{"id":175,"title":"ELECTRONIC EQUIPMENT INSURANCE CLAIM FORM","purpose":"claim","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/electronic-equipment-insurance/claim-forms/electronic-equipment-insurance-retail-claim-form.pdf","sha256":"84c93144c7c4f1e26e34789692dc171ddbcb716792553db8a64d2dbcc10ed857","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim insurance for loss or damage to electronic equipment covered under the policy.","notes":["The issue of this claim form is not an admission of liability."],"title":"ELECTRONIC EQUIPMENT INSURANCE CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"DETAILS OF INSURED","fields":[{"help":"","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Fill full postal address including city, state and pin code","type":"text","label":"Address: City: State: Pin:","options":[],"required":null,"pdf_field":""},{"help":"Provide a contact phone number","type":"phone","label":"Telephone contact:","options":[],"required":null,"pdf_field":""},{"help":"Provide an email address","type":"email","label":"e-mail","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF ACCIDENT","fields":[{"help":"Provide the date and time when the accident occurred","type":"date","label":"Date & time of occurrence","options":[],"required":null,"pdf_field":""},{"help":"Describe the accident and affected parts; attach sketches or photographs","type":"text","label":"Brief details of accident and parts affected (please provide Sketch / Photographs)","options":[],"required":null,"pdf_field":""},{"help":"Explain the cause of the loss or damage","type":"text","label":"Cause of loss / damage","options":[],"required":null,"pdf_field":""},{"help":"Provide witness details if any","type":"text","label":"Details of witness (name, address, tel nos)","options":[],"required":null,"pdf_field":""},{"help":"State if FIR was filed and provide details if applicable","type":"text","label":"Is FIR filed with police authorities? if Yes please provide details","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF ITEM AFFECTED","fields":[{"help":"Provide the serial number of the damaged item","type":"text","label":"Serial no of item affected","options":[],"required":null,"pdf_field":""},{"help":"Describe the equipment including make and model","type":"text","label":"Description of equipment, Make and Model","options":[],"required":null,"pdf_field":""},{"help":"Attach repair cost estimates","type":"amount","label":"Estimate(s) of repairs(please attach estimates)","options":[],"required":null,"pdf_field":""},{"help":"Provide maintenance schedule details and AMC status","type":"text","label":"Details of Maintenance schedule (Date, Scope etc.) Whether under AMC ?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any previous repairs","type":"text","label":"Previous repair details of affected machinery, including nature of repairs","options":[],"required":null,"pdf_field":""},{"help":"Provide current replacement cost","type":"amount","label":"Current Cost of replacement of machinery","options":[],"required":null,"pdf_field":""},{"help":"Provide warranty or guarantee details","type":"text","label":"Details of Manufacturers warranty / Guarantee","options":[],"required":null,"pdf_field":""},{"help":"Provide details if loss/damage is claimed under other policy sections","type":"text","label":"Details of loss or damage under other section (s) of the policy","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAIL OF OTHER INSURANCES","fields":[{"help":"Provide details of any other insurance covering this loss","type":"text","label":"Give details of other Insurance, if any, covering the present loss","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF PREVIOUS LOSSES","fields":[{"help":"Provide details of any previous claims","type":"text","label":"Give details of previous Claims, if any","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you wish to Reinstate the Policy : Yes/ No :","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DECLARATION","fields":[{"help":"Read and sign the declaration","type":"text","label":"Declaration","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":""},{"help":"Sign and affix company seal","type":"signature","label":"Signature of insured with companies seal","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Electronic Equipment Insurance","attachments":["Sketch / Photographs of accident","Estimates of repairs"],"declarations":["The insured agrees to provide additional information if required.","The insured warrants the truth of the statements made in the form.","If any false or fraudulent statement or concealment is made, the policy shall be void and rights to recover forfeited."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"GCIcare@generalicentral.com","label":"Claim Intimation Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"ses.\nCLAIM FORM\nYou can\nclick here\nand check our claim form\nCALL ON\n1800 220233\n1860 500 3333\n022 6783 7800\nEMAIL US AT\nGCIcare@generalicentral.com\nVISIT OUR BRANCH\nYou can check for your nearest branch\nhere\nClaim Process Simplified\nSimple steps to help you file a cl","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"GCIClaims@generalicentral.com","label":"Other Claim Intimation Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/other-claim-process","quote":"NLINE CLAIM INTIMATION\nYou can\nclick here\nto intimate claim\nCALL ON\n1800 220233\n1860 500 3333\n022 6783 7800\nEMAIL US AT\nGCIClaims@generalicentral.com\nVISIT OUR BRANCH\nYou can check for your nearest branch\nhere\nInitiate Quick Claim\nExtended Warranty\nMarine & Others\nProd","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 220 233","label":"Claim Intimation Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"aim under your insurance policy.\nCashless Claim Process\nReimbursement Claim Process\n1\nIntimate us online or  Call us on 1800 220 233\n2\nSurveyor will inspect the vehicle.\n3\nProvide requested documents to surveyor\n4\nApproved claim amount will be communic","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1860 500 3333","label":"Claim Intimation Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"Motor Claim Process | Generali Central\nGrievance Redressal\nQuick Pay\nNeed Analysis\n1860 500 3333\n|\n022 6783 7800\n1860 500 3333\n022 6783 7800\nProducts\nRenew\nClaim\nHelp & Support\nAbout Us\nTrending Searches\nHealth Insur","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 6783 7800","label":"Claim Intimation Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/motor-insurance/motor-claim-process","quote":"Motor Claim Process | Generali Central\nGrievance Redressal\nQuick Pay\nNeed Analysis\n1860 500 3333\n|\n022 6783 7800\n1860 500 3333\n022 6783 7800\nProducts\nRenew\nClaim\nHelp & Support\nAbout Us\nTrending Searches\nHealth Insurance\nDog Insuran","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/generali-central-insurance/175-electronic-equipment-insurance-claim-form"}