{"id":607,"title":"Portable Electronic Equipment Insurance Claim Form","purpose":"claim","insurer":{"slug":"indusind-general-insurance","name":"IndusInd General Insurance Company Limited"},"source_pdf":"https://www.indusindinsurance.com/downloads/portable-electronic-equipment-insurance-claim-form","sha256":"905f2a26f7f2012deac9099b60be987f44190f71087cfdb255f44f4b1607f184","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to claim insurance for loss or damage to portable electronic equipment covered under their policy.","notes":["Fill the form in BLOCK LETTERS.","Attach self attested copies of PAN card/Form 60 and Aadhaar Card as mandatory as per IRDAI guidelines.","Attach cancelled cheque leaf if opting for NEFT payment.","Any major repairs are to be executed only with prior consent and approval of the company.","Issuance of this form does not imply acceptance of liability."],"title":"Portable Electronic Equipment Insurance Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"SECTION 1 - INSURED DETAILS","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim 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 Code/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":""},{"help":"Fill in BLOCK LETTERS; select Mr., Mrs., or Ms.","type":"text","label":"Name of the Insured","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Customer ID","options":[],"required":null,"pdf_field":""},{"help":"Include Plot No./Flat No., Building Name, Road, Area, City, State, Pin Code","type":"text","label":"Address of the Insured","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Attach self attested copy of Aadhaar Card","type":"text","label":"UID Aadhar No.","options":[],"required":null,"pdf_field":""},{"help":"Attach self attested copy of PAN card or Form 60 as per IRDAI guidelines","type":"text","label":"PAN No.","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have a GST Registration Number","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide GST Registration Number if applicable","type":"text","label":"If Yes, please specify","options":[],"required":false,"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":""}],"filled_by":"insured"},{"title":"SECTION 2 - DETAILS OF LOSS","fields":[{"help":"Date in DD/MM/YYYY and time in HH:MM AM/PM format","type":"date","label":"Date & time of loss","options":[],"required":true,"pdf_field":""},{"help":"Describe the damaged equipment fully","type":"text","label":"Full description of the damaged equipment","options":[],"required":true,"pdf_field":""},{"help":"Provide item number as per policy schedule","type":"text","label":"Item Number in the policy schedule","options":[],"required":false,"pdf_field":""},{"help":"State the value; attach extra sheet if needed","type":"amount","label":"Value of the damaged equipment (attach separate sheet if required)","options":[],"required":true,"pdf_field":""},{"help":"Provide names of any witnesses","type":"text","label":"Name of the person(s) if any who witnessed the occurrence","options":[],"required":false,"pdf_field":""},{"help":"Describe the damage or loss in detail","type":"text","label":"Details of damage/loss sustained","options":[],"required":true,"pdf_field":""},{"help":"Explain the cause of the breakdown or loss","type":"text","label":"Cause of Breakdown/loss","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"State whether item damaged was under any guarantee from supplier/manufacturer/repairer","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe guarantee details if applicable","type":"text","label":"If so, state the nature of guarantee and guarantee period","options":[],"required":false,"pdf_field":""},{"help":"This appears twice; confirm if repairs executed","type":"yes-no","label":"State whether item damaged was under any guarantee from supplier/manufacturer/repairer","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide repair details if applicable","type":"text","label":"If so, give particulars with details of repairs executed?","options":[],"required":false,"pdf_field":""},{"help":"Explain usage at time of loss","type":"text","label":"For what purpose was the equipment being used at the time of breakdown /loss","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Have the repairers/engineers commenced repairs?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide repairer/engineer details if repairs started","type":"text","label":"If so, Give the name and address of the repairers/engineers","options":[],"required":false,"pdf_field":""},{"help":"Describe repairs and parts to be replaced","type":"text","label":"State nature of repairs and particulars of replacement of parts required","options":[],"required":false,"pdf_field":""},{"help":"Provide cost estimate","type":"amount","label":"Estimate of the cost of repairs / replacement (Any major repairs are to be executed only with prior consent and approval of the company)","options":[],"required":false,"pdf_field":""},{"help":"Provide salvage value if any","type":"amount","label":"State salvage value on the damaged items","options":[],"required":false,"pdf_field":""},{"help":"Provide location for inspection","type":"text","label":"Where can the damaged items be inspected?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is there any other insurance effected by you or any other person covering the loss sustained or any part thereof?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide any other relevant information","type":"text","label":"Please give any other particulars relevant to the damage","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"SECTION 3 - BANK DETAILS","fields":[{"help":"If yes, enclose a cancelled cheque leaf","type":"yes-no","label":"Would you like to opt for NEFT payment?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Branch Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"A/C Holder Name as in Bank Record","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Account No","options":[],"required":false,"pdf_field":""},{"help":"Provide IFSC code from cheque leaf","type":"text","label":"IFSC Code (this is a 11 digit code printed on your cheque leaf)","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"DECLARATION BY INSURED","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":["Please return the completed form within Fourteen days of the loss together with the relevant vouchers, documents etc."],"applies_to":"Portable Electronic Equipment Insurance","attachments":["Self attested copy of PAN card/Form 60 & Aadhaar Card","Cancelled cheque leaf (if opting for NEFT payment)","Relevant vouchers and documents related to the loss"],"declarations":["The statements made in this claim form are true to the best of the insured's knowledge and belief.","The address mentioned shall be taken as address on record for the purpose of GST."],"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/607-portable-electronic-equipment-insurance-claim-form"}