{"id":802,"title":"HOUSEHOLDER’S PACKAGE POLICY (RETAIL) Burglary 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+%282%29.pdf/f9aeed04-b9e8-e0b8-1d83-9c2d1b1a286c?t=1789043016613","sha256":"2c4730df43a410f1d5008026be580860de1e126af76470d961fd2687ec0147d1","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim for burglary losses under the Householder’s Package Policy (Retail). The insured person fills it.","notes":["All questions must be answered fully; incomplete forms will be returned.","Use separate sheets if space is insufficient.","Amount claimed should exclude any profit and indicate add-on covers separately.","Option to reinstate sum insured is subject to company consent and additional premium.","The form is issued without prejudice to policy terms and conditions."],"title":"HOUSEHOLDER’S PACKAGE POLICY (RETAIL) Burglary Claim Form","submit":{"to":"Company/Surveyor immediately","how":"","address":""},"purpose":"claim","sections":[{"title":"A. The Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Full postal address","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":"Name of alternate contact person","type":"text","label":"Contact name","options":[],"required":false,"pdf_field":""},{"help":"Mobile of alternate contact","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Email of alternate contact","type":"email","label":"email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"B. Policy Details","fields":[{"help":"Policy number as per your insurance documents","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Start date of policy period","type":"date","label":"Period of Insurance : From","options":[],"required":true,"pdf_field":""},{"help":"End date of policy period","type":"date","label":"to","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"C. Loss Details","fields":[{"help":"Date of loss","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Time of loss with am/pm","type":"text","label":"Time","options":["am","pm"],"required":true,"pdf_field":""},{"help":"When the loss was discovered","type":"text","label":"Date/Time Discovered","options":[],"required":true,"pdf_field":""},{"help":"Person who discovered the loss","type":"text","label":"By whom","options":[],"required":true,"pdf_field":""},{"help":"Full address where loss occurred","type":"text","label":"Location/Address of Loss","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Describe how premises are used (e.g. residence, shop)","type":"text","label":"Premises occupied as","options":[],"required":true,"pdf_field":""},{"help":"Explain how the burglary happened and entry was made","type":"text","label":"Describe fully circumstances of Loss, how the entry into the premises was effected","options":[],"required":true,"pdf_field":""},{"help":"Describe signs of forced entry or exit","type":"text","label":"State the evidence of forcible entry/exit from the premises","options":[],"required":true,"pdf_field":""},{"help":"List each lost item, insured amount, and amount claimed separately","type":"table","label":"What is Lost & Extent of Loss (Attach separate sheet if more than 1 items) - Item Lost, Amount insured, Amount claimed*","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"D. General","fields":[{"help":"Tick Yes or No","type":"choice","label":"Has the loss or damage been reported to the Police?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide FIR number and date if reported","type":"text","label":"If yes please provide the following-: a) The FIR no. & Date","options":[],"required":false,"pdf_field":""},{"help":"Name and address of police station","type":"text","label":"b) The Police Station name & Address","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Has the Police apprehended any person ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of apprehended person if any","type":"text","label":"If yes, please provide details","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Is there any other insurance in force providing cover for this loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of other insurance if applicable","type":"text","label":"If yes, please provide name of Insurer(s), policy no. and copy of Policy","options":[],"required":false,"pdf_field":""},{"help":"Fire insurance policy number if any","type":"text","label":"Please provide details of Fire insurance of the premises/property - Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Fire insurance end date","type":"date","label":"to","options":[],"required":false,"pdf_field":""},{"help":"Name of fire insurance company","type":"text","label":"Insurer","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Have you ever suffered a loss in the past?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of past losses if any","type":"text","label":"If yes, please provide Date, Amount of Loss and Name of Insurer","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Are there any steps taken to prevent a recurrence","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe preventive measures taken","type":"text","label":"If yes, please provide details (please attach separate sheet if required)","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Are the premises protected by Burglar Alarm, security system, armed guard (common or dedicated)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of security measures","type":"text","label":"If yes, please provide details of the same","options":[],"required":false,"pdf_field":""},{"help":"Details about security guard if any","type":"text","label":"If guarded by a security personnel, was the guard armed and whether on duty at the time of incident","options":[],"required":false,"pdf_field":""},{"help":"Whether alarm/system was activated","type":"text","label":"If installed with burglar alarm or a security system, was the same activated during the incident","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Was there another person, in your opinion, suspected of the theft?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of suspected person if any","type":"text","label":"If yes, please provide name, address & phone no.","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Is the property subject to a hire purchase or hypothecation agreement?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of financial institution if applicable","type":"text","label":"If yes, please provide name & address of relevant parties/financial institution","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Has there been any alteration in the occupation or use of the premises since the Policy was taken up?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe changes in use or occupation","type":"text","label":"If yes, please provide details of changes/alterations","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Were the premises occupied at the time of the loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Date since premises were unoccupied","type":"text","label":"If not, unoccupied since","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Are you the sole owner of the premises/property?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of other owners or interested parties","type":"text","label":"If not, please provide details of other interested. Parties","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Is any part of the premises lent, let or sub-let?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of tenancy or subletting","type":"text","label":"If yes, please provide details of the same","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Are you responsible for repairs?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Total value of all property present","type":"amount","label":"At the time of loss, what was the total value of all property in the premises?","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No; subject to company consent and premium acceptance","type":"choice","label":"Would you like to reinstate the Sum Insured of the affected items by payment of additional premium?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Sign here","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Householder’s Package Policy (Retail) burglary claims","attachments":["Separate sheet if insufficient space","Copy of Police FIR","Copy of other insurance policy if applicable","Details of preventive measures if applicable"],"declarations":["The form is not an admission of liability by the insurer.","The insured must provide full and accurate information.","The insured should not admit liability to third parties.","Any communications about the accident must be sent to the company immediately.","The insured declares all information is true and no material information is withheld.","The claim may be refused if information is untrue, inaccurate or concealed."],"dropped_labels":1},"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/802-householders-package-policy-retail-burglary-claim-form"}