{"id":1248,"title":"CLAIM FORM HOME SECURE (HOUSEHOLDERS) POLICY","purpose":"claim","insurer":{"slug":"tata-aig-general-insurance","name":"Tata AIG General Insurance Company Limited"},"source_pdf":"https://www.tataaig.com/s3/Homesecure_Householders_Claim_Form_bd5da61015.pdf","sha256":"f1dcb1c244e694decf5730852436f15797d8ea7b715efdd2feeb9f5f9162557c","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim loss under the Home Secure (Householders) insurance policy by providing details of the loss and related information.","notes":["Do not delay dispatch of this form for unavailable information; send later if needed.","If space is insufficient, attach separate sheets.","The issue of this form does not constitute admission of liability.","The company may call for additional information to establish cause, admissibility, and extent of loss."],"title":"CLAIM FORM HOME SECURE (HOUSEHOLDERS) POLICY","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured and Claimant","fields":[{"help":"Enter the claim number if available","type":"text","label":"Claim No:","options":[],"required":null,"pdf_field":""},{"help":"Enter your policy number","type":"text","label":"Policy No:","options":[],"required":null,"pdf_field":""},{"help":"Enter policy start date","type":"date","label":"Policy Period: From","options":[],"required":null,"pdf_field":""},{"help":"Enter policy end date","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Enter the insured person's address","type":"text","label":"2. Address:","options":[],"required":null,"pdf_field":""},{"help":"Enter postal PIN code","type":"number","label":"PIN:","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"3. Contact Information: Phone: Mobile","options":[],"required":null,"pdf_field":""},{"help":"Enter landline STD code and number","type":"phone","label":"STD Code, Number","options":[],"required":null,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email :","options":[],"required":null,"pdf_field":""},{"help":"Enter claimant's name","type":"text","label":"Details of Claimant: 1. Name:","options":[],"required":null,"pdf_field":""},{"help":"Enter claimant's address","type":"text","label":"2. Address:","options":[],"required":null,"pdf_field":""},{"help":"Enter claimant's postal PIN code","type":"number","label":"PIN:","options":[],"required":null,"pdf_field":""},{"help":"Enter claimant's mobile phone number","type":"phone","label":"3. Contact Information: Phone: Mobile","options":[],"required":null,"pdf_field":""},{"help":"Enter claimant's landline STD code and number","type":"phone","label":"STD Code, Number","options":[],"required":null,"pdf_field":""},{"help":"Enter claimant's email address","type":"email","label":"Email :","options":[],"required":null,"pdf_field":""},{"help":"Tick the applicable coverage; specify if 'Others'","type":"checkbox","label":"Coverage under which loss is claimed: (Please tick as applicable)","options":["Home Building","Home Contents","Others"],"required":null,"pdf_field":""},{"help":"Tick all applicable causes; specify if 'Others'","type":"checkbox","label":"Cause of loss: (Please tick as applicable)","options":["Fire","Explosion of domestic pressure vessels or Implosion","Lightning","Earthquake, volcanic eruption, or other convulsions of nature","Storm, Cyclone, Typhoon, Tempest, Hurricane, Tornado","Tsunami, Flood and Inundation","Acts of Terrorism (Coverage as per terrorism clause attached)","Subsidence, Landslide, Rockslide, Avalanche","Additional Covers: a. Bush fire, Forest Fire, Jungle Fire","b. Impact damage","c. Missile testing operations","d. Riot, Strikes, Malicious Damages","e. Bursting or overflowing of water tanks, apparatus and pipes","f. Leakage from automatic sprinkler installations","g. Theft within 7 (seven) days from the occurrence of and proximately caused by any of the above Insured Events","Others"],"required":null,"pdf_field":""},{"help":"Enter date of loss","type":"date","label":"6. Loss details: Date of loss:","options":[],"required":null,"pdf_field":""},{"help":"Enter time of loss with AM/PM","type":"text","label":"Time of loss:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Loss Details and Incident Information","fields":[{"help":"Enter date when loss was discovered","type":"date","label":"Date of discovery:","options":[],"required":null,"pdf_field":""},{"help":"Enter time of discovery with AM/PM","type":"text","label":"Time of discovery:","options":[],"required":null,"pdf_field":""},{"help":"Enter full address where loss occurred","type":"text","label":"Place of loss (Full address):","options":[],"required":null,"pdf_field":""},{"help":"Describe how the loss happened","type":"text","label":"7: A brief note on how the loss occurred / Incident Note.","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"8: Has the fire / loss been reported to fire brigade and/or Police?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter FIR number if reported","type":"text","label":"FIR No:","options":[],"required":null,"pdf_field":""},{"help":"Enter fire brigade report number if reported","type":"text","label":"Fire Brigade Report No:","options":[],"required":null,"pdf_field":""},{"help":"Explain why not reported if applicable","type":"text","label":"If no, please give reasons:","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"9. Was the premise occupied at the time of loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter date since premise was unoccupied","type":"date","label":"If no, since when it was unoccupied? (Date)","options":[],"required":null,"pdf_field":""},{"help":"Provide financier details if applicable","type":"text","label":"10. State whether the property damaged, is Hypothecated / Financed / Leased / Hire purchase, If yes, please give details. (Name and address of the financier):","options":[],"required":null,"pdf_field":""},{"help":"Enter the claimed amount","type":"amount","label":"11. Value of loss / amount of claim lodged:","options":[],"required":null,"pdf_field":""},{"help":"Provide details of other insurance policies if any","type":"text","label":"12. Details of other policies covering the present loss:","options":[],"required":null,"pdf_field":""},{"help":"Provide details of previous losses if any","type":"text","label":"13. Details of previous losses, if any, under the current policy with this company or similar policy under any other company:","options":[],"required":null,"pdf_field":""},{"help":"Provide witness details if available","type":"text","label":"14. Details of witness - Name and address (if any):","options":[],"required":false,"pdf_field":""},{"help":"List damaged items with columns: Sr No, Description on Property, No of units, Insured Value, Value claimed","type":"table","label":"15. List of Items/property damaged: (As per annexure in Page 3).","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration by Insured","fields":[{"help":"Enter date of signing","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":["Inform Company of the loss without any delay, keeping in mind the timelines specified in the Policy"],"applies_to":"Home Secure (Householders) Policy","attachments":["Separate sheet(s) if space is insufficient in any column","Annexure listing items/property damaged (Page 3)"],"declarations":["The insured declares that the answers are conscientious and faithful and is liable for correctness and completeness.","If any information is false, fraudulent, or there is misrepresentation or concealment, the policy shall be void and rights forfeited.","The insured authorizes the company or its representatives to collect relevant information and documents to verify the loss."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"TATA AIG General Insurance Company Limited, 5th and 6th Floor, Imperial Towers, H.No 7-1-6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana","label":"Claims Submission Address","level":null,"hours":null,"applies_to":"health","source_url":"https://www.tataaig.com/s3/medicare_select_cis_e7df7ce2ec.pdf","quote":"tion or procedure. Submit claim documents within 15 days of occurrence of incident. Kindly send the claim documents to: TATA AIG General Insurance Company Limited, 5th and 6th Floor, Imperial Towers, H.No 7-1- 6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana, Phone-040-66864900 Assistance: 1. Website www.tataaig.com or Call 24*7 Customer Support No.: 022 6489 8282/1800 267 1","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"healthclaimsupport@tataaig.com","label":"Health Claims Support Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.tataaig.com/s3/medicare_select_prospectus_efd23b0ad6.pdf","quote":"al Towers, H.No 7-1-6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana, Phone: 040-66864900\nEmail ID | healthclaimsupport@tataaig.com\nCustomer Support Number: | 022 6489 8282 / 1800 267 1955 (nly for senior citizen policy holders)\nWebsite | www.tataaig.","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"040-66864900","label":"Claims Administrator Phone","level":null,"hours":null,"applies_to":"health","source_url":"https://www.tataaig.com/s3/medicare_select_prospectus_efd23b0ad6.pdf","quote":"th and 6th Floor, Imperial Towers, H.No 7-1-6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana, Phone: 040-66864900\nEmail ID | healthclaimsupport@tataaig.com\nCustomer Support Number: | 022 6489 8282 / 1800 267 1955 (nly for senior citi","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/tata-aig-general-insurance/1248-claim-form-home-secure-householders-policy"}