{"id":1178,"title":"Plate Glass and/or Sanitary Fittings-Claim Form","purpose":"claim","insurer":{"slug":"shriram-general-insurance","name":"Shriram General Insurance Company Limited"},"source_pdf":"https://cdn.shriramgi.com/webassets/download/claim/PlateGlass_ClaimForm.pdf","sha256":"a6a25b108c740cdf2616cff13c5711e628435ee990e03c985602293c800ecd01","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim insurance for loss or damage to plate glass and/or sanitary fittings at their insured premises.","notes":["Signature of the Insured is required.","Place and Date must be filled at the time of signing."],"title":"Plate Glass and/or Sanitary Fittings-Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"A. INSURED","fields":[{"help":"","type":"text","label":"Name :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation :","options":[],"required":null,"pdf_field":""},{"help":"Enter your insurance policy number","type":"text","label":"Policy No. :","options":[],"required":null,"pdf_field":""},{"help":"Enter the start and end dates of your insurance coverage","type":"date","label":"Period of Insurance : From                   To","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone Number :","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E-mail :","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"B. DETAILS OF THE PREMISES WHERE LOSS HAS OCCURRED","fields":[{"help":"Address of the premises where the loss occurred","type":"text","label":"Address :","options":[],"required":null,"pdf_field":""},{"help":"City and postal code of the premises","type":"text","label":"City :                                    Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"Purpose or usage of the premises","type":"text","label":"What was the premise used for? :","options":[],"required":null,"pdf_field":""},{"help":"Specify the affected area within the premises","type":"text","label":"Which portion of the premises was affected?","options":[],"required":null,"pdf_field":""},{"help":"State if premises was under construction or vacant and duration","type":"text","label":"Whether the premises was under construction /vacant at the time of loss. If yes, since how many days? :","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"C. DETAILS OF THE LOSS","fields":[{"help":"Date and time when the loss occurred","type":"date","label":"Date & Time of Loss.","options":[],"required":null,"pdf_field":""},{"help":"Describe the incident and specify damaged items","type":"text","label":"Give brief details of how exactly the loss occurred. (Specify the Glass/ sanitary fitting damaged)","options":[],"required":null,"pdf_field":""},{"help":"Estimated financial loss amount","type":"amount","label":"Amount of Loss","options":[],"required":null,"pdf_field":""},{"help":"Actions taken to recover salvage value","type":"text","label":"Initiatives taken for recovery of salvage","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"D. DETAIL OF OTHER INSURANCES","fields":[{"help":"List other insurance policies covering this loss","type":"text","label":"Give details of other Insurance’s, if any, covering the present loss.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"E. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"Provide information on any prior losses on this property","type":"text","label":"Give details of Previous losses, if any, on the affected property.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Plate Glass and/or Sanitary Fittings claims","attachments":[],"declarations":["The particulars given are true and correct in every respect.","The articles or properties described belong to the insured with no other person having any interest."],"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/1178-plate-glass-and-or-sanitary-fittings-claim-form"}