{"id":813,"title":"SHOPKEEPER’S PACKAGE POLICY (RETAIL) Public Liability 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+%283%29.pdf/1695011a-3a85-eef1-9316-4f27e305e6f9?t=1789044313009","sha256":"3ffbf6a98e6dd83fb4ee4e3c896810953aeea179c2d275551d9e321df757576f","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to claim for public liability 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 attached to this form.","The issue or acceptance of this form is not an admission of liability by Magma General Insurance."],"title":"SHOPKEEPER’S PACKAGE POLICY (RETAIL) Public Liability 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 name","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":"Format: DD/MM/YYYY to DD/MM/YYYY","type":"text","label":"Period of Insurance","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"Limit of Indemnity AOA","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"C. Details of Accident","fields":[{"help":"Format: DD/MM/YYYY","type":"date","label":"Date of Accident","options":[],"required":true,"pdf_field":""},{"help":"Specify AM or PM","type":"text","label":"Time of accident","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Where did the accident happen","options":[],"required":true,"pdf_field":""},{"help":"Describe the accident in detail","type":"text","label":"State clearly how the accident occurred","options":[],"required":true,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"When was the accident first reported to you","options":[],"required":true,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"When did you come to know of the accident","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the accident reported to Police or any other authority?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach copy of police or authority report if applicable","type":"text","label":"If yes, please provide details & attach copy of the Report lodged","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Whether any action taken by such authority","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"D. Witness Details","fields":[{"help":"List all witnesses with their full name and address","type":"text","label":"Please provide name and address of all witnesses to the incident/accident","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"E. Demand or Claim Indication","fields":[{"help":"","type":"yes-no","label":"Have you received any indication that a demand or claim will be made upon you for the incident or accident?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach documents if demand or claim is indicated","type":"text","label":"If yes, please provide details including who has raised the demand and attach documents indicating the demand made","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"F. Damage caused to property/livestock","fields":[{"help":"","type":"text","label":"Name of owner","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Description of property/Livestock","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nature of Damage","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Estimate cost of damage","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"G. Injury to persons","fields":[{"help":"","type":"yes-no","label":"Has the accident resulted in death/injuries to any person?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide full details of injured persons","type":"text","label":"If yes, provide name, address, age and occupation of person(s) injured","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Where was the above person(s) at the time of incident","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether injured taken to hospital or treated medically?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide hospital or medical treatment details","type":"text","label":"If yes, provide details","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"H. Estimated claim","fields":[{"help":"Provide estimated claim amounts separately for demand, damage, and injury","type":"amount","label":"Estimated claim, separately under E, F & G above","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"I. Details of other insurances","fields":[{"help":"List other insurance policies covering this incident if any","type":"text","label":"Provide details of other insurances, if any, covering the incident/damage or items/injuries","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"J. Details of previous losses","fields":[{"help":"Provide details of any previous losses related to this policy","type":"text","label":"Details of previous losses, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"K. Declaration","fields":[{"help":"","type":"signature","label":"Signature of insured","options":[],"required":true,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Shopkeeper's Package Policy (Retail) - Public Liability claims","attachments":["Copy of the Police or other authority report if the accident was reported","Documents indicating any demand or claim made"],"declarations":["The information provided on this claim form and statement of claim is true in every respect.","The claim may be refused if information is withheld, false, misleading or concealed.","There was no other insurance covering this loss current as on date of this incident.","This claim form is a legal document and may be used in any legal proceedings resulting from this claim."],"dropped_labels":3},"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/813-shopkeepers-package-policy-retail-public-liability-claim-form"}