{"id":1256,"title":"Intimation Cum Preliminary Claim Form - Auto Policy","purpose":"claim","insurer":{"slug":"tata-aig-general-insurance","name":"Tata AIG General Insurance Company Limited"},"source_pdf":"https://www.tataaig.com/s3/claim_form_4c959b32ff.pdf","sha256":"37342e626e669f7280ec0a31da09d79f9d3260b141ceb92d3ec4ff6075afd96c","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to notify and initiate a claim under the auto insurance policy after an accident or loss.","notes":["Sign on both sides of the claim form.","Do not leave any column unanswered.","Please enclose self-certified copies of required documents.","Attach additional sheet with full particulars if needed."],"title":"Intimation Cum Preliminary Claim Form - Auto Policy","submit":{"to":"CLAIMS DEPARTMENT Tata AIG General Insurance Company Ltd. Peninsula Business Park, Tower- A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013, Maharashtra, India","how":"post","address":"Peninsula Business Park, Tower- A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013, Maharashtra, India"},"purpose":"claim","sections":[{"title":"Claim and Vehicle Details","fields":[{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy no.","options":[],"required":null,"pdf_field":""},{"help":"Vehicle registration number","type":"text","label":"Vehicle No.","options":[],"required":null,"pdf_field":""},{"help":"Engine number of the vehicle","type":"text","label":"Eng No.","options":[],"required":null,"pdf_field":""},{"help":"Chassis number of the vehicle","type":"text","label":"Chassis No.","options":[],"required":null,"pdf_field":""},{"help":"Name of the insured or claimant","type":"text","label":"INSURED/CLAIMANT NAME:","options":[],"required":null,"pdf_field":""},{"help":"Email address of the insured/claimant","type":"email","label":"email:","options":[],"required":false,"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":"Postal PIN code","type":"number","label":"Pin","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mob","options":[],"required":null,"pdf_field":""},{"help":"Residential telephone number","type":"phone","label":"Tel Res","options":[],"required":false,"pdf_field":""},{"help":"Office telephone number","type":"phone","label":"Tel off","options":[],"required":false,"pdf_field":""},{"help":"Date and time when the accident occurred","type":"date","label":"Time & Date of Accident / Occurrence","options":[],"required":true,"pdf_field":""},{"help":"Location where the accident happened","type":"text","label":"Place of Accident","options":[],"required":true,"pdf_field":""},{"help":"Select the type of loss","type":"choice","label":"Type of Loss (details overleaf)","options":["OWN DAMAGE","THIRD PARTY","Bodily Injury","Property Damage"],"required":true,"pdf_field":""},{"help":"Briefly describe the accident; sketch on the back","type":"text","label":"Short Description of Accident/Incidence (Sketch overleaf)","options":[],"required":true,"pdf_field":""},{"help":"For commercial vehicles only","type":"date","label":"Permit valid upto","options":[],"required":false,"pdf_field":""},{"help":"For commercial vehicles only","type":"date","label":"Fitness valid upto","options":[],"required":false,"pdf_field":""},{"help":"For commercial vehicles only","type":"text","label":"Load carried at the time of accident","options":[],"required":false,"pdf_field":""},{"help":"For commercial vehicles only","type":"number","label":"No. of passengers carried at the time of accident","options":[],"required":false,"pdf_field":""},{"help":"Police FIR number if filed","type":"text","label":"Police FIR no. (lodged if any)","options":[],"required":false,"pdf_field":""},{"help":"Name of police station where FIR was lodged","type":"text","label":"Police Station","options":[],"required":false,"pdf_field":""},{"help":"Fill driver details: Name, Age, Occupation, Driver is (Owner/Paid Driver/Relative/Friend), Driving License No., Badge no, Effective for (type of vehicles), Effective upto","type":"table","label":"Details of the driver at the subject time of accident","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Declaration","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date: DD MMYYYY","options":[],"required":true,"pdf_field":""},{"help":"Signature of the insured or claimant","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Details of Third Party/Occupants/Injuries","fields":[{"help":"Serial number for each entry","type":"number","label":"Sr no","options":[],"required":null,"pdf_field":""},{"help":"Full name","type":"text","label":"Name of Third Party/Occupant/Driver","options":[],"required":null,"pdf_field":""},{"help":"Address of the person","type":"text","label":"Address (Village/Town)","options":[],"required":null,"pdf_field":""},{"help":"Contact number","type":"phone","label":"Contact No.","options":[],"required":false,"pdf_field":""},{"help":"Describe injury or damage","type":"text","label":"Type of Injury/ Damage","options":[],"required":null,"pdf_field":""},{"help":"Hospital name if admitted","type":"text","label":"Name of the Hospital where admitted","options":[],"required":false,"pdf_field":""},{"help":"Name of attending doctor","type":"text","label":"Doctor Attending","options":[],"required":false,"pdf_field":""},{"help":"Indicate if any legal or court notice received","type":"yes-no","label":"Any Legal/Court Notice Recd.","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Accident Diagram","fields":[{"help":"Draw or sketch the accident scene with street names, directions, and location of objects","type":"photo","label":"Show how the accident occurred by using this diagram","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Declaration (Page 2)","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date: DD MMYYYY","options":[],"required":true,"pdf_field":""},{"help":"Signature of the insured or claimant","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured/claimant"}],"deadlines":[],"applies_to":"Auto insurance claims including own damage, third party bodily injury, and property damage","attachments":["self-certified copies of Registration Certificate","Driving License","Fitness Certificate","Permit Certificate (by the insured as applicable)","copies of Police Report and Fire Brigade Report, if lodged"],"declarations":["The insured agrees to provide additional information if required.","The insured warrants the truth of the statements and understands that false or fraudulent statements will void the policy and forfeit claim rights.","The company reserves the right to verify facts and documents related to the policy and claim."],"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/1256-intimation-cum-preliminary-claim-form-auto-policy"}