{"id":777,"title":"Product Liability Insurance Policy Claims Form","purpose":"claim","insurer":{"slug":"magma-general-insurance","name":"Magma General Insurance Limited"},"source_pdf":"https://www.magmainsurance.com/documents/5553002/0/Claim+Form+%E2%80%93+Product+Liability+%284%29.pdf/b14edfed-2ec0-a0cf-cc27-628dde7719e3?t=1789044281596","sha256":"4d9ede46945aaad96d62e9baaff009b086409820fb1623a4d1ec740fc593ec17","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to file a claim under the Product Liability Insurance Policy for accidents or incidents causing injury or damage.","notes":[],"title":"Product Liability Insurance Policy Claims Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured Details","fields":[{"help":"Enter the claim number if available","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"Enter your policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the full name of the insured","type":"text","label":"(a) Name of Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter the full address of the insured","type":"text","label":"(b) Address","options":[],"required":true,"pdf_field":""},{"help":"Enter the start and end dates of the policy period","type":"date","label":"(c) Period of the Policy From __ / __ / ____ to __ / __ / ____","options":[],"required":true,"pdf_field":""},{"help":"Enter the indemnity limits as per the policy","type":"text","label":"(d) Limits of Indemnity under the Policy","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Accident/Incident","fields":[{"help":"Enter the date when the accident/incident occurred","type":"date","label":"(a) Date of Occurrence","options":[],"required":true,"pdf_field":""},{"help":"Enter the time of occurrence in HH:MM AM/PM format","type":"text","label":"Time","options":[],"required":true,"pdf_field":""},{"help":"Enter the location where the accident/incident happened","type":"text","label":"(b) Place of accident/incident","options":[],"required":true,"pdf_field":""},{"help":"Enter the date or time when you first became aware of the accident/incident","type":"text","label":"(c) When did you first come to know of the accident/incident?","options":[],"required":true,"pdf_field":""},{"help":"Enter the date or time when the accident/incident was reported to you","type":"text","label":"(d) When was the accident/incident reported to you?","options":[],"required":true,"pdf_field":""},{"help":"Enter the date when the claim was first notified to the insurer","type":"text","label":"(e) When the claim was first notified to the Insurer?","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Consequences of the Accident/Incident","fields":[{"help":"List names, addresses, and occupations of injured persons","type":"text","label":"(a) Has any person/s sustained any injuries in the accident/incident? If so, i. Give name/s, address/es and occupation/s of such person/s.","options":[],"required":null,"pdf_field":""},{"help":"Describe the location of the injured persons at the time of the accident","type":"text","label":"ii. State where such person/s was at the time of accident/incident.","options":[],"required":null,"pdf_field":""},{"help":"Provide details of medical treatment or hospital admission","type":"text","label":"iii. Have the injured person/s been removed to hospital or medically attended? If so, give particulars.","options":[],"required":null,"pdf_field":""},{"help":"Provide details of property or livestock damage including owner information","type":"text","label":"(b) Has the accident/incident caused damage to property or livestock? If so, give name/s and address/es of the owner/s of the property and/or the livestock and full description of the property and state the nature of and extent of damage.","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any claims made against you and attach copies if available","type":"text","label":"(c) Has any claim been made upon you by any person/s? If so, state by whom and give full particulars (If claim has been made in writing, attach a copy of the notification received and of the bill, If submitted)","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated claim amounts for injuries, property damage, and claims","type":"amount","label":"(d) Estimated amount of claim (INR) separately under (a), (b) & (c)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Additional Information","fields":[{"help":"List names and addresses of witnesses if available","type":"text","label":"(a) Give, if possible, the names and addresses of all witnesses to the accident/incident","options":[],"required":null,"pdf_field":""},{"help":"Provide details of authority notified and attach report copy","type":"text","label":"(b) Has the accident/incident been reported to any authority? If so, state to whom and attach a copy of the report submitted.","options":[],"required":null,"pdf_field":""},{"help":"Describe any action taken by the authority","type":"text","label":"(c) What action, if any, has been taken by the authority?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any other insurance covering the same risk","type":"text","label":"(d) Give particulars of any other insurance, if any, in respect of the same risk/liability.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Enter the date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter the place where the form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Print your name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Product Liability Insurance Policy (Commercial)","attachments":["Copy of the notification received if claim has been made in writing","Copy of the bill if submitted","Copy of the report submitted to authority if accident/incident reported"],"declarations":["The insured warrants the truth of the statements made in the form to the best of their knowledge and belief.","If any false or fraudulent statement, suppression or concealment is made, the claim shall be forfeited and the policy shall be null and void."],"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/777-product-liability-insurance-policy-claims-form"}