{"id":1255,"title":"AUTO EXTENDED WARRANTY 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_Form_Auto_Secure_Private_Car_Extended_Warranty_Insurance_Policy_6ff12568a4.pdf","sha256":"b13132c5168564c52b42cef9e0adb26823168da402bfba176ec469bfb54e550d","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to file a claim under the Auto Secure Private Car Extended Warranty Insurance Policy for vehicle repairs or part replacements.","notes":["Do not delay dispatch of this form for unavailable information; such information can be sent later.","If space is insufficient in any column, attach separate sheets.","Claims can be intimated via toll free number, email, or website.","The issue of this claim form is not an admission of liability."],"title":"AUTO EXTENDED WARRANTY POLICY CLAIM FORM","submit":{"to":"Tata AIG General Insurance Company Limited","how":"post / e-mail / upload via website or toll free call","address":"Toll Free No: 1800 266 7780, Email: General.Claims@tataaig.com, Website: www.tataaig.com"},"purpose":"claim","sections":[{"title":"Claim Details and Insured Information","fields":[{"help":"","type":"text","label":"Policy no.:","options":[],"required":null,"pdf_field":""},{"help":"Start date of the policy period","type":"date","label":"Policy Period: From","options":[],"required":null,"pdf_field":""},{"help":"End date of the policy period","type":"date","label":"to","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim no.:","options":[],"required":null,"pdf_field":""},{"help":"Date when claim is made","type":"date","label":"Claim dated:","options":[],"required":null,"pdf_field":""},{"help":"Name of the policyholder","type":"text","label":"Insured name:","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"City of residence","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"State of residence","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"Postal PIN code","type":"number","label":"PIN code:","options":[],"required":null,"pdf_field":""},{"help":"Contact details","type":"text","label":"Contact:","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile:","options":[],"required":null,"pdf_field":""},{"help":"Make and model of the vehicle","type":"text","label":"Vehicle Make/ Model:","options":[],"required":null,"pdf_field":""},{"help":"Year vehicle was manufactured","type":"number","label":"Year of Manufacture:","options":[],"required":null,"pdf_field":""},{"help":"Vehicle registration number","type":"text","label":"Vehicle Registration no.:","options":[],"required":null,"pdf_field":""},{"help":"Vehicle chassis number","type":"text","label":"Chassis Number:","options":[],"required":null,"pdf_field":""},{"help":"Indicate if the vehicle was pre-owned","type":"yes-no","label":"Is the vehicle pre-owned?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Kilometers covered under warranty","type":"number","label":"Kilometre’s Covered:","options":[],"required":null,"pdf_field":""},{"help":"Owner serial number if vehicle is pre-owned","type":"text","label":"If Yes, kindly mention Owner Serial number","options":[],"required":null,"pdf_field":""},{"help":"Date when vehicle was repurchased","type":"date","label":"Date of Re-purchase:","options":[],"required":null,"pdf_field":""},{"help":"Describe the incident causing the claim","type":"text","label":"Brief Description of Incident:","options":[],"required":null,"pdf_field":""},{"help":"List parts needing replacement or repair","type":"text","label":"Name of the part /s required for replacement / repairs:","options":[],"required":null,"pdf_field":""},{"help":"Estimated cost in currency","type":"amount","label":"Estimated Cost of Replacement / repairs:","options":[],"required":null,"pdf_field":""},{"help":"Name of dealer or service centre","type":"text","label":"Name of the Dealer/ Service Centre where it was notified earlier:","options":[],"required":null,"pdf_field":""},{"help":"Email of dealer or service centre","type":"email","label":"Email Id:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Workshop and Service Details","fields":[{"help":"Date and time vehicle was taken to workshop","type":"date","label":"Date & Time when vehicle reported to Workshop for present claim:","options":[],"required":null,"pdf_field":""},{"help":"Dealer or service centre handling current claim","type":"text","label":"Name of the Dealer / Service Centre:","options":[],"required":null,"pdf_field":""},{"help":"Indicate if service history documents are attached","type":"yes-no","label":"Vehicle Service History Attached:","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration and Authorization","fields":[{"help":"Date of signing","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":["Inform Company of the loss without any delay, keeping in mind the timelines specified in the Policy"],"applies_to":"claims under the Auto Secure Private Car Extended Warranty Insurance Policy","attachments":["Vehicle Service History","Any other additional information / documents as may be deemed necessary"],"declarations":["The claimant warrants the truth of the statements made in this form to the best of their knowledge and belief.","If any false or fraudulent statement or concealment is made, the policy shall be void and rights to recover forfeited.","The Company reserves the right to verify facts and documents relating to the policy and claim.","The claimant authorizes the insurance company or its representatives to collect relevant information to verify the loss."],"dropped_labels":4},"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/1255-auto-extended-warranty-policy-claim-form"}