{"id":807,"title":"Electronic Equipment Claim Form","purpose":"claim","insurer":{"slug":"magma-general-insurance","name":"Magma General Insurance Limited"},"source_pdf":"https://www.magmainsurance.com/documents/5553002/5571051/Claim+Form+%E2%80%93+Shopkeeper%27s+Package+%2811%29.pdf/b25cb7e0-915d-e344-7c91-6b6fa1cec729?t=1789043037506","sha256":"a45b10a956a37c015d6f8cf9f505f0aee00d48f661c7f90adb8d3794f419d3e4","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to claim for damage or loss of electronic equipment under the Shopkeeper's Package Policy (Retail).","notes":["All questions must be answered fully; incomplete forms will be returned.","If insufficient space, use a separate sheet attached to the form.","Do not dispose or destroy damaged parts/machinery without consent of surveyor/Magma General Insurance."],"title":"Electronic Equipment Claim Form","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":"Name of the contact person for the claim","type":"text","label":"Contact name","options":[],"required":false,"pdf_field":""},{"help":"Mobile number of the contact person","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Email of the contact person","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 and end date of the policy period","type":"date","label":"Period of Insurance","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"C. Equipment Details","fields":[{"help":"Where the damaged equipment is located","type":"text","label":"Location of damaged machine","options":[],"required":true,"pdf_field":""},{"help":"Brief description of the damaged equipment","type":"text","label":"Description of damaged machine","options":[],"required":true,"pdf_field":""},{"help":"Manufacturer or brand of the equipment","type":"text","label":"Make","options":[],"required":true,"pdf_field":""},{"help":"Type or category of the equipment","type":"text","label":"Type","options":[],"required":true,"pdf_field":""},{"help":"Model number or name","type":"text","label":"Model","options":[],"required":true,"pdf_field":""},{"help":"Serial number of the equipment","type":"text","label":"Serial No.","options":[],"required":true,"pdf_field":""},{"help":"Year the equipment was manufactured","type":"number","label":"Year of Manufacture","options":[],"required":true,"pdf_field":""},{"help":"Item number as listed in your policy schedule","type":"text","label":"Item No. as per Policy","options":[],"required":false,"pdf_field":""},{"help":"Select if the equipment is under guarantee","type":"choice","label":"Whether covered under guarantee from supplier/manufacturer","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If under guarantee, indicate if repair/replacement will be done by supplier","type":"choice","label":"If yes, is the manufacturer/supplier going to repair/replace the damaged machine","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if maintenance agreement was active at loss time","type":"choice","label":"Whether covered under maintenance agreement at the time of loss","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If maintenance agreement active, indicate if damage is covered","type":"choice","label":"If yes, is the damage repair/replacement covered under the agreement","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"D. Loss Details","fields":[{"help":"Date when the loss/damage occurred","type":"date","label":"Date of loss","options":[],"required":true,"pdf_field":""},{"help":"Time of loss with am/pm","type":"text","label":"Time of loss","options":[],"required":true,"pdf_field":""},{"help":"Estimated repair cost; attach repairer's estimate","type":"amount","label":"Estimate of cost of damage (please attach repairers estimate) Rs.","options":[],"required":true,"pdf_field":""},{"help":"Value of salvageable damaged items","type":"amount","label":"Salvage value of damaged items Rs.","options":[],"required":false,"pdf_field":""},{"help":"Indicate if software was lost or damaged","type":"choice","label":"Was any software lost or damaged","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Name or description of software lost/damaged","type":"text","label":"If yes, what was it","options":[],"required":false,"pdf_field":""},{"help":"Cause or reason for the damage","type":"text","label":"What caused the damage","options":[],"required":true,"pdf_field":""},{"help":"Cost to replace the damaged equipment","type":"amount","label":"What is the replacement cost Rs.","options":[],"required":true,"pdf_field":""},{"help":"Indicate if any data was lost","type":"choice","label":"Was any data lost","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Description of the lost data","type":"text","label":"If yes, what was the nature of the data","options":[],"required":false,"pdf_field":""},{"help":"Reason for data loss","type":"text","label":"What caused the data loss","options":[],"required":false,"pdf_field":""},{"help":"Cost to replace lost data","type":"amount","label":"What is the replacement cost Rs.","options":[],"required":false,"pdf_field":""},{"help":"Indicate if backup data or disk is available","type":"choice","label":"Is there a back-up data/disk","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"State usability of backup or reason if not usable","type":"text","label":"If yes, is the same usable. If not, why not","options":[],"required":false,"pdf_field":""},{"help":"Time of equipment failure with am/pm","type":"text","label":"If increased cost of working or business interruption is insured - What time did the equipment fail","options":[],"required":false,"pdf_field":""},{"help":"List affected departments","type":"text","label":"Which departments are affected by the stoppage","options":[],"required":false,"pdf_field":""},{"help":"Approximate daily business turnover","type":"amount","label":"What is approximate daily turnover Rs.","options":[],"required":false,"pdf_field":""},{"help":"Items or services purchased due to increased cost","type":"text","label":"What is being purchased with the increased cost","options":[],"required":false,"pdf_field":""},{"help":"Expected completion date of repairs or replacement","type":"date","label":"When is repairs/replacement of the damaged machine expected to be completed","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"E. Details of other insurances","fields":[{"help":"List other insurance policies covering this loss","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":"F. Details of previous losses","fields":[{"help":"Provide information on any prior losses","type":"text","label":"Details of previous losses, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"H. Steps taken to prevent future recurrence","fields":[{"help":"Describe measures to avoid similar loss in future","type":"text","label":"Steps taken to prevent future recurrence","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Sign to declare the truthfulness of the information","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":"Shopkeeper's Package Policy (Retail) - Electronic Equipment claims","attachments":["Repairers estimate"],"declarations":["The insured declares that no material information has been withheld and all statements are true to the best of their knowledge.","The insured confirms that the described property belongs to them and no other person has interest except as mentioned in the policy.","The insured understands that the claim may be refused if 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/807-electronic-equipment-claim-form"}