{"id":835,"title":"FIDELITY GUARANTEE INSURANCE POLICY (RETAIL) 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+Fidelity+Guarantee.pdf/73682dd3-39ef-5ef9-9ecd-231b16aed5fe?t=1789044384830","sha256":"de9daf32dd1ca0888b8435148757d9ae63ffcf46c9d7edb97bc9d3d75bbbd6e1","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim under the Fidelity Guarantee Insurance Policy (Retail) for losses due to defalcation by an employee.","notes":["All questions must be answered fully; use a separate sheet if space is insufficient.","Incomplete or blank sections will cause the form to be returned for completion.","The issue or acceptance of this form is not an admission of liability by the insurer.","If the matter is not reported to police, lodge FIR at the earliest."],"title":"FIDELITY GUARANTEE INSURANCE POLICY (RETAIL) 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":""},{"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 insurance period","type":"date","label":"Period of Insurance : From to","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"C. Loss Details","fields":[{"help":"Enter amount in Rs.","type":"amount","label":"Amount of loss sustained","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date of discovery of defalcation","options":[],"required":true,"pdf_field":""},{"help":"Provide the date range when defalcation occurred","type":"text","label":"Dates of defalcation","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name, designation and address of defaulting employee","options":[],"required":true,"pdf_field":""},{"help":"Explain the manner of defalcation","type":"text","label":"Describe how the defalcation was committed","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Has the matter been reported to Police","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach FIR copy if reported","type":"attachment","label":"If yes, please attach copy of FIR","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"D. Details of defaulting employee","fields":[{"help":"Describe employee's role and location","type":"text","label":"In what capacity the defaulting employee was engaged and where","options":[],"required":true,"pdf_field":""},{"help":"Explain the process of money handling","type":"text","label":"How did the money reach his hands","options":[],"required":true,"pdf_field":""},{"help":"Provide amount and duration","type":"text","label":"State the largest sum held by him at any one time and for how long","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Was he allowed to pay out any amounts in insured’s behalf","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide authorizer's name and designation","type":"text","label":"Who authorized these payments, state name and designation","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Was the defaulting employee required to give printed receipts from a book with counterfoils","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Frequency and person checking counterfoils","type":"text","label":"If yes, how often were the counterfoils checked and by whom","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Was any money paid into the Bank by defaulting employee","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Frequency and person reconciling bank-books","type":"text","label":"If yes, how often were the Bank-books examined/reconciled and by whom","options":[],"required":false,"pdf_field":""},{"help":"Amount of balance allowed","type":"text","label":"What balance, if any, was allowed to be kept in defaulting employee’s hands","options":[],"required":false,"pdf_field":""},{"help":"Frequency and method of cash account checks","type":"text","label":"How often his the Cash accounts balanced and how was their accuracy checked","options":[],"required":false,"pdf_field":""},{"help":"Frequency of independent account sending","type":"text","label":"How often were account sent directly to customers independently of the employee","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"E. Claim involving Stocks","fields":[{"help":"Tick Yes or No","type":"choice","label":"Did the employee have charge of stocks","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain how stocks were handled","type":"text","label":"If yes, in what way did the stocks reach his hands","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Was he allowed to issue stores/materials independently","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide authorizer's name and designation","type":"text","label":"If not, who authorized these issues, state name and designation","options":[],"required":false,"pdf_field":""},{"help":"Frequency and person checking stocks","type":"text","label":"How often was the position of stocks handled by the defaulting employee checked and by whom","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"When was the last check made","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"F. General","fields":[{"help":"Frequency and auditor details","type":"text","label":"How often the Accounts Books/Stock Books at the place of defaulting employee’s employment were audited and by whom","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Date of last audit","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Was there a previous irregularity as regards defaulter’s work area","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of previous irregularity","type":"text","label":"If yes, state the details","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Has the insured any money (salary, remuneration, commission etc), estate or effects of the defaulting employee in his possession","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details and amount","type":"text","label":"If yes, give details with amount","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Does the insured hold any other security/ guarantee from the defaulting employee","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details and amount","type":"text","label":"If yes, give details and amount","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Is the defaulting employee member of a joint family or does he hold any property, furniture or other effects","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details","type":"text","label":"If yes, give details","options":[],"required":false,"pdf_field":""},{"help":"Provide names and addresses","type":"text","label":"Give names and addresses of employee’s near relatives","options":[],"required":false,"pdf_field":""},{"help":"Describe actions taken","type":"text","label":"What action has been taken against the defaulting employee","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"G. Declaration","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":""},{"help":"Affix company stamp","type":"text","label":"Company’s stamp","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Fidelity Guarantee Insurance Policy (Retail)","attachments":["Copy of FIR if reported to police"],"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 articles/property described belong to me/us and no other person has any interest 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/835-fidelity-guarantee-insurance-policy-retail-claim-form"}