{"id":2273,"title":"LOAN GUARD - CLAIM FORM","purpose":"claim","insurer":{"slug":"magma-general-insurance","name":"Magma General Insurance Limited"},"source_pdf":"https://www.magmainsurance.com/documents/5553002/0/Claim+Form+-+Loan+Guard.pdf/fe08d6f3-2110-6912-e0fe-ba93077468c2?t=1765016428696","sha256":"7a9468af831467a3682c4317099d018b99de186374a05b6c6a7bb3e11081b994","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to file a claim under the Loan Guard insurance policy.","notes":["Fill the form in capital letters and sign it.","Do not leave any column unanswered.","Use separate sheet if space is insufficient.","Attach all required documents to speed up claim processing."],"title":"LOAN GUARD - CLAIM FORM","submit":{"to":"Magma General Insurance Limited","how":"","address":"Registered Office: Equinox Business Park, Tower 3, Ambedkar Nagar, 2nd Floor, Unit Number 1B & 2B, LBS Marg, Kurla (West), Mumbai - 400070, Maharashtra, India"},"purpose":"claim","sections":[{"title":"Details of Insured and Claimant","fields":[{"help":"Enter the claim number if available","type":"text","label":"Claim Number","options":[],"required":null,"pdf_field":""},{"help":"Enter first, middle, and last name in capital letters","type":"text","label":"Name of the Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter first, middle, and last name in capital letters","type":"text","label":"Name of the Claimant","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship to the insured","type":"text","label":"Relationship with Insured","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Designation (If applicable)","options":[],"required":false,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Select the appropriate gender","type":"choice","label":"Sex","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter full postal address including city, district, state, pin code","type":"text","label":"Communication Address","options":[],"required":true,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Phone No","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Policy Details","fields":[{"help":"Enter policy number","type":"text","label":"Policy No","options":[],"required":true,"pdf_field":""},{"help":"Enter start and end dates of insurance period","type":"date","label":"Period of insurance from to","options":[],"required":true,"pdf_field":""},{"help":"Enter sum insured amount","type":"amount","label":"Sum Insured","options":[],"required":true,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Have you been insured under any Policy of any other insurance companies?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach photocopies if applicable","type":"attachment","label":"If yes please enclose photocopies of all previous policies.","options":[],"required":false,"pdf_field":""},{"help":"Enter dates if applicable","type":"date","label":"Date of commencement of very first insurance for the Beneficiary with continuous insurance coverage from to","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Benefits","fields":[{"help":"Select applicable plan as per policy documents","type":"choice","label":"Section 1 – Critical Illness: (Various Plans*)","options":["1 star Plan","2 Star Plan","3 Star Plan","4 Star Plan"],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Details of Incidence","fields":[{"help":"Describe the nature of the condition or injury","type":"text","label":"Nature of Disease / Illness / Injury","options":[],"required":true,"pdf_field":""},{"help":"Describe the cause","type":"text","label":"Cause of Disease / Illness / Injury","options":[],"required":true,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of incidence","options":[],"required":true,"pdf_field":""},{"help":"Enter time and select AM or PM","type":"text","label":"Time of incidence","options":[],"required":false,"pdf_field":""},{"help":"Enter location where incidence occurred","type":"text","label":"Place of incidence","options":[],"required":true,"pdf_field":""},{"help":"Enter to whom the incidence was reported","type":"text","label":"Incidence Reported to","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Are there any witness to incidence","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if witnesses exist","type":"text","label":"Names and Address of witnesses","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Details of Hospital Applicable for Section I & II","fields":[{"help":"Select yes or no","type":"yes-no","label":"Was the insured person moved to hospital immediately after the incidence","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter date if admitted","type":"date","label":"Date of admission","options":[],"required":false,"pdf_field":""},{"help":"Enter time and select AM or PM","type":"text","label":"Time of admission","options":[],"required":false,"pdf_field":""},{"help":"Enter date if discharged","type":"date","label":"Date of discharge","options":[],"required":false,"pdf_field":""},{"help":"Enter time and select AM or PM","type":"text","label":"Time of discharge","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital name","type":"text","label":"Name of the Hospital","options":[],"required":false,"pdf_field":""},{"help":"Enter full hospital address including city, district, state, pin code","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Phone No","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital mobile number if available","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Describe treatment details","type":"text","label":"Particulars of treatment","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Medical Practitioner’s Declaration Applicable for Section I & II","fields":[{"help":"Additional medical details","type":"text","label":"Details","options":[],"required":false,"pdf_field":""},{"help":"Enter medical registration number","type":"text","label":"Registration No","options":[],"required":true,"pdf_field":""},{"help":"Enter medical qualification","type":"text","label":"Qualification","options":[],"required":true,"pdf_field":""},{"help":"Date of declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Doctor to sign and stamp","type":"signature","label":"Stamp and Signature","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":false,"pdf_field":""}],"filled_by":"treating doctor"},{"title":"Section III – Loss of Job","fields":[{"help":"Enter loan account number","type":"text","label":"Loan A/c No","options":[],"required":true,"pdf_field":""},{"help":"Enter bank or institution details","type":"text","label":"Name & Address of Bank / Institution","options":[],"required":true,"pdf_field":""},{"help":"Provide contact information","type":"text","label":"Contact Details (Phone / E-Mail)","options":[],"required":false,"pdf_field":""},{"help":"Specify loan type","type":"text","label":"Type of loan taken","options":[],"required":true,"pdf_field":""},{"help":"Enter repayment start date","type":"date","label":"Date of inception of repayment","options":[],"required":true,"pdf_field":""},{"help":"Enter loan amount","type":"amount","label":"Amount of loan taken","options":[],"required":true,"pdf_field":""},{"help":"Enter outstanding loan balance","type":"amount","label":"Loan Balance as on date","options":[],"required":true,"pdf_field":""},{"help":"Enter last month of repayment","type":"text","label":"Last Month for repayment","options":[],"required":false,"pdf_field":""},{"help":"Enter EMI amount","type":"amount","label":"EMI / Pre EMI Rs.","options":[],"required":false,"pdf_field":""},{"help":"Enter employer name","type":"text","label":"Employer Details: Name of Organization employed","options":[],"required":true,"pdf_field":""},{"help":"Enter employer address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Provide employer contact numbers","type":"text","label":"Contact numbers of the Company in which employed","options":[],"required":false,"pdf_field":""},{"help":"Enter job designation","type":"text","label":"Designation","options":[],"required":true,"pdf_field":""},{"help":"Enter appointment date","type":"date","label":"Date of appointment","options":[],"required":true,"pdf_field":""},{"help":"Enter confirmation date if applicable","type":"date","label":"Date of confirmation","options":[],"required":false,"pdf_field":""},{"help":"Select applicable employment type","type":"choice","label":"Nature of employment","options":["Permanent","probation","casual","temporary","seasonal","contractual"],"required":true,"pdf_field":""},{"help":"Enter termination date","type":"date","label":"Date of termination","options":[],"required":true,"pdf_field":""},{"help":"Enter last working day","type":"date","label":"Last working day","options":[],"required":false,"pdf_field":""},{"help":"Enter last salary amount","type":"amount","label":"Last salary after termination / suspension Rs.","options":[],"required":false,"pdf_field":""},{"help":"Enter suspension period if applicable","type":"text","label":"Period of suspension if applicable","options":[],"required":false,"pdf_field":""},{"help":"Enter amount drawn during suspension","type":"amount","label":"Amount drawn during suspension period Rs.","options":[],"required":false,"pdf_field":""},{"help":"Enter re-employment date and details if applicable","type":"text","label":"Date of re-employment and details","options":[],"required":false,"pdf_field":""},{"help":"Attach separate sheet if necessary","type":"text","label":"Any other relevant details","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Details of Claimed Amount","fields":[{"help":"Enter claimed amount for Critical Illness","type":"amount","label":"Critical Illness","options":[],"required":false,"pdf_field":""},{"help":"Enter claimed amount for Death","type":"amount","label":"Death","options":[],"required":false,"pdf_field":""},{"help":"Enter claimed amount for Permanent Total Disability","type":"amount","label":"Permanent Total Disability","options":[],"required":false,"pdf_field":""},{"help":"Enter claimed amount for Loss of Job","type":"amount","label":"Loss of Job","options":[],"required":false,"pdf_field":""},{"help":"Enter claimed amount for Fire and Allied Perils","type":"amount","label":"Fire and Allied Perils – Dwelling and Household Contents","options":[],"required":false,"pdf_field":""},{"help":"Enter claimed amount for Business Interruption","type":"amount","label":"Business Interruption","options":[],"required":false,"pdf_field":""},{"help":"Enter total claimed amount","type":"amount","label":"TOTAL AMOUNT CLAIMED","options":[],"required":true,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Enclosures","fields":[{"help":"Attach signed claim form","type":"checkbox","label":"Claim form duly signed","options":[],"required":true,"pdf_field":""},{"help":"Attach policy copy","type":"checkbox","label":"Policy copy","options":[],"required":true,"pdf_field":""},{"help":"Attach claim intimation document","type":"checkbox","label":"Claim intimation","options":[],"required":false,"pdf_field":""},{"help":"Attach FIR or MLC copy if applicable","type":"checkbox","label":"FIR/ MLC copy","options":[],"required":false,"pdf_field":""},{"help":"Attach death certificate if applicable","type":"checkbox","label":"Death certificate","options":[],"required":false,"pdf_field":""},{"help":"Attach post mortem report if applicable","type":"checkbox","label":"Post mortem report","options":[],"required":false,"pdf_field":""},{"help":"Attach inquest or coroner’s report if applicable","type":"checkbox","label":"Inquest / Coroner’s report","options":[],"required":false,"pdf_field":""},{"help":"Attach final police report if applicable","type":"checkbox","label":"Final police report","options":[],"required":false,"pdf_field":""},{"help":"Attach disability certificate if applicable","type":"checkbox","label":"Disability Certificate","options":[],"required":false,"pdf_field":""},{"help":"Attach investigation reports if applicable","type":"checkbox","label":"Investigation reports","options":[],"required":false,"pdf_field":""},{"help":"Attach medical certificate if applicable","type":"checkbox","label":"Medical certificate","options":[],"required":false,"pdf_field":""},{"help":"Attach nominee certificate if applicable","type":"checkbox","label":"Nominee certificate","options":[],"required":false,"pdf_field":""},{"help":"Attach employer certificate if applicable","type":"checkbox","label":"Employer Certificate","options":[],"required":false,"pdf_field":""},{"help":"Attach photograph if applicable","type":"photo","label":"Photograph of the injured with reflecting disablement","options":[],"required":false,"pdf_field":""},{"help":"Specify and attach any other relevant documents","type":"attachment","label":"Any other documents","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Insured’s / Claimant’s Declaration","fields":[{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Claimant","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":false,"pdf_field":""},{"help":"Print claimant's name","type":"text","label":"Name of the Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Nominee Details (To be completed in event of Insured’s death)","fields":[{"help":"Enter first, middle, and last name","type":"text","label":"Name of the Nominee","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship with Claimant","options":[],"required":true,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Sex","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Communication Address","options":[],"required":true,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Phone No","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Enter guardian's full name","type":"text","label":"If nominee is minor, kindly provide the Legal Guardian details - Name of the Guardian","options":[],"required":false,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Nominee to sign","type":"signature","label":"Signature of Nominee","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":false,"pdf_field":""},{"help":"Print nominee's name","type":"text","label":"Name of the Nominee","options":[],"required":true,"pdf_field":""}],"filled_by":"nominee"}],"deadlines":[],"applies_to":"Loan Guard insurance claims including Critical Illness, Personal Accident, Loss of Job, Fire and Allied Perils, and Business Interruption","attachments":["Photocopies of all previous policies (if insured under other policies)","Certificate from Bank stating amortization schedule, EMI amounts, principal outstanding","Certificate from employer confirming termination, dismissal, suspension or retrenchment with reasons and period if suspension","Appointment and confirmation letter of employment","Claim form duly signed","Policy copy","Claim intimation","FIR/ MLC copy","Death certificate","Post mortem report","Inquest / Coroner’s report","Final police report","Disability Certificate","Investigation reports","Medical certificate","Nominee certificate","Employer Certificate","Photograph of the injured with reflecting disablement","Any other documents"],"declarations":["The insured/claimant declares that all information provided is true and no material information is concealed.","False declarations may result in claim refusal by Magma General Insurance Limited.","Receipt of claim form or documents does not constitute admission of liability by the insurer.","Nominee declares truthfulness and accepts the claim amount as full discharge of insurer's obligations."],"dropped_labels":9},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"Magma General Insurance Limited (Claims Hub), Srinilaya Cyber Spazio Suite 101, 102, Ground Floor, Road No. 2, Banjara Hills, Hyderabad, Telangana – 500034","label":"Claims Hub Address","level":null,"hours":null,"applies_to":"health","source_url":"https://www.magmainsurance.com/learn-about-claims","quote":"fe takes an unexpected turn. When that moment comes, a clear and dependable claims process makes all the difference. At Magma General Insurance, our aim is to make the process simple to understand, transparent to follow, and supportive at every step. This page explains how claims work across Health, Motor and Non‑Motor policies.\nClaim is easy at Magma General Insurance.\nRegister Claim\nHealth","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"customercare@magmainsurance.com","label":"Customer Care Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.magmainsurance.com/web/magmainsurance/claims","quote":"ma HDI General Insurance Company Limited) | All Rights Reserved\n| IRDAI Reg. No. 149 |\nwww.magmainsurance.com\n| E-mail:\ncustomercare@magmainsurance.com\n| Registered & Corporate Office: Equinox Business Park, Tower 3, Ambedkar Nagar, 2\nnd\nFloor, Unit Number 1B & 2B, LBS M","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 266 3202","label":"Claims Intimation Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.magmainsurance.com/web/magmainsurance/claims","quote":"surance Claims - Motor & Health Insurance Claim Process - Magma Insurance - Magma\nSkip to Content\nOne-Line-Hearder-Test\n1800 266 3202\nNavigation\nCustomer Service\nSenior Citizen Services\nRoad side Assistance\nAnnual Health Check-up\nPolicy Servicing assist","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/magma-general-insurance/2273-loan-guard-claim-form"}