{"id":1219,"title":"Shri Carrier’s Legal Liability Insurance Claims Form","purpose":"claim","insurer":{"slug":"shriram-general-insurance","name":"Shriram General Insurance Company Limited"},"source_pdf":"https://cdn.shriramgi.com/webassets/download/claim/Shri_CLL_Claim_Form.pdf","sha256":"1c72e777db5db9b0521be5389ac47e7cdefd46ce187247e871ac1360d26e1a2b","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim under the Shri Carrier’s Legal Liability Insurance policy for losses related to goods carried by the insured vehicle.","notes":["The issue of this form is not to be taken as an admission of liability."],"title":"Shri Carrier’s Legal Liability Insurance Claims Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Insured Vehicle","fields":[{"help":"","type":"text","label":"Registration No.","options":[],"required":null,"pdf_field":""},{"help":"Enter vehicle make and year of manufacture","type":"text","label":"Make and year of Built","options":[],"required":null,"pdf_field":""},{"help":"Enter weight in appropriate units","type":"number","label":"Gross Vehicle Weight","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the owner","options":[],"required":null,"pdf_field":""},{"help":"Select if the vehicle is comprehensively insured","type":"choice","label":"Whether insured comprehensively.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Under Motor Policy.","options":[],"required":null,"pdf_field":""},{"help":"Provide insurer details if comprehensively insured","type":"text","label":"If yes, give name and address of Insurance Co. & Policy No/ Place of Issue","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Goods","fields":[{"help":"Describe the type of goods","type":"text","label":"Nature of goods carried","options":[],"required":null,"pdf_field":""},{"help":"Enter weight of goods","type":"number","label":"Weight of goods carried","options":[],"required":null,"pdf_field":""},{"help":"Enter location from where goods were dispatched","type":"text","label":"Place of despatch","options":[],"required":null,"pdf_field":""},{"help":"Enter destination location","type":"text","label":"Place of destination","options":[],"required":null,"pdf_field":""},{"help":"Enter total number of cases or packages dispatched","type":"number","label":"Total No of cases and/or packages dispatch","options":[],"required":null,"pdf_field":""},{"help":"Describe condition of cases/packages on delivery","type":"text","label":"Full details of condition of case and / or packages taken delivery of","options":[],"required":null,"pdf_field":""},{"help":"Enter the monetary value of goods","type":"amount","label":"Value of the goods","options":[],"required":null,"pdf_field":""},{"help":"Enter name of consignor or consignee","type":"text","label":"Name of the Consigner/Consignee","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Particulars of Accident","fields":[{"help":"Enter date and time of accident","type":"date","label":"Date and time","options":[],"required":null,"pdf_field":""},{"help":"Enter location of accident","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Describe how the accident happened","type":"text","label":"Nature and cause of accident","options":[],"required":null,"pdf_field":""},{"help":"Enter date/time accident was reported","type":"text","label":"When was the accident reported to you","options":[],"required":null,"pdf_field":""},{"help":"Provide third party details if applicable","type":"text","label":"If any third party was responsible for the accident, give name and address.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Details","fields":[{"help":"Enter number of damaged or destroyed packages","type":"number","label":"No of packages damaged / destroyed","options":[],"required":null,"pdf_field":""},{"help":"Enter estimated loss amount","type":"amount","label":"Quantum of loss","options":[],"required":null,"pdf_field":""},{"help":"Select if any third party claim has been made","type":"choice","label":"Whether any claim has been made upon you by third party in respect of damage to goods carried.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of third party claim and attach notification if available","type":"text","label":"If so, state by whom and give full particulars (If claim has been made in writing attach a copy of notification received.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Witness and Authority Details","fields":[{"help":"List all witnesses with their addresses","type":"text","label":"Give the names and addresses of all witness to the accident.","options":[],"required":null,"pdf_field":""},{"help":"Select if accident was reported to authority and attach report if yes","type":"choice","label":"Has the accident been reported to any Authority? If so, state to whom and attach a copy of the report.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain reasons if accident not reported","type":"text","label":"If not reported, rest thereof","options":[],"required":null,"pdf_field":""},{"help":"Describe any action taken by authority","type":"text","label":"What action, if any, has been taken by the authority?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Other Insurance","fields":[{"help":"Provide details of any other insurance covering this risk","type":"text","label":"Give particulars, of any other insurance If any, in respect of the same risk","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Sign the form","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""},{"help":"Print your name","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Enter your address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Signature of witness","type":"signature","label":"Witness: Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"ECS Details of the Insured","fields":[{"help":"Enter bank account holder name","type":"text","label":"Name of the Insured (as appearing in the Bank Account)","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch and address","type":"text","label":"Branch and address","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Specify account type (e.g. Savings, Current)","type":"text","label":"Bank Account Type","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code of bank branch","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"Enter MICR code of bank branch","type":"text","label":"MICR Code","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Claims under Shri Carrier’s Legal Liability Insurance policy","attachments":["Copy of notification received if a third party claim has been made","Copy of the accident report if reported to authority"],"declarations":["The insured declares that the statements made are true to the best of their knowledge and belief.","If any false statement or concealment is made, the claim shall be forfeited and the policy shall be null and void."],"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/1219-shri-carriers-legal-liability-insurance-claims-form"}