{"id":184,"title":"MACHINERY BREAKDOWN 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/machinery-breakdown-insurance/claim-forms/machinery-breakdown-insurance-retail-claim-form.pdf","sha256":"491475cc6e4d6122c04821147d712bbe88d91b67432b7dfea23cc1de19ae9c50","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim for damages under the Machinery Breakdown Insurance policy.","notes":["The issue of this claim form is not an admission of liability.","Attach sketch or photographs of the accident and affected parts.","Attach maintenance records where applicable."],"title":"MACHINERY BREAKDOWN 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":"","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"Postal PIN code","type":"text","label":"Pin:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone contact:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"e-mail","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF ACCIDENT","fields":[{"help":"Provide date and time when the accident occurred","type":"date","label":"Date & time of occurrence","options":[],"required":null,"pdf_field":""},{"help":"Provide name and contact details of first witness","type":"text","label":"Name and contact details of witness i)","options":[],"required":null,"pdf_field":""},{"help":"Provide name and contact details of second witness if any","type":"text","label":"Name and contact details of witness ii)","options":[],"required":false,"pdf_field":""},{"help":"Describe accident and affected parts; attach sketch or photos","type":"text","label":"Brief details of accident and parts affected (please provide Sketch / Photographs)","options":[],"required":null,"pdf_field":""},{"help":"Explain cause of damage","type":"text","label":"Cause of loss / damage","options":[],"required":null,"pdf_field":""},{"help":"Provide contact details of repairer","type":"text","label":"Name ,address, telephone no of repairer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DETAILS OF ITEM AFFECTED","fields":[{"help":"Provide serial number of damaged machinery","type":"text","label":"Serial no of item affected","options":[],"required":null,"pdf_field":""},{"help":"Describe machinery including make and model","type":"text","label":"Description of machinery / Make & Model","options":[],"required":null,"pdf_field":""},{"help":"Provide current replacement cost","type":"amount","label":"Current replacement cost of damaged item","options":[],"required":null,"pdf_field":""},{"help":"Provide maintenance details and attach records","type":"text","label":"Date and nature of maintenance carried out (attach record), specify details","options":[],"required":null,"pdf_field":""},{"help":"Provide details of previous repairs","type":"text","label":"Previous repair details of affected machinery, including nature of repairs","options":[],"required":null,"pdf_field":""},{"help":"State if item is under warranty or guarantee and provide details","type":"text","label":"Is the damage item under Manufacturers warranty / Guarantee, if so give details","options":[],"required":null,"pdf_field":""},{"help":"Provide indemnity amount if any additional cover applies","type":"amount","label":"Indemnity under any additional cover opted under 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 previous claims if any","type":"text","label":"Give details of previous Claims, if any","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"REINSTATEMENT OPTION","fields":[{"help":"Select Yes or No to reinstate the policy","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":"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 and affix company seal","type":"signature","label":"Signature of insured with company’s seal","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Machinery Breakdown Insurance claims","attachments":["Sketch / Photographs of accident and parts affected","Maintenance record"],"declarations":["The insured agrees to provide additional information if required.","The insured warrants the truth of the statements made in the form to the best of their knowledge.","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/184-machinery-breakdown-insurance-claim-form"}