{"id":1258,"title":"Contractual Liability Insurance Claim Form","purpose":"claim","insurer":{"slug":"tata-aig-general-insurance","name":"Tata AIG General Insurance Company Limited"},"source_pdf":"https://www.tataaig.com/s3/Contractual_Liability_Insurance_Claim_Form_d76b869427.pdf","sha256":"4ac27ebdfb6e167d048d25e37f674dbcf83e72c6424a864bd673141e890c3808","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to report and claim for a loss under the Contractual Liability Insurance policy.","notes":["Notify the company without any delay as soon as loss is known.","If any detail is not readily available, send the form immediately and provide particulars later.","If space is insufficient, attach a separate sheet.","The company may call for additional information to establish cause, admissibility and extent of loss."],"title":"Contractual Liability Insurance Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"","type":"text","label":"Policy No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone Number","options":[],"required":null,"pdf_field":""},{"help":"Enter the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Start date of contractual liability period","type":"date","label":"Contractual Liability Period From:","options":[],"required":null,"pdf_field":""},{"help":"End date of contractual liability period","type":"date","label":"To:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Occurrence","fields":[{"help":"Date and time when the incident occurred","type":"date","label":"Date and Time of Occurrence/Incident","options":[],"required":null,"pdf_field":""},{"help":"Describe the nature of the incident","type":"text","label":"Nature of Occurrence/Incident","options":[],"required":null,"pdf_field":""},{"help":"Explain the incident in detail","type":"text","label":"State in detail as to how the Occurrence/Incident occurred","options":[],"required":null,"pdf_field":""},{"help":"Name(s) of the contracting party or parties","type":"text","label":"(a) Name of the Contracting Party(ies)","options":[],"required":null,"pdf_field":""},{"help":"Full address of the contracting party","type":"text","label":"(b) Complete Address","options":[],"required":null,"pdf_field":""},{"help":"City of the contracting party","type":"text","label":"(c) City","options":[],"required":null,"pdf_field":""},{"help":"Postal code of the contracting party","type":"number","label":"(d) Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Indicate if police complaint was made","type":"yes-no","label":"Has a complaint been made to the Police?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide FIR or crime number and police reply if complaint was made","type":"text","label":"If the answer to 5 is ‘Yes’, FIR/Diary/Crime No. and what reply has been received from the Police? (Attach copies of Police Complaint and reply received from the Police)","options":[],"required":null,"pdf_field":""},{"help":"Date when claim or legal notice was received","type":"date","label":"Date on which Claim/Summons/Legal Notice received from Claimant/Court (Please attach copies)","options":[],"required":null,"pdf_field":""},{"help":"Attach copy of contract related to the incident","type":"attachment","label":"Copy of Contract giving rise to Occurrence","options":[],"required":null,"pdf_field":""},{"help":"Enter the claimed compensation amount","type":"amount","label":"Amount of Compensation Claimed","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Contract Details","fields":[{"help":"Type of contract involved","type":"text","label":"Contract Type","options":[],"required":null,"pdf_field":""},{"help":"Description of the contract","type":"text","label":"Contract Description","options":[],"required":null,"pdf_field":""},{"help":"Description of the occurrence related to the contract","type":"text","label":"Occurrence Description","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Detail of Other Insurances","fields":[{"help":"List other insurance policies covering this loss","type":"text","label":"Give details of other Insurance’s, if any, covering the present loss","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Previous Losses","fields":[{"help":"Provide information on any prior losses under this policy","type":"text","label":"Give details of previous losses, if any, under the Policy","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","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":""},{"help":"Sign here","type":"signature","label":"Signature of the Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Contractual Liability Insurance policies","attachments":["Incident report containing the nature and cause of Occurrence/Incident","Reports of any Statutory/Local Authority","Copies of Police Complaint and reply received from the Police (if complaint made)","Copy of Contract giving rise to Occurrence","Copies of Claim/Summons/Legal Notice received from Claimant/Court"],"declarations":["The answers given are conscientious and faithful and the insured is liable for correctness and completeness.","The insured authorizes the company or its representatives to collect relevant information/documents to verify the loss."],"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/1258-contractual-liability-insurance-claim-form"}