{"id":617,"title":"PLATE GLASS INSURANCE - CLAIM FORM","purpose":"claim","insurer":{"slug":"indusind-general-insurance","name":"IndusInd General Insurance Company Limited"},"source_pdf":"https://www.indusindinsurance.com/downloads/plate-glass-insurance-claim-form","sha256":"efdcb56d0e9827009891a8f8ea4dcf14cc5644c07a2abe56a505423dc9f00ea4","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for the insured person to claim insurance for plate glass breakage under their policy.","notes":["Fill in BLOCK LETTERS.","Attach self attested copies of PAN card/Form 60 and Aadhaar Card as mandatory as per IRDAI guidelines.","If opting for NEFT payment, enclose a cancelled cheque leaf.","The issue of this form does not constitute admission of liability."],"title":"PLATE GLASS 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":"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","type":"text","label":"Name of the Insured","options":["Mr.","Mrs.","Ms."],"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":null,"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 guideline","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":"Describe exact location of the broken glass","type":"text","label":"Address where glass was situated (Please state the precise position of the glass)","options":[],"required":null,"pdf_field":""},{"help":"Specify dimensions of the broken glass plate","type":"text","label":"Size of the plate broken","options":[],"required":null,"pdf_field":""},{"help":"Explain how the breakage occurred","type":"text","label":"Cause of breakage","options":[],"required":null,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Date of breakage","options":[],"required":null,"pdf_field":""},{"help":"HH/MM AM or PM format","type":"text","label":"Time of breakage","options":[],"required":null,"pdf_field":""},{"help":"Provide details if someone is responsible","type":"text","label":"Name and address of the person responsible for breakage, if any","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Was he in any way employed by the insured?","options":["Yes","No"],"required":null,"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":null,"pdf_field":""},{"help":"","type":"text","label":"Branch Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"A/C Holder Name as in Bank Record","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":"","type":"text","label":"Account No","options":[],"required":null,"pdf_field":""},{"help":"This is an 11 digit code printed on your cheque leaf","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"DECLARATION BY INSURED","fields":[{"help":"","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","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":"Plate Glass Insurance claims","attachments":["Self attested copy of PAN card/Form 60 & Aadhaar Card","Cancelled cheque leaf (if opting for NEFT payment)"],"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/617-plate-glass-insurance-claim-form"}