{"id":1205,"title":"Shri Loan Protect Insurance (Individual)- 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-Loan-Protect-Insurance-Claim-Form.pdf","sha256":"8f16703b17554b28599a9b029ae845c2a9c223d4351338b4db793c85ddf6dfaf","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for insured individuals to claim benefits under the Shri Loan Protect Insurance (Individual) policy. The insured must fill in all relevant details about the policy, loss, and claim.","notes":["All columns of the claim form must be filled by the insured; no column should remain unanswered.","Attach a separate sheet if space is insufficient."],"title":"Shri Loan Protect Insurance (Individual)- Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Claim Number","options":[],"required":false,"pdf_field":""},{"help":"Enter the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":true,"pdf_field":""},{"help":"Name of the insured","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Landline phone number","type":"phone","label":"Contact Number Landline","options":[],"required":false,"pdf_field":""},{"help":"Email address","type":"email","label":"E-mail","options":[],"required":false,"pdf_field":""},{"help":"Loan account number related to the insurance","type":"text","label":"Loan Account Number","options":[],"required":true,"pdf_field":""},{"help":"Outstanding loan principal amount","type":"amount","label":"Principal Outstanding Amount","options":[],"required":true,"pdf_field":""},{"help":"Equated Monthly Installment amount","type":"amount","label":"EMI","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Section (A) Personal Accident","fields":[{"help":"Date when the loss or injury occurred","type":"date","label":"Date of loss/injury","options":[],"required":true,"pdf_field":""},{"help":"Time of accident with AM/PM","type":"text","label":"Time of Accident","options":[],"required":true,"pdf_field":""},{"help":"Location where the loss or injury happened","type":"text","label":"Place of loss/injury","options":[],"required":true,"pdf_field":""},{"help":"Details of the loss or injury","type":"text","label":"Particulars of loss/injury","options":[],"required":true,"pdf_field":""},{"help":"Cause or reason for the injury","type":"text","label":"Reason for injury","options":[],"required":true,"pdf_field":""},{"help":"Describe the injury and specify left or right if applicable","type":"text","label":"Nature of injury received (if to eye or limbs, please state left or right?)","options":[],"required":true,"pdf_field":""},{"help":"Describe the disablement caused by the injury","type":"text","label":"Nature of disablement","options":[],"required":true,"pdf_field":""},{"help":"Current condition of the disability","type":"text","label":"Present state of disability","options":[],"required":true,"pdf_field":""},{"help":"Provide full names and addresses including city, state, pin code, country and phone","type":"text","label":"Names & Addresses of Treating physicians & Hospitals","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Section (B) Loss of Employment and Loss of Earnings","fields":[{"help":"Employer's name","type":"text","label":"Name of the employer","options":[],"required":false,"pdf_field":""},{"help":"Employer's address","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"HR department contact information","type":"text","label":"HR Contact details","options":[],"required":false,"pdf_field":""},{"help":"Job title or designation","type":"text","label":"Designation","options":[],"required":false,"pdf_field":""},{"help":"Department name","type":"text","label":"Department","options":[],"required":false,"pdf_field":""},{"help":"Date when employment started","type":"date","label":"Date of Joining the Organization","options":[],"required":false,"pdf_field":""},{"help":"Date when employment ended","type":"date","label":"Date of Separation","options":[],"required":false,"pdf_field":""},{"help":"Reason for leaving the job","type":"text","label":"Reason for separation","options":[],"required":false,"pdf_field":""},{"help":"Details of business or occupation","type":"text","label":"Business/ Occupation Details","options":[],"required":false,"pdf_field":""},{"help":"Business address","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Monthly income amount","type":"amount","label":"Monthly Income","options":[],"required":false,"pdf_field":""},{"help":"Attach or mention financial statements","type":"text","label":"Last 3 years Financial Statements","options":[],"required":false,"pdf_field":""},{"help":"Attach or mention books of accounts","type":"text","label":"Books of Accounts","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Section (D) Critical Illness","fields":[{"help":"Select the critical illness for the claim","type":"choice","label":"Select one of the below against which claim is being made","options":["Cancer","First heart attack","Open chest CABG","Open heart replacement","Kidney failure","Stroke","Major Organ","Paralysis","Primary (Idiopathic) Pulmonary Hypertension","Multiple sclerosis"],"required":true,"pdf_field":""},{"help":"Name of the insured person","type":"text","label":"Name of Insured","options":[],"required":true,"pdf_field":""},{"help":"Date when illness was first diagnosed or procedure done","type":"date","label":"Date of first diagnosis/ occurrence/ procedure","options":[],"required":true,"pdf_field":""},{"help":"Place of diagnosis or procedure","type":"text","label":"Place","options":[],"required":false,"pdf_field":""},{"help":"Description of the sickness","type":"text","label":"Nature of Sickness","options":[],"required":true,"pdf_field":""},{"help":"Details of how the loss or sickness occurred","type":"text","label":"Circumstances of loss/ sickness","options":[],"required":true,"pdf_field":""},{"help":"Full name and address of hospital or doctor","type":"text","label":"Name & Address of treating hospital / doctor","options":[],"required":true,"pdf_field":""},{"help":"City of hospital or doctor","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"State of hospital or doctor","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Pin code of hospital or doctor","type":"text","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Date of birth of insured if applicable","type":"date","label":"Date of Birth (if applicable)","options":[],"required":false,"pdf_field":""},{"help":"Place of death if applicable","type":"text","label":"Place of Death","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Sign to confirm the details are true and correct","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"claims under Shri Loan Protect Insurance (Individual)","attachments":[],"declarations":["The insured confirms that the details provided are true and correct to the best of their knowledge."],"dropped_labels":11},"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/1205-shri-loan-protect-insurance-individual-claim-form"}