{"id":1212,"title":"Claim Discharge Cum Satisfaction Voucher","purpose":"claim","insurer":{"slug":"shriram-general-insurance","name":"Shriram General Insurance Company Limited"},"source_pdf":"https://cdn.shriramgi.com/webassets/download/claim/DischargeVoucher_Claim_form.pdf","sha256":"5accee8e05832a3830f995604b671b9b69dff44b94f521a6af750f8b14e6158a","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to acknowledge full and final settlement of their insurance claim with Shriram General Insurance Co. Ltd.","notes":[],"title":"Claim Discharge Cum Satisfaction Voucher","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claim Settlement Details","fields":[{"help":"Enter your claim number as provided by the insurer.","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the amount received as full and final settlement.","type":"amount","label":"Received from SHRIRAM GENRAL INSURANCE CO. LTD. the sum of Rs.","options":[],"required":null,"pdf_field":""},{"help":"Enter your insurance policy number.","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Describe the damaged or lost item related to the claim.","type":"text","label":"in respect of damage to /loss of","options":[],"required":null,"pdf_field":""},{"help":"Enter the date of the damage or loss.","type":"date","label":"on","options":[],"required":null,"pdf_field":""},{"help":"Tick to confirm satisfaction with the settlement.","type":"checkbox","label":"I am fully satisfied with Full & Final settlement with respect to my claim.","options":["Yes"],"required":null,"pdf_field":""},{"help":"Repeat the settlement amount in words or figures as per the form.","type":"amount","label":"Rs.","options":[],"required":null,"pdf_field":""},{"help":"Affix the required revenue stamp here.","type":"attachment","label":"Revenue Stamp","options":[],"required":null,"pdf_field":""},{"help":"Sign here to acknowledge receipt and satisfaction.","type":"signature","label":"Signature of Insured","options":[],"required":null,"pdf_field":""},{"help":"Signature of the surveyor verifying the insured's signature.","type":"signature","label":"Insured Signature Verified (Signature of Surveyor)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"","attachments":["Revenue Stamp"],"declarations":["I am fully satisfied with Full & Final settlement with respect to my claim."],"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/1212-claim-discharge-cum-satisfaction-voucher"}