{"id":262,"title":"Machinery Breakdown Insurance Claim Form","purpose":"claim","insurer":{"slug":"iffco-tokio-general-insurance","name":"IFFCO TOKIO General Insurance Company Limited"},"source_pdf":"https://www.iffcotokio.co.in/content/dam/iffcotokio/iffco-pdf/sites/default/files/pdf/machinery-breakdown-claim-form.pdf","sha256":"744a2e2f3c68013be9337c21815d77bab06636e1c89d1b35b32a621df8b38202","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is for the insured person to claim insurance for machinery breakdown under their policy.","notes":["This Claim Form is issued without prejudice to the terms and conditions of the policy and issuance of this form should not be construed as admission of Liability.","Fill in all blanks and provide complete details; attach a separate sheet if space is insufficient."],"title":"Machinery Breakdown Insurance Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"","type":"text","label":"Name & Address of Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""},{"help":"Available between specified hours","type":"phone","label":"Telephone Numbers (O)","options":[],"required":null,"pdf_field":""},{"help":"Available between specified hours","type":"phone","label":"Telephone Numbers (R)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Policy and Item Details","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Specify the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Provide make, model and manufacturing year","type":"text","label":"Description of Item affected Make / Model / Year of Mfr.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Serial No. of item in schedule","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Identification No. of item","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Loss Details","fields":[{"help":"Date when the breakdown or incident occurred","type":"date","label":"Date of Loss / accident / incident","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the item used as prescribed by the manufacturer?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe how and when the breakdown was noticed","type":"text","label":"Circumstance of Loss (Brief write up on circumstances under which the equipment broke down and how & when it was detected)","options":[],"required":null,"pdf_field":""},{"help":"Provide your view on what caused the breakdown","type":"text","label":"Your opinion about the cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Where the item was located when the loss happened","type":"text","label":"Location of item at the time of loss","options":[],"required":null,"pdf_field":""},{"help":"Current location for inspection","type":"text","label":"Where can it be examined now?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has item been dismantled?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Annual Maintenance Contract","type":"yes-no","label":"Is item covered under any A.M.C.?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the item under warranty?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe the damage or loss extent","type":"text","label":"Extent of damage / loss","options":[],"required":null,"pdf_field":""},{"help":"Provide repair cost estimate or quotation","type":"amount","label":"Estimated amount for repair / Quote if any.","options":[],"required":null,"pdf_field":""},{"help":"Details of any additional costs due to breakdown","type":"amount","label":"Increased Cost of working (if applicable); specific details of the increased cost likely to be incurred may please be provided","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Other Insurance Details","fields":[{"help":"If item is insured elsewhere","type":"text","label":"Name & Address of Company","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration and Signature","fields":[{"help":"Name of the person signing","type":"text","label":"Name:","options":[],"required":true,"pdf_field":""},{"help":"Signer's designation","type":"text","label":"Designation:","options":[],"required":false,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature:","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":false,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":["Please submit this form, duly filled & signed, within 15 days, from the date of occurrence."],"applies_to":"","attachments":[],"declarations":["The statements made in the claim form are true to the best of the claimant's knowledge and belief.","No material information relevant to the claim has been withheld."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"policy issuing Branch","label":"Walk in claim intimation","level":null,"hours":"Mon- Fri 09:30 AM to 06:00 PM (Except for National Holidays)","applies_to":"all","source_url":"https://www.iffcotokio.co.in/claims/register-a-claim","quote":"65 days.\nToll No. 1800-103-5499\nWalk in\nShall you wish to intimate your claim in person, please feel free to visit your policy issuing Branch Mon- Fri 09:30 AM to 06:00 PM (Except for National Holidays). Please refer to our\nBranch Locator\nfor information on our","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"support@iffcotokio.co.in","label":"Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"se\nTelugu\nOriya\nPolicy Copy\nService Request\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengali\nKannada\nAssamese\nTelugu\nOriya","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-103-5499","label":"Toll free","level":null,"hours":"24 X 7","applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"engali\nKannada\nAssamese\nTelugu\nOriya\nPolicy Copy\nService Request\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengal","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"sms","value":"56161","label":"SMS “CLAIM” to 56161","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/claims/register-a-claim","quote":"avor to take customer service at newer heights, we now bring claim Intimation at your fingertips. Please SMS “CLAIM” to 56161 and one of our Claims representatives will get in touch with you in 4 Working Hours.\n* Note:\nPlease have all the detail","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"whatsapp","value":"7993407777","label":"Say Hi to IRA","level":null,"hours":null,"applies_to":"all","source_url":"https://www.iffcotokio.co.in/contact-us/customer-services/grievance-redressal","quote":"est\nLocators\nClaims\nRegister Claim\nClaim Status\nToll free: 1800-103-5499\nEmail: support@iffcotokio.co.in\nSay Hi to IRA: 7993407777\nEnglish\nHindi\nMarathi\nGujarati\nPunjabi\nMalayalam\nTamil\nBengali\nKannada\nAssamese\nTelugu\nOriya\nCustomer Login\nAgent Login","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/iffco-tokio-general-insurance/262-machinery-breakdown-insurance-claim-form"}