{"id":598,"title":"AGRICULTURAL PUMPSET INSURANCE POLICY - RETAIL - CLAIM FORM","purpose":"claim","insurer":{"slug":"indusind-general-insurance","name":"IndusInd General Insurance Company Limited"},"source_pdf":"https://www.indusindinsurance.com/downloads/agriculture-pumpset-claim-form","sha256":"c41f86d3542159a7d698af34b2156734c377c99f93d4fa2379258b087de99800","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim insurance for loss or damage to their agricultural pumpset under the retail insurance policy.","notes":["Fill all details in BLOCK LETTERS where specified.","Attach original cancelled cheque and PAN card copy for bank details verification.","Payments to insured are made only through electronic mode as per IRDAI.","Politically Exposed Persons (PEPs) definition and declaration is mandatory as per AML/CFT guidelines."],"title":"AGRICULTURAL PUMPSET INSURANCE POLICY - RETAIL - CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured Details","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Registration","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Area Office/Service Centre Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Broker/Agent Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Code","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of Insured","fields":[{"help":"Fill in BLOCK LETTERS","type":"text","label":"Insured's Name","options":["Mr.","Mrs.","Ms."],"required":null,"pdf_field":""},{"help":"Include Flat/Building/Door/Block No., Road/Street/Sector, Nearest Landmark, Area/Village, City, Pin Code, State, Country","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Phone","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Profession/Occupation","options":["Business","Profession","Salary","Agricultural Income","Savings","Others"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Monthly Income","options":["Upto ` 20,000","` 20,001 to ` 50,000","` 50,001 to ` 1,00,000","` 1,00,001 and above"],"required":null,"pdf_field":""},{"help":"Unique Identification Number (Aadhar)","type":"text","label":"UID Aadhar No.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of the Pumpset Insured","fields":[{"help":"","type":"text","label":"Full description of the Pumpset / loss damaged","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Item Number in the policy schedule","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Value of the lost / damage Pumpset","options":[],"required":null,"pdf_field":""},{"help":"Date in DD/MM/YYYY and time in HH:MM AM/PM format","type":"date","label":"Date & Time of loss","options":[],"required":null,"pdf_field":""},{"help":"Full name in BLOCK LETTERS","type":"text","label":"Name of the person(s) if any who witness the occurrence","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of loss/damage sustained","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of loss / breakdown","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Additional Loss Details","fields":[{"help":"","type":"text","label":"State whether item loss/damage was under any guarantee from supplier/Manufacture/repairer. If so, state the nature of guarantee and guarantee period.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Did the pumpset in question suffer any earlier damage due to accident? If so, give particular with details of repairs executed?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"In which section and for what purpose was the pumpset being used at the time of breakdown?","options":[],"required":null,"pdf_field":""},{"help":"Include name and address","type":"text","label":"Have the repairers commenced repairs? If so, Give the name and address of the repairers.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State nature of repairs and particular of replacement of parts required.","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Estimate of the cost of repairs / replacement","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"State salvage value on the lost / damaged items","options":[],"required":null,"pdf_field":""},{"help":"Provide location details","type":"text","label":"Where can the lost / damaged items be inspected","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Are there any other insurance effected by you or any other person covering the loss sustained or any part thereof?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please give any other particular relevant to the loss/damage.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Policyholder Bank Details","fields":[{"help":"Fill in BLOCK LETTERS","type":"text","label":"Name of the Bank Account Holder","options":["Mr.","Mrs.","Ms."],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Account No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Account","options":["Saving","Current"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Branch","options":[],"required":null,"pdf_field":""},{"help":"9 digit MICR code from cheque","type":"text","label":"MICR Code (9 digit MICR code number of the bank and branch appearing on the cheque issued by the bank)","options":[],"required":null,"pdf_field":""},{"help":"11 character IFSC code from cheque","type":"text","label":"IFSC Code (11 character code appearing on your cheque leaf)","options":[],"required":null,"pdf_field":""},{"help":"Mandatory as per IRDAI for electronic payments","type":"checkbox","label":"I understand that any refund due on the premium payment / any payment / claims to be directly credited to my aforesaid Bank Account.*","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"PEP Declaration","fields":[{"help":"","type":"choice","label":"Are you a Politically Exposed Person (PEP)?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If yes, please mention the position held","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Is any of your close relation or family member a PEP?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If yes, please mention the name and relation and the position held by such close relative/family member.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declarations and Consent","fields":[{"help":"Sign to confirm declarations","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration by Insured","fields":[{"help":"Sign to declare truthfulness of claim form","type":"signature","label":"Signature of the Borrower","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Agricultural Pumpset Insurance Policy - Retail","attachments":["original cancelled cheque","copy of PAN card"],"declarations":["I understand that any refund or claim payment will be credited directly to my bank account as per IRDAI regulations.","I declare that if I or my close relatives become Politically Exposed Persons (PEP) in future, I will inform the insurer.","I confirm that all premiums are paid from bonafide sources and not from proceeds of crime.","I understand the insurer may verify my KYC and PAN details and I accept responsibility for any mismatch consequences.","I declare that the statements made in this claim form are true to the best of my knowledge and belief."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"services@indusindinsurance.com","label":"Health Insurance Claims Email","level":1,"hours":null,"applies_to":"health","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"nce Claim\nTravel Insurance Claim\nCommercial Insurance Claim\nSupport\nSign In\nSelf Help\nVideo Chat\nContact Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"indusind@europ-assistance.in","label":"Travel Insurance Claims Email","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail:\nindusind@europ-assistance.in\nMobile Application:\nIndusInd Insurance App\nWebsite:\nOnline Claim Intimation\nOffline Visit:\nLocate your nearest branch\nh","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+91 22 48903009","label":"Car Insurance Claim Intimation","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.indusindinsurance.com/car-insurance-claim","quote":"Us\nEmail us at\nservices@indusindinsurance.com\ngrievances@indusindinsurance.com\ncareers@indusindinsurance.com\nCall us at\n+91 22 48903009 (Paid Number)\n+91 22 65934185 (Senior Citizen)\n+91 7400422200 (WhatsApp)\n+91 22 48903051 (Become our Partner)\nVisit us:","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934189","label":"Motor Claims Helpline","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.indusindinsurance.com/car-insurance-claim","quote":"ation.\nNeed Guidance on Car Coverage?\nTalk to Our Professional Advisors\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nSteps to Take After a Car ​Accident\nThe following steps can expedite the road accident insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934188","label":"Health Claims Helpline","level":null,"hours":null,"applies_to":"health","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"your nearest location.\nExpert health advice you can trust\nGet in touch with our team today!\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nCommon Reasons for Health Insurance Claim Rejection\nIncomplete Documentation","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022 65934184","label":"Travel Claims Helpline","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/health-insurance-claims","quote":"e you can trust\nGet in touch with our team today!\nCall Us\nCall Us!!\nHealth -\n022 65934188\nMotor -\n022 65934189\nTravel -\n022 65934184\nCommon Reasons for Health Insurance Claim Rejection\nIncomplete Documentation\nYour claim gets rejected when you don't gi","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"+912248903009","label":"Inland Travel Helpline","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"rds your registered bank account.\nHow to Contact Us For Travel Insurance Claim?\nContact Details\nInland Travel Helpline:\n+912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 552","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"91-22-67347843","label":"International Travel Helpline (abroad)","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"For Travel Insurance Claim?\nContact Details\nInland Travel Helpline:\n+912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 209 5522","label":"International Travel Helpline (in India)","level":null,"hours":null,"applies_to":"travel","source_url":"https://www.indusindinsurance.com/travel-insurance-claim","quote":"912248903009\nInternational Travel (while abroad):\n91-22-67347843/ 91-22-67347844\nInternational Travel (while in India):\n1800 209 5522\nWhatsApp:\n7400422200 for Inland Travel Claim\nEmail:\nindusind@europ-assistance.in\nMobile Application:\nIndusInd Insurance","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/indusind-general-insurance/598-agricultural-pumpset-insurance-policy-retail-claim-form"}