{"id":1251,"title":"Home Guard Plus Policy Claim Form","purpose":"claim","insurer":{"slug":"tata-aig-general-insurance","name":"Tata AIG General Insurance Company Limited"},"source_pdf":"https://www.tataaig.com/s3/Claims_Forms_home-guard-plus-claim-form.pdf_2cf7d859c3.pdf","sha256":"188e838a5cf7c36d0c107df67a60ccba312f3b04fd8f71beea200cfe4ef45e01","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to file a claim under the Home Guard Plus insurance policy for various benefits such as critical illness, accidental death, permanent total disability, education benefit, involuntary loss of job, and home standard fire and special perils.","notes":["Answer all questions completely; attach additional sheets if space is insufficient.","Use original documents and certificates as required.","Purchase of Tata AIG products is voluntary.","For risk factors, terms and conditions, read the sales brochure carefully before concluding a sale."],"title":"Home Guard Plus Policy Claim Form","submit":{"to":"Tata AIG General Insurance Company Limited","how":"","address":"A-501, 5th Floor, Building No.4, Infinity Park, Gen. A.K. Vaidya Marg, Dindoshi, Malad (East), Mumbai 400 097"},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"","type":"text","label":"Certificate/Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Start date of policy period","type":"date","label":"Period From","options":[],"required":null,"pdf_field":""},{"help":"End date of policy period","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"First Name, Middle Name, Surname","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"PIN","options":[],"required":null,"pdf_field":""},{"help":"Office phone number","type":"phone","label":"Phone (O)","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Fax","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E-mail id","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Sex:","options":["M","F"],"required":null,"pdf_field":""},{"help":"Select one claim type","type":"choice","label":"Please indicate whether claim is in respect of:","options":["Critical Illness","Accidental Death","Permenant Total Disability","Education benefit","Involuntary loss of job","Home standard fire and special perils"],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Critical Illness Benefit","fields":[{"help":"Select the disease or condition claimed","type":"choice","label":"Disease or condition claimed for :","options":["Cancer of specified severity","Kidney Failure Requiring Regular Dialysis","Open Chest CABG","Stroke resulting in Permanent Symptoms","Multiple Sclerosis with persisting symptoms","Permanent Paralysis of Limbs","Major Organ / Bone Marrow Transplant","First Heart Attack - of specified severity","Open Heart Replacement or Repair of Heart Valves"],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"What was the date of first consultation with a Medical Practioner ?","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"What was the date of first diagnosis of disease or condition ?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Hospital :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please provide any details of treatment given for any similar or related illness.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Details of Family Doctor - Name & Qualification","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Details of Specialist consulted in the past and reason for consultation :","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Details of Domestic Health Insurance or other Policy covering same loss and Claims history , (if any) :","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Accidental Death","fields":[{"help":"","type":"text","label":"Details of accident i.e. how, when, where it took place:","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"FIR No:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Location of Police station","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the Hospital where treatment is being taken:","options":[],"required":false,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date of Admission:","options":[],"required":false,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date of Discharge:","options":[],"required":false,"pdf_field":""},{"help":"Include PIN, Phone (O), Phone (R)","type":"text","label":"Provide name, address & Contact No. of your treating physician:","options":[],"required":false,"pdf_field":""},{"help":"Include PIN, Phone (O), Phone (R)","type":"text","label":"Provide name, address & Contact No. of your family physician:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Indicate other health insurance coverages, including name, address, policy number & certificate number of insurer:","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Permanent Total Disability","fields":[{"help":"","type":"text","label":"Details of accident i.e. how, when, where it took place:","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"FIR No:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the Hospital where treatment is being taken:","options":[],"required":false,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date of Admission:","options":[],"required":false,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date of Discharge:","options":[],"required":false,"pdf_field":""},{"help":"Include PIN, Phone (O), Phone (R)","type":"text","label":"Provide name, address & Contact No. of your treating physician:","options":[],"required":false,"pdf_field":""},{"help":"Include PIN, Phone (O), Phone (R)","type":"text","label":"Provide name, address & Contact No. of your family physician:","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Involuntary Loss of Job","fields":[{"help":"","type":"text","label":"Details of loan account number .:","options":[],"required":null,"pdf_field":""},{"help":"Support with documentary evidence from HR of last company attended","type":"text","label":"Current employment status :","options":[],"required":null,"pdf_field":""},{"help":"Attach certificate","type":"attachment","label":"Medical/Disability certificate from government authority:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Reason for loss of job :","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Attending Physician's Statement","fields":[{"help":"","type":"text","label":"Patient's Name :","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Detailed Diagnosis :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Type of Symptoms :","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"First Date of Symptoms :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Any other disease / medical condition affecting present condition :","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Hospitalisation Details - Name & Address of the Hospital :","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nature of Treatment / Surgical Procedure undergone","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is illness due to any pre-ex conditions :","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nature of disability :","options":[],"required":false,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"Percentage of disability :","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Time required for Recovery:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Attenting Doctor's Name :","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature:","options":[],"required":null,"pdf_field":""}],"filled_by":"attending doctor"},{"title":"Education Benefit","fields":[{"help":"","type":"text","label":"Name of child/Children :","options":[],"required":null,"pdf_field":""},{"help":"in years","type":"number","label":"Age:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Education institute :","options":[],"required":null,"pdf_field":""},{"help":"Standard/class","type":"text","label":"STD.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the Legal Guardian (if child is minor)","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Home Standard Fire and Special Perils (Material Damage)","fields":[{"help":"","type":"text","label":"Details of property loss :","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Amount of Loss :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"FIR No. & Details","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Date of loss / location :","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Authorisation for Release of Medical Information","fields":[{"help":"","type":"signature","label":"Signature of insured :","options":[],"required":null,"pdf_field":""},{"help":"Format DDMMYYYY","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Authorization and Declaration","fields":[{"help":"Format DDMMYYYY","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of insured/Nominee:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant or nominee"}],"deadlines":[],"applies_to":"Home Guard Plus insurance policy claims","attachments":["Medical/Disability certificate from government authority (for Involuntary Loss of Job claim)"],"declarations":["Issuance of the form is not an admission of liability or waiver of terms, conditions and exceptions of the insurance contract.","All details given are absolutely true and correct.","Rights to compensation will be forfeited if any facts or details are found false or incorrect.","Authorization to release medical information to the company or its authorized representative."],"dropped_labels":7},"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/1251-home-guard-plus-policy-claim-form"}