{"id":1350,"title":"FINE ARTS INSURANCE POLICY CLAIM FORM","purpose":"claim","insurer":{"slug":"universal-sompo-general-insurance","name":"Universal Sompo General Insurance Company Limited"},"source_pdf":"https://www.universalsompo.com/assets/file/fine-arts-insurance-policy/claim-form.pdf","sha256":"6a5aafd3df3239735ae1c0da3119f0c5096e233a0529090c6e2f744f1ab0a28e","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for insured persons to claim under their Fine Arts Insurance Policy for loss or damage to insured artwork.","notes":["All questions must be answered fully; use separate sheet if needed.","Do not dispose or destroy damaged property without consent of surveyor or insurer.","The issue or acceptance of this form is not admission of liability by the insurer.","Make no offer or admission of liability to third parties.","Send any communications regarding the accident to the company immediately.","This form is issued without prejudice to policy terms and conditions.","The form must be returned immediately to the company or surveyor.","Use block letters and attach original documents as required."],"title":"FINE ARTS INSURANCE POLICY 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":"Full postal address","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":"Name of alternate contact person","type":"text","label":"Contact name","options":[],"required":false,"pdf_field":""},{"help":"Mobile of contact person","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Email of contact person","type":"email","label":"Email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"B. Policy Details","fields":[{"help":"Policy number as per your insurance documents","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Start date of policy coverage","type":"date","label":"Period of Insurance","options":[],"required":true,"pdf_field":""},{"help":"End date of policy coverage","type":"date","label":"to","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"C. Loss Details","fields":[{"help":"Date of loss","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Time of loss with am or pm","type":"text","label":"Time","options":["am","pm"],"required":true,"pdf_field":""},{"help":"Full address where loss occurred","type":"text","label":"Location/Address of Loss","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Describe use of premises (e.g. gallery, residence)","type":"text","label":"Premises occupied as","options":[],"required":true,"pdf_field":""},{"help":"Nature of loss or damage","type":"text","label":"Type of Loss","options":[],"required":true,"pdf_field":""},{"help":"Cause or reason for loss","type":"text","label":"Cause of Loss","options":[],"required":true,"pdf_field":""},{"help":"Explain details of the incident","type":"text","label":"Describe fully circumstances of Loss, how it happened","options":[],"required":true,"pdf_field":""},{"help":"List each artwork with artist/origin and year created","type":"table","label":"Details of Artwork Insured: 1. Art work 2. Artist/Origin 3. Year of creation","options":[],"required":true,"pdf_field":""},{"help":"Claim amount for loss","type":"amount","label":"Amount Claimed","options":[],"required":true,"pdf_field":""},{"help":"Value recovered from damaged item if applicable","type":"amount","label":"Salvage towards damaged Item, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"D. General","fields":[{"help":"Tick yes or no; if yes attach FIR/Fire Brigade report","type":"yes-no","label":"Has the loss or damage been reported to the Police/Fire Brigade?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if yes attach meteorological report or newspaper clipping","type":"yes-no","label":"Has the loss/damage been caused due to flood, earthquake, storm or any other Act of God?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if yes provide insurer name, policy no. and copy of policy","type":"yes-no","label":"Is there any other insurance in force providing cover for this loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if yes provide date, amount and insurer name","type":"yes-no","label":"Have you ever suffered a loss or damage in the past?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick applicable fire protection systems and indicate if activated","type":"checkbox","label":"Are the premises protected by a Fire Protection/Detection system? Hydrant Yes No Sprinkler Yes No Smoke Detector Yes No Extinguisher(s) Yes No Was the same activated during the incident","options":["Hydrant Yes","Hydrant No","Sprinkler Yes","Sprinkler No","Smoke Detector Yes","Smoke Detector No","Extinguisher(s) Yes","Extinguisher(s) No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if yes provide details","type":"yes-no","label":"Did you take any measures to minimize the loss?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if yes provide details","type":"yes-no","label":"Are there any steps taken to prevent a reoccurrence?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if yes provide name, address & phone no.","type":"yes-no","label":"Was there another person, in your opinion, responsible for the loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if yes provide name, address, phone no. and enclose statement","type":"yes-no","label":"Was there any witness(es) to the incident?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if yes provide name & address of relevant parties","type":"yes-no","label":"Is the property subject to a hire purchase or hypothecation agreement?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if yes provide details","type":"yes-no","label":"Has there been any alteration in the occupation or use of the premises since the Policy was taken up?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if no, specify since when unoccupied","type":"yes-no","label":"Were the premises occupied at the time of the loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if no provide details of other interested parties","type":"yes-no","label":"Are you the sole owner of the premises/property?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Are you responsible for repairs?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide total value of all property at premises","type":"amount","label":"At the time of loss, what was the total value of all property in the premises?","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Signature of the insured person","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Fine Arts Insurance Policy claims","attachments":["Legible copy of FIR/Fire Brigade Report if loss reported to Police/Fire Brigade","Copy of report from meteorological department or newspaper clipping if loss caused by Act of God","Copy of other insurance policy if other insurance covers the loss","Statement from witness(es) if any","List of documents as received with this claim form"],"declarations":["All statements made are true and no material information is withheld.","Articles/property belong to the insured and no other person has interest except as mentioned in the policy.","Company may verify identity, address, facts and documents with third parties.","The insured agrees to the company's privacy policy as amended from time to time.","The insured has received and understood the list of required documents for claim processing.","Details of all persons having interest in the property are provided and no duplicate claims have been made.","Consent is given to verify identity/address/bank details through Central KYC Registry, UIDAI or other modes for KYC."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"contactclaims@universalsompo.com","label":"Claims Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/resourse-grievance-redressal/","quote":"e Claim Details\nTPA’s Servicing Group Health Insurance\nDownload Pulz App\nConnect with Us\ncontactus@universalsompo.com\ncontactclaims@universalsompo.com\nHealth Insurance :\nComplete Healthcare Insurance\nA Plus Health Insurance\nSaral Suraksha Bima\nGroup Mashak Rakshak Polic","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"contactus@universalsompo.com","label":"Theft Claim Email","level":null,"hours":null,"applies_to":"motor","source_url":"https://www.universalsompo.com/claimintimation/","quote":"ntimate claim.\nFor\nTheft Claim\n, please connect with us on below details.\nPhone:\n1800-22-4030\n,\n1800-200-4030\nor\nEmail:\ncontactus@universalsompo.com\nOk\nView All Policies\nHealth Insurance\nComplete Healthcare Insurance\nSuper Healthcare Insurance\nArogya SanjeevaniInsuran","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-22-4030","label":"Claims Toll Free Number (MTNL/BSNL Lines)","level":null,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/claims/","quote":null,"fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"022-41582900 - 41582999","label":"Claims Helpline Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.universalsompo.com/claims/","quote":"tactclaims@universalsompo.com 2. Call on our Toll Free number 1-800-22-4030 (from MTNL & BSNL Lines) 3. Helpline number 022-41582900 - 41582999\nIn case of telephonic contact, our call centre executive shall note down the basic requirements and pass on the informa","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-200-4030","label":"Motor Claim Intimation Toll Free","level":null,"hours":"24/7","applies_to":"motor","source_url":"https://www.universalsompo.com/claimintimation/","quote":"Motor Claim Intimation for Coverage | Universal Sompo\n24/7, Customer Care\n1800-22-4030\n,\n1800-200-4030\nCrop Helpline No.\n1800-200-5142\nSenior Citizen\n1800-267-4030\nAbout\r\n                                us\nContact Us\nLogin","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-200-5142","label":"Crop Helpline Number","level":null,"hours":null,"applies_to":"crop","source_url":"https://www.universalsompo.com/claimintimation/","quote":"otor Claim Intimation for Coverage | Universal Sompo\n24/7, Customer Care\n1800-22-4030\n,\n1800-200-4030\nCrop Helpline No.\n1800-200-5142\nSenior Citizen\n1800-267-4030\nAbout\r\n                                us\nContact Us\nLogin\nI am a Customer\nI am an Agent\nP","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/universal-sompo-general-insurance/1350-fine-arts-insurance-policy-claim-form"}