{"id":1276,"title":"BUILDERS RISK 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/builders_risk_insurance_claim_form_bde67ca477.pdf","sha256":"953d5a7d2735f8e4be7c647077d317dcc15e364aa341fb13372df48a63cabaab","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to report and claim for loss or damage under Builders Risk Insurance.","notes":["The issue of this form is not an admission of liability.","Notify the company without delay as soon as loss or damage is known.","If any detail is not readily available, send the form immediately and provide particulars later.","Do not proceed with repairs without company approval.","Attach at least two repair/replacement estimates to support the claim."],"title":"BUILDERS RISK INSURANCE CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policyholder and Principal Details","fields":[{"help":"","type":"text","label":"Insured Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Registered business address of Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the manufacturing location the same as the business address of insured?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide site address if different from business address","type":"text","label":"If no, please provide address of site where manufacturing is being undertaken?","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E Mail id","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Principal Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Registered business address of Principal","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E Mail id","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Type of Claim and Coverages","fields":[{"help":"Select if applicable","type":"checkbox","label":"Section I: Hull & Machinery etc. under construction at the yard or other premises of the builders; Machinery etc. Insured hereon whilst under construction by sub-contractors","options":["Section I"],"required":null,"pdf_field":""},{"help":"Select if applicable","type":"checkbox","label":"Section II: Machinery etc. Insured hereon from delivery to builders","options":["Section II"],"required":null,"pdf_field":""},{"help":"Select all applicable coverages","type":"checkbox","label":"Coverages","options":["Delayed Delivery","Pollution Hazard","Deviation on change of voyage","Faulty Design","Transit","Perils","Navigation","Collision Liability","Protection and Indemnity","Institute War Clauses Builders Risk","Institute Strikes Clauses Builders Risk","Institute clause for limitation of liability in respect of faulty design and P&I Risk Builders Risk","Others"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Particulars of Vessel / Technical Specifications","fields":[{"help":"Provide hull details","type":"text","label":"Hull","options":[],"required":null,"pdf_field":""},{"help":"Provide machinery details","type":"text","label":"Machinery","options":[],"required":null,"pdf_field":""},{"help":"Length in meters","type":"number","label":"Length Overall (LOA)","options":[],"required":null,"pdf_field":""},{"help":"Length between perpendiculars in meters","type":"number","label":"Length B.P.","options":[],"required":null,"pdf_field":""},{"help":"Breadth in meters","type":"number","label":"Breadth (Mounded)","options":[],"required":null,"pdf_field":""},{"help":"Depth in meters","type":"number","label":"Depth (Minimum) up to deck","options":[],"required":null,"pdf_field":""},{"help":"Draft in meters","type":"number","label":"Design Draft","options":[],"required":null,"pdf_field":""},{"help":"Displacement in tonnes","type":"number","label":"Displacement","options":[],"required":null,"pdf_field":""},{"help":"Range details","type":"text","label":"Endurance Range","options":[],"required":null,"pdf_field":""},{"help":"Speed in knots","type":"number","label":"Maximum Speed","options":[],"required":null,"pdf_field":""},{"help":"Area in square meters","type":"number","label":"Main Deck Area","options":[],"required":null,"pdf_field":""},{"help":"Area in square meters","type":"number","label":"Lower Deck Area","options":[],"required":null,"pdf_field":""},{"help":"Capacity in tonnes","type":"number","label":"Dead Weight Capacity","options":[],"required":null,"pdf_field":""},{"help":"Gross registered tonnage","type":"number","label":"Gross Tonnage (GRT)","options":[],"required":null,"pdf_field":""},{"help":"Classification and flag details","type":"text","label":"Classification Flags","options":[],"required":null,"pdf_field":""},{"help":"Details of diesel generator","type":"text","label":"Diesel Generator details","options":[],"required":null,"pdf_field":""},{"help":"Main engine details","type":"text","label":"Main Engine","options":[],"required":null,"pdf_field":""},{"help":"Number of crew by category","type":"text","label":"Accommodation/crews etc (in numbers for each category)","options":[],"required":null,"pdf_field":""},{"help":"Details of bow","type":"text","label":"Bow details","options":[],"required":null,"pdf_field":""},{"help":"International Maritime Organization number if available","type":"text","label":"IMO Number (If Assigned)","options":[],"required":null,"pdf_field":""},{"help":"Additional relevant information","type":"text","label":"Any other information","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Particulars of Engine","fields":[{"help":"Engine manufacturer","type":"text","label":"Makers Name","options":[],"required":null,"pdf_field":""},{"help":"Engine type and number","type":"text","label":"Type of engines & Nos","options":[],"required":null,"pdf_field":""},{"help":"Type of fuel","type":"text","label":"Fuel used","options":[],"required":null,"pdf_field":""},{"help":"Gear box details","type":"text","label":"Gear box","options":[],"required":null,"pdf_field":""},{"help":"Number of propellers","type":"number","label":"No. of propellers","options":[],"required":null,"pdf_field":""},{"help":"Horsepower rating","type":"number","label":"Horse power","options":[],"required":null,"pdf_field":""},{"help":"Number of cylinders","type":"number","label":"No. cylinders","options":[],"required":null,"pdf_field":""},{"help":"Auxiliary equipment details","type":"text","label":"Auxiliaries related to main engine","options":[],"required":false,"pdf_field":""},{"help":"Additional relevant information","type":"text","label":"Any other information","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Circumstances of Loss","fields":[{"help":"Date and time when loss occurred","type":"date","label":"Date and time of loss","options":[],"required":null,"pdf_field":""},{"help":"Exact location of incident","type":"text","label":"Location address of Contract or Yard No. where the incident occurred","options":[],"required":null,"pdf_field":""},{"help":"Indicate if incident location is on water and provide geo-coordinates","type":"yes-no","label":"Is the location on water where the incident occurred? Please share details with geo-coordinates","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Confirm if port authorities have been informed","type":"yes-no","label":"Are the local port authorities informed","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Contact person details for inspection","type":"text","label":"Person to be contacted for inspection","options":[],"required":null,"pdf_field":""},{"help":"Detailed description of incident","type":"text","label":"Explain fully and in detail how the incident occurred","options":[],"required":null,"pdf_field":""},{"help":"Location of wreck site if vessel sunk","type":"text","label":"Please give us an accurate position of the wreck site. (This is only applicable if the vessel has sunk.)","options":[],"required":false,"pdf_field":""},{"help":"Purpose of vessel use at incident time","type":"text","label":"Please state the purpose for which the vessel was being used at time of the incident","options":[],"required":null,"pdf_field":""},{"help":"Number of persons onboard","type":"number","label":"Please state the number of persons which were on board at the time of the incident","options":[],"required":null,"pdf_field":""},{"help":"Ownership details if not sole owner","type":"text","label":"If Insured is not the sole owner, the nature of his/their interests in the property and details of other interests","options":[],"required":false,"pdf_field":""},{"help":"Additional loss details","type":"text","label":"Any other details pertaining to the loss","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of Claim","fields":[{"help":"Dates for keel laying and expected completion by yard","type":"text","label":"Please share the Keel laying date & Expected Completion table yard wise","options":[],"required":null,"pdf_field":""},{"help":"Inspection location details","type":"text","label":"Where can the vessel or machinery be inspected","options":[],"required":null,"pdf_field":""},{"help":"Describe loss or damage","type":"text","label":"Nature and extent of loss or damage to vessel or machinery","options":[],"required":null,"pdf_field":""},{"help":"Actions taken to reduce loss","type":"text","label":"What is being done to minimize the loss or damage","options":[],"required":false,"pdf_field":""},{"help":"Indicate involvement of sub-contractors and attach documents if yes","type":"yes-no","label":"Are sub-contractors involved? If yes, please share contract copy signed with sub-contractors, AMC Certificates","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Shipyard facilities details","type":"text","label":"Details of shipyard including slipways, travel lifts, cranes etc","options":[],"required":false,"pdf_field":""},{"help":"Security measures at yard","type":"text","label":"Details of yard security including fire prevention/control and public access control","options":[],"required":false,"pdf_field":""},{"help":"Security services details","type":"text","label":"Is there a night watchmen service/Is there a central alarm system","options":[],"required":false,"pdf_field":""},{"help":"Attach documents proving safeguards taken","type":"text","label":"Substantiate with documentation reasonable steps taken by insured to safeguard the interests of the insured against loss or damage","options":[],"required":false,"pdf_field":""},{"help":"Additional claim details","type":"text","label":"Any other details pertaining to the claim","options":[],"required":false,"pdf_field":""},{"help":"Attach at least two repair/replacement estimates","type":"yes-no","label":"Quotations are attached","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Hull, Machinery, Navigation & Others - Damage and Loss Details","fields":[{"help":"List damaged items with repairer, repair cost estimate, and claim amount","type":"table","label":"Description of item, Name of repairer, Estimate cost of repairs, Amount Being Claimed","options":[],"required":null,"pdf_field":""},{"help":"List lost or stolen property details with purchase and claim info","type":"table","label":"Full description of article including make & model, Date purchased or age and from where purchased, Replacement cost, Amount claimed (Value at date of loss)","options":[],"required":null,"pdf_field":""},{"help":"Provide salvage service details if applicable","type":"text","label":"SALVAGE: If any salvage services have been rendered, please give full details including names and addresses of those who claim to have rendered such services and under what circumstances.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Ownership and Other Insurance","fields":[{"help":"","type":"yes-no","label":"Are you the sole owner of the lost or damaged property?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide ownership details if not sole owner","type":"text","label":"If not, please provide details.","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you put forward any claim for property damage following this incident with another insurance company?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of other insurance claims","type":"text","label":"If Yes, please provide details.","options":[],"required":false,"pdf_field":""},{"help":"Describe steps taken to protect recovery rights","type":"text","label":"STEPS TAKEN TO PROTECT THE RIGHTS OF RECOVERY","options":[],"required":false,"pdf_field":""},{"help":"Provide additional info or sketch if collision involved","type":"text","label":"PLEASE PROVIDE FURTHER INFORMATION IF NECESSARY - Should the incident involve a collision with a third party please draw a sketch plan highlighting the dynamics of the collision","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration","fields":[{"help":"Sign the form","type":"signature","label":"Signature(s)","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Builders Risk Insurance claims related to hull, machinery under construction, and related coverages","attachments":["Contract copy signed with sub-contractors","AMC Certificates","A minimum of two estimates for the repairs / replacement of items being claimed","Documentation substantiating reasonable steps taken to safeguard the insured interests"],"declarations":["The information provided is conscientious and faithful and the signer is liable for correctness and completeness."],"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/1276-builders-risk-insurance-claim-form"}