{"id":767,"title":"Claim Form - Machinery Breakdown Policy (Retail)","purpose":"claim","insurer":{"slug":"magma-general-insurance","name":"Magma General Insurance Limited"},"source_pdf":"https://www.magmainsurance.com/documents/5553002/5571171/Claim+Form+-+Machinery+Breakdown+Policy.pdf/d1c8587a-7e95-12d3-6ab6-0dbe8b9d302c?t=1789043217010","sha256":"e52c6481d3f9fef7b2812b3b6c143a00baf818bf71961e3d4d5af5ecf179483e","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to file a claim under the Machinery Breakdown Policy (Retail) for damage to machinery covered by the policy.","notes":["All questions must be answered fully; incomplete forms will be returned.","Do not dispose or destroy damaged parts/machinery without consent of surveyor or Magma General Insurance Limited.","If there is insufficient space, use a separate sheet and attach it to this form."],"title":"Claim Form - Machinery Breakdown Policy (Retail)","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"A. The Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Tel No. Office","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"email","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Contact name","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"B. Policy Details","fields":[{"help":"","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"From and to dates","type":"date","label":"Period of Insurance","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"C. Machinery details","fields":[{"help":"","type":"text","label":"Location of damaged machinery","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Description of damaged machinery","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Make","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Type","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Model","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Serial No.","options":[],"required":true,"pdf_field":""},{"help":"Year only","type":"number","label":"Year of manufacture","options":[],"required":true,"pdf_field":""},{"help":"Horsepower or kilowatt rating","type":"text","label":"HP/KW","options":[],"required":false,"pdf_field":""},{"help":"dd/mm/yyyy","type":"date","label":"Date of expiry of manufacturer warranty","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"Cost of replacement by a new machine of same type/capacity","options":[],"required":false,"pdf_field":""},{"help":"dd/mm/yyyy","type":"date","label":"Date of last maintenance service/overhaul of machine","options":[],"required":false,"pdf_field":""},{"help":"Describe any prior repairs","type":"text","label":"Details of previous repairs, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"D. Loss details","fields":[{"help":"Date of loss","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Specify am or pm","type":"text","label":"Time","options":["am","pm"],"required":true,"pdf_field":""},{"help":"Describe the incident in detail","type":"text","label":"Describe what happened (Attach sketch if appropriate)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Probable cause of damage","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name & Address of repairer","options":[],"required":false,"pdf_field":""},{"help":"Provide separate costs for parts and labour","type":"text","label":"Estimate of cost of repairs, itemized separately for parts and labour","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"E. If Spoilage of frozen food is insured?","fields":[{"help":"","type":"choice","label":"Did spoilage of frozen goods occur?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Describe the frozen goods spoiled","type":"text","label":"If yes, what type of goods","options":[],"required":false,"pdf_field":""},{"help":"Current storage location","type":"text","label":"Where are the goods stored now","options":[],"required":false,"pdf_field":""},{"help":"Attach invoices as proof","type":"amount","label":"What was the value of goods (please attach invoices in support)","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"F. If Business Interruption or Machinery Loss of Profits is insured","fields":[{"help":"Specify am or pm","type":"text","label":"What time did the machine stop?","options":["am","pm"],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Has any production been lost?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"List affected departments","type":"text","label":"Which departments are affected by the stoppage","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is your approximate daily turnover","options":[],"required":false,"pdf_field":""},{"help":"Expected completion date","type":"date","label":"When do you anticipate repairs/replacement to the damaged machine to be completed","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the estimated loss of turnover during the period of breakdown","options":[],"required":false,"pdf_field":""},{"help":"Daily increased cost","type":"amount","label":"If you are incurring increased cost of working, what is the daily cost of these","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"G. Details of other insurances","fields":[{"help":"List other insurance policies if applicable","type":"text","label":"Provide details of other insurances, if any, covering the incident/damage or items","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"H. Details of previous losses","fields":[{"help":"Describe any prior losses","type":"text","label":"Details of previous losses, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"I. Steps taken to prevent future reoccurrence","fields":[{"help":"Describe preventive measures","type":"text","label":"Steps taken to prevent future reoccurrence","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Company stamp if applicable","type":"signature","label":"Company’s stamp","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Machinery Breakdown Policy (Retail)","attachments":["Attach sketch if appropriate for description of what happened","Attach invoices in support of value of spoiled frozen goods"],"declarations":["I/We declare that I/We have not withheld any material information and that all statements made on this form are true to the best of my/our knowledge and belief.","I/We declare that the articles/property described belong to me/us and no other person has any interest except as mentioned in the Policy.","I/We understand that the claim may be refused if the information is untrue, inaccurate or concealed."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"Magma General Insurance Limited (Claims Hub), Srinilaya Cyber Spazio Suite 101, 102, Ground Floor, Road No. 2, Banjara Hills, Hyderabad, Telangana – 500034","label":"Claims Hub Address","level":null,"hours":null,"applies_to":"health","source_url":"https://www.magmainsurance.com/learn-about-claims","quote":"fe takes an unexpected turn. When that moment comes, a clear and dependable claims process makes all the difference. At Magma General Insurance, our aim is to make the process simple to understand, transparent to follow, and supportive at every step. This page explains how claims work across Health, Motor and Non‑Motor policies.\nClaim is easy at Magma General Insurance.\nRegister Claim\nHealth","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"customercare@magmainsurance.com","label":"Customer Care Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.magmainsurance.com/web/magmainsurance/claims","quote":"ma HDI General Insurance Company Limited) | All Rights Reserved\n| IRDAI Reg. No. 149 |\nwww.magmainsurance.com\n| E-mail:\ncustomercare@magmainsurance.com\n| Registered & Corporate Office: Equinox Business Park, Tower 3, Ambedkar Nagar, 2\nnd\nFloor, Unit Number 1B & 2B, LBS M","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800 266 3202","label":"Claims Intimation Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.magmainsurance.com/web/magmainsurance/claims","quote":"surance Claims - Motor & Health Insurance Claim Process - Magma Insurance - Magma\nSkip to Content\nOne-Line-Hearder-Test\n1800 266 3202\nNavigation\nCustomer Service\nSenior Citizen Services\nRoad side Assistance\nAnnual Health Check-up\nPolicy Servicing assist","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/magma-general-insurance/767-claim-form-machinery-breakdown-policy-retail"}