{"id":1195,"title":"Shri Hotel and Restaurant Sampurna Surksha Insurance Policy (Laghu Udyam) Claim Form","purpose":"claim","insurer":{"slug":"shriram-general-insurance","name":"Shriram General Insurance Company Limited"},"source_pdf":"https://cdn.shriramgi.com/webassets/download/claim/Shri_Hotel_and_Restaurant_(Laghu_Udyam)_Claim_Form.pdf","sha256":"8cf54a6c40f062fd01c363b69acf1a12fc276e190c1c88680417ed714e282b18","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for the insured to claim under the Shri Hotel and Restaurant Sampurna Surksha Insurance Policy (Laghu Udyam). The policyholder fills this form to report and claim losses under the policy.","notes":["Please ensure that all columns of the claim forms are filled in by the insured and no column remains unanswered","Attach Separate Sheet if the space is not sufficient"],"title":"Shri Hotel and Restaurant Sampurna Surksha Insurance Policy (Laghu Udyam) Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"1. INSURED 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 of the insured","type":"email","label":"E-mail","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"2. CLAIM LODGED UNDER WHICH SECTION OF THE POLICY","fields":[{"help":"Select the section under which the claim is lodged","type":"choice","label":"Section","options":["1. Shri Bharat Laghu Udyam Suraksha Policy","2. Burglary Insurance","3. Fire Loss of Profit Policy","4. All Risk Insurance","5. Money Insurance Policy","6. Machinery Breakdown Insurance Policy","7. Boiler and Pressure Plant Insurance","8. Electronic Equipment Insurance Policy","9. Plate Glass and/or Sanitary Fitting Insurance","10. Neon Sign/Glow Sign/Hoarding Insurance Policy","11. Shri Personal Accident Insurance","12. Baggage Insurance","13. Fidelity Guarantee Policy","14. Employee’s Compensation Insurance","15. Public Liability (Non-Industrial) Insurance Policy"],"required":null,"pdf_field":""},{"help":"Enter the amount of loss for the selected section","type":"amount","label":"Amount of Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the loss incurred","type":"text","label":"Description of Loss","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"3. DETAILS OF PREVIOUS LOSS","fields":[{"help":"Serial number of previous loss","type":"number","label":"Sr.","options":[],"required":false,"pdf_field":""},{"help":"Date when previous loss occurred","type":"date","label":"Date of Loss","options":[],"required":false,"pdf_field":""},{"help":"Amount of previous loss","type":"amount","label":"Amount of Loss","options":[],"required":false,"pdf_field":""},{"help":"Name of insurer for previous loss","type":"text","label":"Name of Insurance Company","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"4. ESTIMATE OF LOSS","fields":[{"help":"Serial number for estimate entries","type":"number","label":"Sr.","options":[],"required":false,"pdf_field":""},{"help":"Description of contents lost or damaged","type":"text","label":"Contents","options":[],"required":false,"pdf_field":""},{"help":"Description of other items lost or damaged","type":"text","label":"Others (furniture/fixture/fittings if owned by insured)","options":[],"required":false,"pdf_field":""},{"help":"Total estimated loss amount","type":"amount","label":"Total","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Claims under Shri Hotel and Restaurant Sampurna Surksha Insurance Policy (Laghu Udyam)","attachments":["Attach Separate Sheet if the space is not sufficient","Please attach relevant claim form for each section"],"declarations":["The issue of this form is not to be taken as an admission of liability","I/We, undersigned confirmed that the above given details are true & correct to the best of my 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/1195-shri-hotel-and-restaurant-sampurna-surksha-insurance-policy-laghu-udyam-claim-fo"}