{"id":812,"title":"SHOPKEEPER’S PACKAGE POLICY (RETAIL) Plate Glass Insurance Claim 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+Shopkeeper%27s+Package+%282%29.pdf/fa736220-e026-3c79-fc2a-ca77d4b2757b?t=1789044312541","sha256":"f14ba2360c30f011bc85b9bf2fc265eb7d7523358a26759d2701944a608b035b","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to claim insurance for damage to plate glass under the Shopkeeper's Package Policy (Retail).","notes":["All questions must be answered fully; incomplete forms will be returned.","If there is insufficient space, use a separate sheet and attach it.","The issue or acceptance of this form is not an admission of liability by Magma General Insurance."],"title":"SHOPKEEPER’S PACKAGE POLICY (RETAIL) Plate Glass Insurance 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":"","type":"text","label":"Contact person’s name","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":""}],"filled_by":"insured"},{"title":"B. Policy Details","fields":[{"help":"","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Enter start and end dates of the policy period","type":"date","label":"Period of Insurance ____/____/____ to ____/____/___","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"C. Accident details","fields":[{"help":"Date when the damage occurred","type":"date","label":"Date of occurrence","options":[],"required":true,"pdf_field":""},{"help":"Time of occurrence with am or pm","type":"text","label":"Time","options":["am","pm"],"required":true,"pdf_field":""},{"help":"Describe the damaged glass and its location","type":"text","label":"Details of plate glass damaged and address where installed","options":[],"required":true,"pdf_field":""},{"help":"Specify the exact place in the premises","type":"text","label":"Where was the broken glass fitted in the premises","options":[],"required":true,"pdf_field":""},{"help":"Provide approximate dimensions","type":"text","label":"Approx size of damaged glass","options":[],"required":true,"pdf_field":""},{"help":"Specify the glass type","type":"text","label":"Type of glass","options":[],"required":true,"pdf_field":""},{"help":"Explain the cause or circumstances of damage","type":"text","label":"Describe how the damage happened","options":[],"required":true,"pdf_field":""},{"help":"Describe the condition of the glass","type":"text","label":"Is the glass broken/cracked/scratched","options":[],"required":true,"pdf_field":""},{"help":"Select if the frame is damaged","type":"choice","label":"Is the glass frame also damaged","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select the cause; if 'Any other', specify","type":"choice","label":"What is probable cause of the damage","options":["Carelessness","Malicious Act","Fire/Explosion","Storm/hail","Burglary","Any other"],"required":true,"pdf_field":""},{"help":"If 'Any other' cause selected, specify here","type":"text","label":"Any other","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"choice","label":"Did the plate glass have any other damage before the above incident occurred?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe previous damage if any","type":"text","label":"If yes, provide details","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"choice","label":"Is anyone else responsible for the damage","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of responsible party","type":"text","label":"If yes, provide details","options":[],"required":false,"pdf_field":""},{"help":"Name the person or company responsible for repairs","type":"text","label":"Who is responsible for repairs","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"D. Estimated cost of Repairs/replacements","fields":[{"help":"Provide estimated repair or replacement cost","type":"amount","label":"Estimated cost of Repairs/replacements","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"E. Details of other insurances","fields":[{"help":"List other insurance policies covering this damage","type":"text","label":"Provide details of other insurances, if any, covering the incident/damage","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"F. Details of previous losses, if any","fields":[{"help":"Describe any prior losses","type":"text","label":"Details of previous losses, if any","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"choice","label":"If the breakage or damage involved malicious person or burglars, was FIR lodged","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"choice","label":"Any steps taken to prevent future recurrence","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Describe preventive steps taken","type":"text","label":"If yes, please provide details (attach separate sheet if required)","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Sign the form","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Affix company stamp if applicable","type":"text","label":"Company’s stamp","options":[],"required":false,"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) - Plate Glass Insurance claims","attachments":["Photographs","Estimate of repairs/replacement","Invoice and payment receipt for repairs/replacement","Copy of FIR (if FIR was lodged)"],"declarations":["I/We declare that I/We have not withheld any material information and that all statements made on this form are true to the best of my/our knowledge and belief.","I/We declare that the items described above belong to me/us, and that no other person has any interest thereon except as mentioned in the Policy.","I/We understand that the claim may be refused if the 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/812-shopkeepers-package-policy-retail-plate-glass-insurance-claim-form"}