipment Insurance Claim Form","purpose":"claim","insurer":{"slug":"shriram-general-insurance","name":"Shriram General Insurance Company Limited"},"source_pdf":"https://cdn.shriramgi.com/webassets/download/claim/Electronic-Equipment-Insurance-Claim-Form.pdf","sha256":"a6cfb14ddbeee6a3060a7739ea96c690a2845c2e03295bcf9aabb04d3b6b54d5","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim for loss or damage to electronic equipment covered under the insurance policy.","notes":["The issue of this form is not to be taken as an admission of liability.","Ensure all columns of the claim form are filled and no column remains unanswered.","Attach separate sheet if space is insufficient."],"title":"Electronic Equipment Insurance Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"A. INSURANCE DETAILS","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim Number","options":[],"required":null,"pdf_field":""},{"help":"Enter the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Name of the insured","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Full postal address of the insured","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number","type":"phone","label":"Contact Number Landline","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"E-mail","options":[],"required":null,"pdf_field":""},{"help":"Bank where insured holds account","type":"text","label":"Name of the Bank","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Saving/Current A/C No","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"B. DETAILS OF THE ACCIDENT/LOSS","fields":[{"help":"Date and time when the accident or loss occurred","type":"date","label":"Date & Time of Accident/loss","options":[],"required":null,"pdf_field":""},{"help":"Location where the accident or loss happened","type":"text","label":"Place of Accident/loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the accident or loss and attach supporting documents if any","type":"text","label":"Nature & cause of accident/loss, how did the damage occur & what was the probable cause (please attach sketches, photos, etc.)","options":[],"required":null,"pdf_field":""},{"help":"Attach loss report from maintenance firm or supplier if applicable","type":"attachment","label":"Loss report drawn up by the maintenance firm or supplier (if damage to EDP systems)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"C. DETAILS OF DAMAGED ITEM","fields":[{"help":"Provide details of each damaged item including make, model, part number, sum insured, purchase date, and guarantee expiry","type":"table","label":"Item, Make & model, Part Number, Sum Insured, Date of Purchase, Has the period of guarantee expired? If so, when?","options":[],"required":null,"pdf_field":""},{"help":"Attach estimate of loss or damage","type":"amount","label":"What is the estimated amount of loss or damage? (Attach estimate)","options":[],"required":null,"pdf_field":""},{"help":"Indicate if the property was repaired before","type":"yes-no","label":"Has the property undergone any repairs previously? Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe previous repairs if any","type":"text","label":"If yes, what was the nature of such repairs?","options":[],"required":null,"pdf_field":""},{"help":"Provide workshop details for repairs","type":"text","label":"Give the name & address of the workshop where repairs will be executed","options":[],"required":null,"pdf_field":""},{"help":"Age of X-ray tubes or valves in months","type":"number","label":"In the event of Damage to X-ray tubes or valves for X-ray equipment: Age in Months","options":[],"required":null,"pdf_field":""},{"help":"Previous usage details of X-ray equipment","type":"text","label":"Previous Usage","options":[],"required":null,"pdf_field":""},{"help":"Total hours of operation of X-ray equipment","type":"number","label":"Hours of Operation","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF OTHER INSURANCE COVERING THE EQUIPMENT","fields":[{"help":"Name of other insurance company if any","type":"text","label":"Company Name","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other insurance","type":"amount","label":"Sum Insured (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Insurance period of other policy","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Indicate if claim was reported to other insurer","type":"yes-no","label":"Has a claim been reported to any other insurer in respect of this accident? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of claim reported to other insurer","type":"text","label":"If ‘yes’ please give details","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured person","type":"signature","label":"Signature of Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Electronic Equipment Insurance Policy claims","attachments":["sketches, photos, etc. of the accident or loss","loss report drawn up by the maintenance firm or supplier (if damage to EDP systems)","estimate of loss or damage"],"declarations":["The insured confirms that the details provided are true and correct to the best of their knowledge."],"dropped_labels":1},"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/1173-electronic-equipment-insurance-claim-form"}