{"id":785,"title":"Directors & Officers Liability Insurance 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+Directors+%26+Officers+Liability+%282%29.pdf/cb85b8ec-4d7b-7cb0-c608-b9defb31e02b?t=1789044318951","sha256":"b534a4fbc0dc809c3deea38738f4a4146dffcf2330beafcfc4604dfb1dd1d080","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to file a claim under the Directors & Officers Liability Insurance policy.","notes":["The issue of this form is not to be taken as an admission of liability."],"title":"Directors & Officers Liability Insurance Claims Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured Details","fields":[{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the full name of the insured entity or person","type":"text","label":"(a) Name of Insured","options":[],"required":null,"pdf_field":""},{"help":"Enter the full address of the insured","type":"text","label":"(b) Address","options":[],"required":null,"pdf_field":""},{"help":"Enter the policy start and end dates in DD/MM/YYYY format","type":"date","label":"(c) Period of the Policy From to","options":[],"required":null,"pdf_field":""},{"help":"Specify the indemnity limits as per the policy","type":"text","label":"(d) Limits of Indemnity under the Policy","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Accident/Incident","fields":[{"help":"Enter the date of the accident/incident in DD/MM/YYYY format","type":"date","label":"(a) Date of Occurrence","options":[],"required":null,"pdf_field":""},{"help":"Enter the time of occurrence with AM/PM","type":"text","label":"Time","options":[],"required":null,"pdf_field":""},{"help":"Enter the location where the accident/incident occurred","type":"text","label":"(b) Place of accident/incident","options":[],"required":null,"pdf_field":""},{"help":"Provide the date or circumstances when you first became aware","type":"text","label":"(c) When did you first come to know of the accident/incident?","options":[],"required":null,"pdf_field":""},{"help":"Provide the date or details of when the accident was reported","type":"text","label":"(d) When was the accident/incident reported to you?","options":[],"required":null,"pdf_field":""},{"help":"Provide the date when the insurer was first notified","type":"text","label":"(e) When the claim was first notified to the Insurer?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Consequences of the Accident/Incident","fields":[{"help":"List injured persons with their details","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 injured persons at the time","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 hospitalisation","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":"Describe property/livestock damage and owners' details","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 witnesses with their contact details","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 reported to 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 other insurance policies 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 in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Insured","options":[],"required":null,"pdf_field":""},{"help":"Enter the place where the form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Print the name of the person signing","type":"text","label":"Name","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Directors & Officers Liability Insurance policies","attachments":["Copy of the notification received if claim 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/785-directors-and-officers-liability-insurance-claims-form"}