{"id":1277,"title":"SHIP REPAIRERS 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/ship_repairers_liability_claim_form_790ab91123.pdf","sha256":"ef260ef9d1f89f2610586a1cfc053a8e25c853ac6cf29335103ff7a1c5586b2b","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to report and claim for loss or damage related to ship repairers liability 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, do not delay dispatch of this form; particulars may be sent later.","Claim form is only for gathering first information about the claim or circumstances that could lead to a claim."],"title":"SHIP REPAIRERS LIABILITY 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":"Write 'Yes' or 'No' and if No, provide the repair site address","type":"text","label":"Is the repairing location the same as the business address of insured? If no, please provide address of site where repairing of vessels is being undertaken?","options":[],"required":null,"pdf_field":""},{"help":"Provide telephone number","type":"phone","label":"Telephone","options":[],"required":null,"pdf_field":""},{"help":"Provide mobile number","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"Provide email address","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":"Provide telephone number","type":"phone","label":"Telephone","options":[],"required":null,"pdf_field":""},{"help":"Provide mobile number","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"Provide email address","type":"email","label":"E Mail id","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Type of Claim and Coverages","fields":[{"help":"Select applicable claim type","type":"choice","label":"TYPE OF CLAIM","options":["Hull & Machinery etc. under repair at the port/yard or other premises of the","Machinery etc. Insured hereon whilst under repair by sub-contractors"],"required":null,"pdf_field":""},{"help":"Tick all applicable coverages","type":"checkbox","label":"COVERAGES","options":["Loss or damage of vessel","Trials","Repair/Modification/Rectification/Replacement expenses","Loss or damage of machinery","Personal Injury","Loss or damage to cargo","Pollution Hazard","Loss or damage to third party property, due to negligence","Act of God","Others"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Particulars of Repair","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"Was the vessel in the care, custody or control of the Insured for repair","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe the nature of control if vessel was not in care/custody/control","type":"text","label":"If no, please share the nature of control of the Insured over the vessel.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of Vessel Owner and Repair","fields":[{"help":"Provide owner details","type":"text","label":"Details of owner of the vessel","options":[],"required":null,"pdf_field":""},{"help":"Describe repair obligations","type":"text","label":"Details of repair, that the Insured was obligated to perform on the vessel","options":[],"required":null,"pdf_field":""},{"help":"Provide date","type":"date","label":"Date on which vessel was submitted to Insured for repair","options":[],"required":null,"pdf_field":""},{"help":"Provide expected completion date","type":"date","label":"Expected completion date of repair","options":[],"required":null,"pdf_field":""},{"help":"Provide agreed contract amount","type":"amount","label":"Contractual amount agreed for such repair","options":[],"required":null,"pdf_field":""},{"help":"Describe other repairers and interests","type":"text","label":"If Insured is not the sole repairer, the nature of his/their interests in the property and details of other interests","options":[],"required":null,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Are sub-contractors involved","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach contract copy and AMC certificates if subcontractors involved","type":"attachment","label":"If yes, please share contract copy signed with sub-contractors, AMC Certificates","options":[],"required":null,"pdf_field":""},{"help":"Provide any additional relevant information","type":"text","label":"Any other information","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Technical Specifications of the Vessel","fields":[{"help":"Provide hull specifications","type":"text","label":"Hull","options":[],"required":null,"pdf_field":""},{"help":"Provide machinery specifications","type":"text","label":"Machinery","options":[],"required":null,"pdf_field":""},{"help":"Provide length overall in meters","type":"number","label":"Length Overall (LOA)","options":[],"required":null,"pdf_field":""},{"help":"Provide length between perpendiculars in meters","type":"number","label":"Length B.P.","options":[],"required":null,"pdf_field":""},{"help":"Provide breadth in meters","type":"number","label":"Breadth (Mounded)","options":[],"required":null,"pdf_field":""},{"help":"Provide minimum depth up to deck in meters","type":"number","label":"Depth (Minimum) up to deck","options":[],"required":null,"pdf_field":""},{"help":"Provide maximum speed in knots","type":"number","label":"Maximum Speed","options":[],"required":null,"pdf_field":""},{"help":"Provide displacement in tonnes","type":"number","label":"Displacement","options":[],"required":null,"pdf_field":""},{"help":"Provide main deck area in square meters","type":"number","label":"Main Deck Area","options":[],"required":null,"pdf_field":""},{"help":"Provide lower deck area in square meters","type":"number","label":"Lower Deck Area","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Particulars of Loss","fields":[{"help":"Provide date and time of the incident","type":"date","label":"Date and time of loss","options":[],"required":null,"pdf_field":""},{"help":"Provide full location address","type":"text","label":"Location address of yard or port or dock where the incident occurred","options":[],"required":null,"pdf_field":""},{"help":"Provide details and geo-coordinates if applicable","type":"text","label":"Did the incident occur during trial trips/in water? If yes, please share details with geo-coordinates","options":[],"required":null,"pdf_field":""},{"help":"Describe the incident in detail","type":"text","label":"Explain fully and in detail how the incident occurred","options":[],"required":null,"pdf_field":""},{"help":"Describe weather conditions","type":"text","label":"Details of weather conditions at the time of the incident","options":[],"required":null,"pdf_field":""},{"help":"Provide damage estimate and justification","type":"amount","label":"Please provide the estimate/valuation of damages resulting from the incident along with justification for such estimate","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Incident and Authority Details","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"Are the local port authorities informed","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach relevant reports if available","type":"attachment","label":"Any relevant reports from any police/regulatory authorities","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Section A – Particulars of Own Damage","fields":[{"help":"Describe cargo details","type":"text","label":"Details of any cargo on the vessel at the time of incident","options":[],"required":null,"pdf_field":""},{"help":"Describe damage to cargo","type":"text","label":"Details of damage to any cargo on the vessel","options":[],"required":null,"pdf_field":""},{"help":"Provide wreck site position if applicable","type":"text","label":"Please give us an accurate position of the wreck site. (This is only applicable if the vessel has sunk due to negligence of the Insured, his employees, servants or sub-contractors)","options":[],"required":null,"pdf_field":""},{"help":"Provide number of persons on board","type":"number","label":"Please state the number of employees/crew/agents/sub-contractors/servants which were on board at the time of the incident","options":[],"required":null,"pdf_field":""},{"help":"Describe injuries or sickness","type":"text","label":"Details of any bodily injury, sickness, or disease sustained by any employees/crew/agents/servants on board, including death / disability resulting from any of these at any time","options":[],"required":null,"pdf_field":""},{"help":"Provide any additional relevant details","type":"text","label":"Any other details pertaining to the loss","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Section B – Particulars of Third-Party Liability","fields":[{"help":"Describe damage to other vessels","type":"text","label":"Details of damage/destruction of any other vessel","options":[],"required":null,"pdf_field":""},{"help":"Describe damage to third-party property","type":"text","label":"Details of damage/loss to any third-party property","options":[],"required":null,"pdf_field":""},{"help":"Provide number of third-party persons involved","type":"number","label":"Please state the number of third-party persons who were involved/were on board at the time of the incident","options":[],"required":null,"pdf_field":""},{"help":"Describe injuries or sickness to third parties","type":"text","label":"Details of any bodily injury, sickness, or disease sustained by any third party person at the time of the incident, including death / disability resulting from any of these at any time","options":[],"required":null,"pdf_field":""},{"help":"Provide any additional relevant 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":"Provide inspection location","type":"text","label":"Where can the vessel or machinery be inspected","options":[],"required":null,"pdf_field":""},{"help":"Provide contact person details","type":"text","label":"Person to be contacted for inspection","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":"Describe mitigation steps","type":"text","label":"What is being done to minimize the loss or damage","options":[],"required":null,"pdf_field":""},{"help":"Provide shipyard details","type":"text","label":"Details of shipyard including slipways, travel lifts, cranes etc","options":[],"required":null,"pdf_field":""},{"help":"Describe yard security measures","type":"text","label":"Details of yard security including fire prevention/control and public access control","options":[],"required":null,"pdf_field":""},{"help":"Provide details of night watch or alarm system","type":"text","label":"Is there a night watchmen service/Is there a central alarm system","options":[],"required":null,"pdf_field":""},{"help":"Attach documents proving safeguarding steps","type":"attachment","label":"Substantiate with documentation reasonable steps taken by insured to safeguard the interests of the insured against loss or damage","options":[],"required":null,"pdf_field":""},{"help":"Provide witness details","type":"text","label":"Name and contact detail of any witness of the incident","options":[],"required":null,"pdf_field":""},{"help":"Provide any additional relevant details","type":"text","label":"Any other details pertaining to the claim","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of Other Insurances","fields":[{"help":"Provide other insurance details","type":"text","label":"Give details of other Insurances, relevant to the present claim","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Hull, Machinery, Navigation & Others - Damage or Loss Details","fields":[{"help":"Describe damaged property","type":"text","label":"Description of item","options":[],"required":null,"pdf_field":""},{"help":"Provide repairer name","type":"text","label":"Name of repairer","options":[],"required":null,"pdf_field":""},{"help":"Provide repair cost estimate","type":"amount","label":"Estimate cost of repairs","options":[],"required":null,"pdf_field":""},{"help":"Provide claim amount","type":"amount","label":"Amount Being Claimed","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Lost or Stolen Property Details","fields":[{"help":"Describe lost or stolen item","type":"text","label":"Full description of article including make & model","options":[],"required":null,"pdf_field":""},{"help":"Provide purchase date or age and source","type":"text","label":"Date purchased or age and from where purchased","options":[],"required":null,"pdf_field":""},{"help":"Provide replacement cost","type":"amount","label":"Replacement cost","options":[],"required":null,"pdf_field":""},{"help":"Provide claim amount","type":"amount","label":"Amount claimed (Value at date of loss)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Salvage","fields":[{"help":"Provide salvage service details if applicable","type":"text","label":"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":"Steps Taken to Protect the Rights of Recovery","fields":[{"help":"Describe steps taken to protect recovery rights","type":"text","label":"STEPS TAKEN TO PROTECT THE RIGHTS OF RECOVERY","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":"Provide date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Provide place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Ship Repairers Liability Insurance claims","attachments":["contract copy signed with sub-contractors","AMC Certificates","relevant reports from any police/regulatory authorities","documentation substantiating reasonable steps taken by insured to safeguard interests"],"declarations":["The answers provided are conscientious and faithful and the signer is liable for their correctness and completeness.","The form is for first information only and the insurer may call for additional information to establish cause, admissibility, and extent of 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/1277-ship-repairers-liability-insurance-claim-form"}