{"id":2345,"title":"CLAIM FORM CONSEQUENTIAL LOSS OF PROFITS","purpose":"claim","insurer":{"slug":"sbi-general-insurance","name":"SBI General Insurance Company Limited"},"source_pdf":"https://content.sbigeneral.in/uploads/c121724bc292404fad83bfceadfe21a2.pdf","sha256":"7264241ccc9ae2d307d6e6b1f8ed48880a78fa397580df520d8399ed31f813d3","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is for claiming consequential loss of profits insurance under a fire insurance policy. It is filled by the insured or claimant.","notes":["If any detail or information is not readily available, do not delay dispatch of this form; such particulars may be sent later.","Issue of this claim form is not to be taken as an admission of liability."],"title":"CLAIM FORM CONSEQUENTIAL LOSS OF PROFITS","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"A. DETAILS OF INSURED/CLAIMANT","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"From and to dates","type":"date","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim Number","options":[],"required":null,"pdf_field":""},{"help":"Name exactly as on the policy","type":"text","label":"Name as per  policy","options":[],"required":null,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Describe your business or occupation briefly","type":"text","label":"Brief Description of Business /Office/Industry/Occupation","options":[],"required":null,"pdf_field":""},{"help":"Sum insured limit in rupees","type":"amount","label":"Limits of Indemnity under the Policy (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"B. DETAILS OF LOSS/ACCIDENT","fields":[{"help":"Date when loss occurred","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Time with AM/PM","type":"text","label":"Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Full address where loss happened","type":"text","label":"Loss Location Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Name of contact person at loss location","type":"text","label":"Contact Details of person/s at Loss Location - Name","options":[],"required":null,"pdf_field":""},{"help":"Relation to insured","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"Landline number","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Explain how the loss/damage happened","type":"text","label":"Describe Cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss amount for building","type":"amount","label":"Estimated Loss (Rs.) (a) Building","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss amount for Plant & Machinery","type":"amount","label":"(b) P&M","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss amount for Furniture, Fixtures & Fittings","type":"amount","label":"(c) FFF","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss amount for stocks","type":"amount","label":"(d) Stocks","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss amount for other items 1","type":"amount","label":"(e) Others1","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss amount for other items 2","type":"amount","label":"(f) Others2","options":[],"required":null,"pdf_field":""},{"help":"Indicate if witnesses were present","type":"yes-no","label":"Were there any witnesses to the loss / accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if loss was reported","type":"yes-no","label":"Has the loss been reported to an Authority?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain why not reported","type":"text","label":"If ‘No’, reason for not reporting","options":[],"required":null,"pdf_field":""},{"help":"Select authority reported to","type":"choice","label":"If “Yes”, provide details - Fire / Police / Municipality / Other","options":["Fire","Police","Municipality","Other"],"required":null,"pdf_field":""},{"help":"Name of reporting authority","type":"text","label":"Name of Authority","options":[],"required":null,"pdf_field":""},{"help":"Report or reference number and date","type":"text","label":"Information Report No./Authority Reference No. and Date","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"C. DETAILS OF OTHER INSURANCE","fields":[{"help":"Indicate if other insurance covers loss","type":"yes-no","label":"Is the loss/damage covered under any other Insurance","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other insurer","type":"text","label":"Name of Insurer","options":[],"required":null,"pdf_field":""},{"help":"Address of other insurer","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"From and to dates","type":"date","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other policy","type":"amount","label":"Sum Insured (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"D. DETAILS OF OTHER INTEREST","fields":[{"help":"Indicate ownership status","type":"yes-no","label":"Is the Insured the Sole Owner of the property?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If not sole owner, specify interest","type":"text","label":"Nature of Interest","options":[],"required":null,"pdf_field":""},{"help":"Names of other interested persons","type":"text","label":"Person/s who has/have interest on property","options":[],"required":null,"pdf_field":""},{"help":"Address of other interested persons","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"E. DETAILS OF CONSEQUENTIAL LOSS","fields":[{"help":"Indicate if business nature changed after policy start","type":"yes-no","label":"Whether any alteration has been made in the nature of business / occupation of premises after inception of Policy?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe alterations if any","type":"text","label":"If “Yes”, please give details","options":[],"required":null,"pdf_field":""},{"help":"Indicate if premises were occupied","type":"yes-no","label":"Were the premises occupied at the time of loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date and reason if unoccupied","type":"text","label":"If No, un-occupied since (date) for (specify reason/s)","options":[],"required":null,"pdf_field":""},{"help":"Name of insurer for material damage","type":"text","label":"Details of Material Damage under Standard Fire & Special Perils Policy / MBD Policy - Name of the Insurer","options":[],"required":null,"pdf_field":""},{"help":"Address of insurer","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline number","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Policy number for material damage","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"From and to dates","type":"date","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for building","type":"amount","label":"Sum Insured (Rs.) (a) Building","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for Plant & Machinery","type":"amount","label":"(b) P&M","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for Furniture, Fixtures & Fittings","type":"amount","label":"(c) FFF","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for stocks","type":"amount","label":"(d) Stocks","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for other items 1","type":"amount","label":"(e) Others1","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for other items 2","type":"amount","label":"(f) Others2","options":[],"required":null,"pdf_field":""},{"help":"Select one occupation","type":"choice","label":"Occupation of premises at the time of loss","options":["Manufacturing facility","Warehouse","Shop","Office","Dwelling"],"required":null,"pdf_field":""},{"help":"Estimated loss for building","type":"amount","label":"Estimated Loss Material Damage (Rs.) (a) Building","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss for Plant & Machinery","type":"amount","label":"(b) P&M","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss for Furniture, Fixtures & Fittings","type":"amount","label":"(c) FFF","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss for stocks","type":"amount","label":"(d) Stocks","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss for other items 1","type":"amount","label":"(e) Others1","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss for other items 2","type":"amount","label":"(f) Others2","options":[],"required":null,"pdf_field":""},{"help":"From and to dates of business interruption","type":"date","label":"Period for which the business was interrupted due to Fire and Special Perils / MBD","options":[],"required":null,"pdf_field":""},{"help":"Annual turnover amount","type":"amount","label":"What was the annual turn-over for the last financial year? Rs.","options":[],"required":null,"pdf_field":""},{"help":"Estimated turnover loss","type":"amount","label":"What is the estimated reduction in turn-over due to interruption? Rs.","options":[],"required":null,"pdf_field":""},{"help":"Estimated gross profit loss","type":"amount","label":"What is the estimated loss of Gross Profit due to interruption? Rs.","options":[],"required":null,"pdf_field":""},{"help":"Expenses to minimize loss","type":"amount","label":"Standing Charges / Expenses incurred for Loss Minimization, if any, Rs.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if anyone is responsible","type":"yes-no","label":"Were there any person / organization, in your opinion, responsible for the loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of responsible party for investigation","type":"text","label":"If “Yes”, please provide details along with contact numbers and address, if available","options":[],"required":null,"pdf_field":""},{"help":"Describe preventive measures taken","type":"text","label":"What steps have been taken to prevent recurrence of similar incidence?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"F. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"List previous losses with date, description, value and insurer","type":"table","label":"Losses during the 3 preceding years - Date of Loss, Claim Description and Cause of Loss, Value of Loss (Rs.), Insurer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"G. DETAILS OF OTHER INFORMATION","fields":[{"help":"Indicate if you want to add more info","type":"yes-no","label":"Do you wish to provide any other information?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Additional information","type":"text","label":"If ‘Yes’, specify","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Declaration and Signature","fields":[{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of insured/claimant","type":"signature","label":"Signature","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Print your name","type":"text","label":"Name of Insured/Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"insured/claimant"}],"deadlines":[],"applies_to":"consequential loss of profits claims under fire insurance policies","attachments":["Copy of other insurance policy if loss covered under other insurance"],"declarations":["The claimant warrants the truth of all statements made in this form to the best of their knowledge and belief.","If any false or fraudulent statement, suppression or concealment is made, the claim shall be forfeited and the policy null and void."],"dropped_labels":16},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"customer.care@sbigeneral.in","label":"Motor Claims Email","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.sbigeneral.in/claim/motor","quote":"m\nRegister or Track Claim Status with one simple click\nIntimate Claim\nCheck Claim Status\n1800 102 1111\n(Available 24/7)\ncustomer.care@sbigeneral.in\nMail ID\nSmooth rides, smoother claims\nBecause you deserve worry-free journeys, always\nDownload SBIG App\nRegister or Tra","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"sbig.health@sbigeneral.in","label":"Health Claims Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"ailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office:\nSBI General Insurance Company Limited,\n9th Floor, Westport, Pan Card","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"seniorcitizen.health@sbigeneral.in","label":"Senior Citizen Health Claims Email","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office:\nSBI General Insurance Company Limited,\n9th","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 102 1111","label":"Motor Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"motor","source_url":"https://www.sbigeneral.in/claim/motor","quote":"e Claim\nFAQs\nDownload Claim Form\nRegister or Track Claim Status with one simple click\nIntimate Claim\nCheck Claim Status\n1800 102 1111\n(Available 24/7)\ncustomer.care@sbigeneral.in\nMail ID\nSmooth rides, smoother claims\nBecause you deserve worry-free journ","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 210 3366","label":"Health Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"e simple click\nCheck Claim Status\nIntimate Claim\nFor any Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 210 6366","label":"Health Claims Toll-free Number","level":null,"hours":"Available 24/7","applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"heck Claim Status\nIntimate Claim\nFor any Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"sms","value":"561612","label":"Health Claims SMS 'HEALTHCLAIM'","level":null,"hours":null,"applies_to":"health","source_url":"https://www.sbigeneral.in/claim/health","quote":"y Queries, Please Feel Free to Reach Out\nCall Us:\nAvailable 24/7\n1800 210 3366\n/\n1800 210 6366\nSMS Us:\n“HEALTHCLAIM”\nto\n561612\nEmail Us:\nseniorcitizen.health@sbigeneral.in\nsbig.health@sbigeneral.in\n18,000+\nNetwork Hospitals\nHealth Vertical Office","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/sbi-general-insurance/2345-claim-form-consequential-loss-of-profits"}