{"id":1184,"title":"Farmers Package Policy: Claim Form (All Sections)","purpose":"claim","insurer":{"slug":"shriram-general-insurance","name":"Shriram General Insurance Company Limited"},"source_pdf":"https://cdn.shriramgi.com/webassets/download/claim/Farmer-Package-Claim-Form.pdf","sha256":"10e74654fd8ec38ce68ba92777c9453f9de65358f5d6f74e3e5a149553a2fcb4","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to file a claim under the Farmers Package Policy for loss, damage, livestock death, or personal injury. It collects details about the insured, the incident, and the claim.","notes":["The issue of this form does not constitute admission of liability."],"title":"Farmers Package Policy: Claim Form (All Sections)","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"A. INSURED DETAILS","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":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Enter start and end dates of insurance period","type":"date","label":"Period of Insurance From To","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone Number/ Mobile no.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"B. DETAILS OF THE PROPERTY LOST/DESTROYED/DAMAGED","fields":[{"help":"","type":"text","label":"Location details where the loss occurred.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of the items lost /damaged","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date & Time of Loss.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Give brief details of how exactly the loss occurred.","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Amount of Loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Initiatives taken for recovery of salvage","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"C. DETAILS OF THE LIVESTOCK DEATH LOSS","fields":[{"help":"","type":"text","label":"Animal type and no. of animal","options":[],"required":null,"pdf_field":""},{"help":"Include date","type":"text","label":"Cause and date of death","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Tag no.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Death certificate no.","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Total Claim amount","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"D. DETAILS OF THE PERSONAL LOSS","fields":[{"help":"","type":"text","label":"Name of claimant","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation/ age","options":[],"required":null,"pdf_field":""},{"help":"Time and date of accident/incident","type":"date","label":"Time and Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Location of Accident/ incident","options":[],"required":null,"pdf_field":""},{"help":"Describe cause of accident/incident","type":"text","label":"Cause (Description)","options":[],"required":null,"pdf_field":""},{"help":"Specify type of disablement if applicable","type":"text","label":"Total Disablement if any(specify the type)","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"D. DETAILS OF THE PERSONAL LOSS - WITNESSES","fields":[{"help":"Name of witness","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Address of witness","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Phone number of witness","type":"phone","label":"Phone No","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"D. DETAILS OF THE PERSONAL LOSS - POLICE REPORT","fields":[{"help":"","type":"yes-no","label":"Has a complaint been lodged with the Police station? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach police report copy","type":"text","label":"If Yes, by whom, when & at which Police station? (Attach a copy of the police report).","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"E. DETAILS OF OTHER INSURANCE","fields":[{"help":"","type":"text","label":"Give details of other Insurance’s, if any, covering the present loss.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"F. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"","type":"text","label":"Give details of Previous losses, if any, on the affected property.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"DECLARATION","fields":[{"help":"","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Insured/Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"ATTENDING PHYSICIAN'S STATEMENT","fields":[{"help":"","type":"text","label":"Name of Injured Person","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nature of the Accident and Details of Injuries Sustained","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the Cause of Accident as stated by the Claimant tally with the Injuries noticed by you?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are the injuries solely due to the accident or traceable to any previous injuries/ disease/ infirmities?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the injured person suffering from any disease or injury which may have contributed to the accident or likely to aggravate his condition?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify hospitalization period","type":"text","label":"Was the Claimant hospitalized? If so for what period?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was he under the influence of intoxicants or drugs at the time of accident","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Are you his usual medical Attendant? If you have treated him for any previous illness or injury, please give details","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Have other Doctors been in Attendance or Consultation? If yes, Please give details","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has this accident been reported to the Police Authorities? If yes,","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Case No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Police Station :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details about disablement due to accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Name and Signature of Physician","options":[],"required":null,"pdf_field":""}],"filled_by":"attending physician"}],"deadlines":[],"applies_to":"Farmers Package Policy claims for property loss/damage, livestock death, and personal loss","attachments":["Copy of the police report (if complaint lodged)"],"declarations":["The particulars given are true and correct and the property belongs to the claimant with no other interest.","Authorization for hospital, doctor, laboratory, or other bodies to provide information or documents to the insurance company."],"dropped_labels":7},"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/1184-farmers-package-policy-claim-form-all-sections"}