{"id":1252,"title":"Intimation Cum Preliminary Claim Form - Auto Secure Motor Insurance","purpose":"claim","insurer":{"slug":"tata-aig-general-insurance","name":"Tata AIG General Insurance Company Limited"},"source_pdf":"https://www.tataaig.com/s3/R3_Auto_Secure_Claim_Form_cdf0776d75.pdf","sha256":"daf83c2045cea7f4783ecc313a9116e6c19305024b997b230ed4466bde542099","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to notify Tata AIG Insurance about a motor vehicle accident and initiate a claim under the Auto Secure Motor Insurance policy.","notes":["Please sign on both sides of claim form.","Do not leave any column unanswered.","Use self-certified copies of documents as applicable.","The issue of this form is not an admission of liability by Tata AIG."],"title":"Intimation Cum Preliminary Claim Form - Auto Secure Motor Insurance","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured/Claimant","fields":[{"help":"Enter the claim number if available","type":"text","label":"Claim No .","options":[],"required":false,"pdf_field":""},{"help":"Enter your insurance policy number","type":"text","label":"Policy No .","options":[],"required":true,"pdf_field":""},{"help":"Enter the vehicle registration number","type":"text","label":"Vehicle No .","options":[],"required":true,"pdf_field":""},{"help":"Enter the full name of the insured or claimant","type":"text","label":"Insured/Claimant Name","options":[],"required":true,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"E-mail Id","options":[],"required":false,"pdf_field":""},{"help":"Enter your full postal address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Enter your city","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Enter your postal PIN code","type":"number","label":"Pin","options":[],"required":true,"pdf_field":""},{"help":"Enter your mobile phone number","type":"phone","label":"Mobile","options":[],"required":true,"pdf_field":""},{"help":"Enter your residential telephone number","type":"phone","label":"Tel Res .","options":[],"required":false,"pdf_field":""},{"help":"Enter your office telephone number","type":"phone","label":"Tel Off .","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Description of the Accident: Your Account","fields":[{"help":"Enter the date and time of the accident; specify am or pm","type":"date","label":"Time & Date of Accident / Occurrence","options":[],"required":true,"pdf_field":""},{"help":"Enter the location where the accident occurred","type":"text","label":"Place of Accident","options":[],"required":true,"pdf_field":""},{"help":"Select the type(s) of loss applicable","type":"choice","label":"Type of Loss (details overleaf)","options":["Own Damage","Third Party","Bodily Injury","Property"],"required":true,"pdf_field":""},{"help":"Provide a brief description of the accident; a sketch can be provided on the back","type":"text","label":"Short description of accident/incident (sketch overleaf)","options":[],"required":true,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Driver Details (at the time of accident)","fields":[{"help":"Enter the full name of the driver at the time of accident","type":"text","label":"Driver's Name","options":[],"required":true,"pdf_field":""},{"help":"Enter the age of the driver","type":"number","label":"Age","options":[],"required":false,"pdf_field":""},{"help":"Enter the occupation of the driver","type":"text","label":"Occupation","options":[],"required":false,"pdf_field":""},{"help":"Enter the driving license number of the driver","type":"text","label":"Driving License No .","options":[],"required":true,"pdf_field":""},{"help":"Enter badge number if applicable","type":"text","label":"Badge No .","options":[],"required":false,"pdf_field":""},{"help":"Specify the vehicle types the license is effective for","type":"text","label":"Effective for (type of vehicles)","options":[],"required":false,"pdf_field":""},{"help":"Enter the expiry date of the driving license","type":"date","label":"Expiry Date","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"To be filled only in case of Commercial Vehicle","fields":[{"help":"Enter the permit validity date","type":"date","label":"Permit validity upto","options":[],"required":false,"pdf_field":""},{"help":"Enter the fitness certificate validity date","type":"date","label":"Fitness validity upto","options":[],"required":false,"pdf_field":""},{"help":"Specify the load carried during the accident","type":"text","label":"Load carried at the time of accident","options":[],"required":false,"pdf_field":""},{"help":"Enter the number of passengers in the vehicle","type":"number","label":"No. of passengers carried at the time of accident","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"},{"title":"Police","fields":[{"help":"Enter the date of the police FIR if lodged","type":"date","label":"FIR Date","options":[],"required":false,"pdf_field":""},{"help":"Enter the FIR number if available","type":"text","label":"Police FIR no. (if any lodged)","options":[],"required":false,"pdf_field":""},{"help":"Enter the name of the police station where FIR was lodged","type":"text","label":"Police Station","options":[],"required":false,"pdf_field":""}],"filled_by":"insured or claimant"}],"deadlines":[],"applies_to":"Private Car/Two Wheeler/Commercial Vehicle motor insurance claims","attachments":["self-certified copies of Registration Certificate and Driving License, Fitness & Permit Certificate (by the insured as applicable)","copies of police report and fire brigade report, if lodged"],"declarations":[],"dropped_labels":0},"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/1252-intimation-cum-preliminary-claim-form-auto-secure-motor-insurance"}