{"id":192,"title":"PLATE GLASS POLICY CLAIM FORM","purpose":"claim","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/plate-glass-policy/claim-forms/plate-glass-insurance-policy-retail-claim-form.pdf","sha256":"97cc8bdb1a597078529d6ead65934f5580a44b3133f9ceff583ffcca0a359407","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim for damage or loss under the Plate Glass Policy.","notes":[],"title":"PLATE GLASS POLICY CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"","type":"text","label":"Name of Insured (in full):","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Occupation:","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Details","fields":[{"help":"Include exact location of the glass within the premises","type":"text","label":"Address of Premises where glass was fitted (Please state the precise position of the glass)","options":[],"required":true,"pdf_field":""},{"help":"Provide date and time when loss occurred","type":"date","label":"Date and time of Loss?","options":[],"required":true,"pdf_field":""},{"help":"Name of first person to notice the damage","type":"text","label":"Name of the person who noticed the loss first?","options":[],"required":true,"pdf_field":""},{"help":"Describe how the loss/damage happened","type":"text","label":"Cause of Loss?","options":[],"required":true,"pdf_field":""},{"help":"Fill details for each damaged glass pane as per columns","type":"table","label":"List of the damaged plate glass\nNo of panes\nKind of Glass (E.g.: f.i. mirror, ornament glass, etc.)\nMeasurement in cm\nIs the Frame also damaged\nSpecify from where glass was damaged (f.i. door, window, mirror, table plates)","options":[],"required":true,"pdf_field":""},{"help":"Select the kind of damage and describe if 'Others'","type":"choice","label":"Kind of damage? Breakage of glass (whole or crack) ▢ Scratches ▢ Others ▢, Then please describe the details","options":["Breakage of glass (whole or crack)","Scratches","Others"],"required":true,"pdf_field":""},{"help":"Provide details if someone caused the damage","type":"text","label":"Name & Address of person, if any, involved in causing breakage?","options":[],"required":false,"pdf_field":""},{"help":"State if the person was employed by the insured","type":"text","label":"Was he in any way employed by the Insured?","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss Amount","fields":[{"help":"Enter the estimated loss amount","type":"amount","label":"What is the amount of loss?","options":[],"required":true,"pdf_field":""},{"help":"Describe extent of damage and attach repair/replacement estimate","type":"text","label":"Extent of damage (Attach estimate for repairing / replacement of the damaged Plate Glass)?","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Miscellaneous Information","fields":[{"help":"Provide details of any other insurance covering this loss","type":"text","label":"Is there any other Insurance against the present loss under any other Policy? If so, give full particulars.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Name of witness","type":"text","label":"Witness","options":[],"required":true,"pdf_field":""},{"help":"Signature of the insured","type":"signature","label":"Insured's Signature (Signature)","options":[],"required":true,"pdf_field":""},{"help":"Name of the insured signing","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Plate Glass Policy claims","attachments":["estimate for repairing / replacement of the damaged Plate Glass"],"declarations":["The insured warrants the truth of the details provided to the best of their knowledge and belief.","If any false or fraudulent declarations are made or material facts are concealed, the policy shall be void and all rights to compensation 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/192-plate-glass-policy-claim-form"}