{"id":970,"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/miscellaneous/machinery-insurance/Claim%20form.pdf","sha256":"ad6c5ddccaff6dc6580409238a3922765288b4dbb0e58c47cf17b7940a068dec","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for policyholders to claim insurance for loss or damage to machinery under their policy with The New India Assurance Company Limited.","notes":["Please use additional pages if required.","The issue of this form is not to be taken as an admission of liability."],"title":"CLAIM FORM MACHINERY INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"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":""},{"help":"Enter your full name","type":"text","label":"1 Name","options":[],"required":null,"pdf_field":""},{"help":"Enter your full address","type":"text","label":"2 Address","options":[],"required":null,"pdf_field":""},{"help":"Provide the exact date and time of the loss or damage","type":"date","label":"3 When did the loss or damage occur ? (State date and hour)","options":[],"required":null,"pdf_field":""},{"help":"Provide full name and address of any witness","type":"text","label":"4 Give the name and address of the witness to the occurrence.","options":[],"required":null,"pdf_field":""},{"help":"Describe the damaged item","type":"text","label":"5 What was damaged ? (a) Item of the Inventory","options":[],"required":null,"pdf_field":""},{"help":"Select whether the property was brand new or second hand","type":"choice","label":"6 (a) Was the property brand new or second hand ?","options":["brand new","second hand"],"required":null,"pdf_field":""},{"help":"Describe the item if totally destroyed","type":"text","label":"7 Is the damaged property totally destroyed ? (a) Item of the Inventory","options":[],"required":null,"pdf_field":""},{"help":"Answer if the property is totally destroyed","type":"yes-no","label":"8 Is the damaged property totally destroyed ?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe the damage and parts needing replacement","type":"text","label":"9 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 expired and date","type":"text","label":"10 Has the period of guarantee expired? If so, when ?","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated loss amount","type":"amount","label":"11 What is the estimated amount of loss or Damage?","options":[],"required":null,"pdf_field":""},{"help":"Explain cause and circumstances of damage; attach sketch if possible","type":"text","label":"12 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","type":"text","label":"13 Has the property undergone any repairs previously (a) What was the nature of such repairs ?","options":[],"required":null,"pdf_field":""},{"help":"Provide workshop name and address for repairs","type":"text","label":"14 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 the form","type":"signature","label":"Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"ECS Details of the Insured","fields":[{"help":"Enter name exactly as in bank account","type":"text","label":"1 Name of the Insured (as appearing in the Bank Account)","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"2 Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch and address","type":"text","label":"3 Branch and address","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"4 Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Specify account type (e.g. savings, current)","type":"text","label":"5 Bank Account Type","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code of the bank branch","type":"text","label":"6 IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"Enter MICR code of the bank branch","type":"text","label":"7 MICR Code","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Machinery Insurance","attachments":[],"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":10},"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/970-claim-form-machinery-insurance"}