{"id":952,"title":"CLAIM FORM MACHINERY INSURANCE","purpose":"claim","insurer":{"slug":"new-india-assurance","name":"The New India Assurance Company Limited"},"source_pdf":"https://www.newindia.co.in/assets/docs/know-more/engineering/contractors-plant-and-mach-fl/CPM%20Claim%20form.pdf","sha256":"115a27a1bae409f75c61c0eddb3d2071f522bd862150cc5653d1c49dc3a54a76","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim insurance for machinery damage under their machinery insurance policy.","notes":["Please use additional pages if required."],"title":"CLAIM FORM MACHINERY INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Claim Details","fields":[{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Insured and Contract Details","fields":[{"help":"","type":"text","label":"Title of contract insured :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name(s) of Insured(s).","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address(es) of Insured(s).","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Location and address of Contract Site:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Supervising Engineer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nearest Railway Station (Airport)","options":[],"required":null,"pdf_field":""},{"help":"Describe the best route to reach the contract site from the nearest railway station or airport","type":"text","label":"Advisable approach route to contract Site from railway station (airport) or otherwise","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Damage Details","fields":[{"help":"Select all that apply","type":"choice","label":"Which items were damaged ?  (a) Contract works (b) Construction plant and equipment (c )Construction machinery","options":["Contract works","Construction plant and equipment","Construction machinery"],"required":null,"pdf_field":""},{"help":"Provide the exact date and time of the loss or damage","type":"date","label":"When did the loss or damage occur? (State date and exact time)","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause and circumstances of the damage; attach sketches or photos if available","type":"text","label":"How did the damage occur and what was its probable cause ? (Attach sketches, photos etc.)","options":[],"required":null,"pdf_field":""},{"help":"Provide contact details of any witness to the damage","type":"text","label":"Give the name and address of the witness to the occurrence","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed information about the damaged item including inventory item, sum insured, machine type and capacity, manufacturer details, and replacement cost","type":"text","label":"What was damaged ?  (a) Item of the Inventory (b) Sum Insured (c) Type of machine output of capacity (d) Manufacturers and year of manufacture (Full details on maker's plate to be given) (e) What is the cost of replacement of the machine by a new machine of the same size and capacity","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"(a) Was the property brand new or second hand ?","options":["Brand new","Second hand"],"required":null,"pdf_field":""},{"help":"Provide date or details of last maintenance or overhaul","type":"text","label":"(b) What was the last occasion before the damage when the machine was over-hauled or attended to for maintenance or damage","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the damaged property totally destroyed ?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe the damage extent and parts needing replacement","type":"text","label":"What has occurred and which parts of the property are damaged to such an extend the replacement is necessary?","options":[],"required":null,"pdf_field":""},{"help":"State if guarantee period is over and provide date if applicable","type":"text","label":"Has the period of guarantee expired? If so, when ?","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated financial loss amount","type":"amount","label":"What is the estimated amount of loss or Damage?","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed explanation and sketches if possible","type":"text","label":"What was the cause of the damage and how did it occur? (This question must be answered in detail and a sketch given wherever possible)","options":[],"required":null,"pdf_field":""},{"help":"Describe any previous repairs and their nature","type":"text","label":"Has the property undergone any repairs previously (a) What was the nature of such repairs ? (a) (b)","options":[],"required":null,"pdf_field":""},{"help":"Provide details of the repair workshop","type":"text","label":"Give the name and address of the workshop where repairs will be executed : (Provisional repairs will be indemnified)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration and Signature","fields":[{"help":"Sign and date the form","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"ECS Details of the Insured","fields":[{"help":"","type":"text","label":"Name of the Insured (as appearing in the Bank Account)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Branch and address","options":[],"required":null,"pdf_field":""},{"help":"Provide bank account number for ECS","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Specify type of bank account (e.g. savings, current)","type":"text","label":"Bank Account Type","options":[],"required":null,"pdf_field":""},{"help":"Provide IFSC code of the bank branch","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"Provide MICR code of the bank branch","type":"text","label":"MICR Code","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"machinery insurance claims","attachments":["sketches","photos"],"declarations":["The policyholder declares to have answered the questions conscientiously and faithfully and is liable for the correctness and completeness of the statement."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"nia.[office code]@newindia.co.in","label":"Email for Claim Intimation (replace [office code] with actual code)","level":null,"hours":null,"applies_to":"all","source_url":"https://www.newindia.co.in/assets/docs/know-more/motor/Customer%20Information%20Sheet%20%28CIS%29%20Two%20Wheeler%20Package%20Policy.pdf","quote":"laim to The New India Assurance Co Ltd via– • Website – www.newindia.co.in • Toll Free Number – 1800-209-1415 • Email – nia.[office code]@newindia.co.in • Details of procedure to be followed for cashless service as well as for reimbursement of claim • Intimation of claim","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-209-1415","label":"Toll Free Number for Claims Intimation","level":null,"hours":null,"applies_to":"all","source_url":"https://www.newindia.co.in/assets/docs/know-more/motor/Customer%20Information%20Sheet%20%28CIS%29%20Two%20Wheeler%20Package%20Policy.pdf","quote":"claimant may intimate claim to The New India Assurance Co Ltd via– • Website – www.newindia.co.in • Toll Free Number – 1800-209-1415 • Email – nia.[office code]@newindia.co.in • Details of procedure to be followed for cashless service as well as for re","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/new-india-assurance/952-claim-form-machinery-insurance"}