{"id":800,"title":"HOUSEHOLDER’S PACKAGE POLICY (RETAIL) Plate Glass & Neon Sign Insurance Claim Form","purpose":"claim","insurer":{"slug":"magma-general-insurance","name":"Magma General Insurance Limited"},"source_pdf":"https://www.magmainsurance.com/documents/5553002/5571045/Claim+Form+%E2%80%93+Householder%27s+Package+%286%29.pdf/d6c368a6-00f5-223a-dbc3-82700d1e151c?t=1789043018502","sha256":"4ef44a194bb3b16356643e1895116454b55d405136cc36498a3de26afbf2e8d7","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim insurance for breakage of plate glass and neon signs under the Householder's Package Policy (Retail).","notes":["The issue of this form does not constitute admission of liability."],"title":"HOUSEHOLDER’S PACKAGE POLICY (RETAIL) Plate Glass & Neon Sign Insurance Claim Form","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured Details","fields":[{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"Full name of the insured person","type":"text","label":"1. a) Name of Insured (in full)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Breakage Details","fields":[{"help":"Date and time when the breakage occurred","type":"date","label":"2. Date and time of breakage","options":[],"required":null,"pdf_field":""},{"help":"Explain how the breakage happened","type":"text","label":"3. Cause of breakage","options":[],"required":null,"pdf_field":""},{"help":"Details of the person responsible if not employed by the insured","type":"text","label":"4. If caused by a person NOT in the Insured’s service state name and full address of the person","options":[],"required":null,"pdf_field":""},{"help":"Provide witness details if available","type":"text","label":"5. Name and address of witness, if any","options":[],"required":false,"pdf_field":""},{"help":"Select whether you are the tenant or owner","type":"choice","label":"6. Is the Insured claiming as tenant or owner?","options":["tenant","owner"],"required":null,"pdf_field":""},{"help":"Indicate if the premises is currently occupied","type":"yes-no","label":"7. Is the premise where breakage occurred at present occupied?","options":[],"required":null,"pdf_field":""},{"help":"State if replacement instructions have been given","type":"yes-no","label":"8. Have instructions been given for replacement?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if immediate replacement is needed","type":"yes-no","label":"If not- i) Is immediate replacement required?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if you prefer to replace later with an undertaking","type":"yes-no","label":"ii) Would the Insured prefer to give an undertaking to effect replacement when convenient to him?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any other insurance covering this loss","type":"text","label":"9. Is there any other insurance against the present loss under any other policy? If so, give full particulars.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Particulars of Breakage","fields":[{"help":"Fill details of broken glass and frames: columns are No. of squares or panes, Description of Glass and where fixed, Size of each Square or Pane in Cms. (Height, Width), Whether cracked or broken out, Cost of broken items requiring replacements Rs.; and No. of Frames/Frameworks, Description of Frame/Frameworks, Size in cms. (Height, Width), Whether cracked or broken out, Cost of broken items requiring replacements Rs.","type":"table","label":"10. PARTICULARS OF BREAKAGE","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration and Signature","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":["Please return this form within fourteen days of the loss together with all enclosures"],"applies_to":"Householder’s Package Policy (Retail) Plate Glass & Neon Sign Insurance","attachments":["All enclosures related to the claim as required"],"declarations":["I/We hereby declare that the foregoing particulars are true and correct in every respect."],"dropped_labels":2},"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/800-householders-package-policy-retail-plate-glass-and-neon-sign-insurance-claim-for"}