{"id":1367,"title":"INLAND FRESH WATER FISHERY 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/commercial/inland-fresh-water-fish-insurance/claim-form.pdf","sha256":"282d657bbcadaa8ffd66cbe21d9bf035350acdf2365bf8fd97981a0b43de51b3","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim under the Inland Fresh Water Fishery Insurance Policy (Commercial) for losses related to fishery projects. The insured fills the form and the State Fisheries Department authority fills the death certificate section.","notes":["The issue of this form is not an admission of liability.","The death certificate section must be completed by the concerned authority of the State Fisheries Department.","Attach original bills to support the claim amount.","Use the form as soon as possible and submit without delay.","The form includes office use sections not to be filled by the claimant."],"title":"INLAND FRESH WATER FISHERY INSURANCE POLICY CLAIM FORM","submit":{"to":"the Company","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details and Claim Information","fields":[{"help":"","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Include country and area code if applicable","type":"phone","label":"Telephone No./Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E-mail ID No.","options":[],"required":null,"pdf_field":""},{"help":"Fill details for each tank/project as applicable","type":"table","label":"Details of Project and Claim : Name and Location of the Project, Water area in hectares, Survey Nos, No. & Species of Fishes stacked tank wise, Average weight at the time of Loss, Value prior to loss (input cost)","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause of loss in detail","type":"text","label":"Cause of loss with full details","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is there any outbreak of epidemic in the vicinity?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date format as DD/MM/YYYY","type":"date","label":"Date of occurrence of accident or disease, when seen first.","options":[],"required":null,"pdf_field":""},{"help":"Describe preventive measures taken","type":"text","label":"What are the steps taken to prevent loss after the accident/disease/epidemic?","options":[],"required":null,"pdf_field":""},{"help":"Specify total or partial loss and extent if partial","type":"text","label":"Whether the accident or disease caused total loss of fishes or only partial loss. If partial, what is the extent of loss?","options":[],"required":null,"pdf_field":""},{"help":"Date format as DD/MM/YYYY","type":"date","label":"If total, date by which the loss was total","options":[],"required":null,"pdf_field":""},{"help":"Date format as DD/MM/YYYY","type":"date","label":"When the notice was sent to the certifying officer?","options":[],"required":null,"pdf_field":""},{"help":"Include source, purchase date and price","type":"text","label":"Source and date of purchase of post larvae & price paid.","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If the loss has been due to pollution, poisoning, riot & strike - give details","options":[],"required":null,"pdf_field":""},{"help":"Attach supporting bills","type":"amount","label":"Amount of Claim (input Cost) to be supported by Bills","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Are fishes insured elsewhere? Are you receiving compensation from any other source? If so, from where?","options":[],"required":null,"pdf_field":""},{"help":"Enter volume in cubic meters","type":"number","label":"Total volume of bunds in cubic meters before loss.","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed volume calculations","type":"text","label":"Volume of earth washed away. Give working separately (tank wise & bunds wise)","options":[],"required":null,"pdf_field":""},{"help":"Specify measurements of breaches","type":"text","label":"Measurement of breaches, if any.","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated repair costs","type":"amount","label":"Cost of repairs of bunds","options":[],"required":null,"pdf_field":""},{"help":"Specify rate per cubic metre","type":"amount","label":"Rate paid for cubic metre of earth work.","options":[],"required":null,"pdf_field":""},{"help":"Provide total claim amounts separately","type":"amount","label":"Total Claim : (a) Fishes (b) Bunds","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Sign the form","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Date of signing (DD/MM/YYYY)","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Death Certificate (To be filled by the concerned authority of the State Fisheries Department)","fields":[{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Location of the Farm","options":[],"required":null,"pdf_field":""},{"help":"Date format as DD/MM/YYYY","type":"date","label":"Date of Stocking (Breed wise)","options":[],"required":null,"pdf_field":""},{"help":"Provide stocking density details","type":"text","label":"Stocking Density","options":[],"required":null,"pdf_field":""},{"help":"Specify age","type":"text","label":"Age at the time of death /loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Species of the fishes","options":[],"required":null,"pdf_field":""},{"help":"Weight in grams","type":"number","label":"Average weight in grams at the time of death/loss","options":[],"required":null,"pdf_field":""},{"help":"Date format as DD/MM/YYYY","type":"date","label":"Date of loss/accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Value at the time of death (in terms of incurred expenses)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Specify total or partial and approximate percentage if partial","type":"text","label":"Whether the loss is total or partial (if partial specify in terms of approximate percentage)","options":[],"required":null,"pdf_field":""},{"help":"List methods and dates used for assessment","type":"text","label":"Methods adopted for assessment of loss and date (a) Drag Netting (b) Draining of pond (c) Any other method","options":[],"required":null,"pdf_field":""},{"help":"Provide salvage percentage and expected value","type":"text","label":"Percentage of salvage and value expected","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether salvage is fit for human consumption","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"If the loss is due to disease, whether any specimen collected and sent to the laboratory","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Remedial measures suggested (if any) prior to occurrence of loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Had the Insured taken necessary preventive measures/steps for minimizing the loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Had the Insured taken proper care and observed all the scientific guidelines?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"List inspection dates","type":"text","label":"Dates of Inspection of the farm","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of certifying authority","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of signing (DD/MM/YYYY)","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name, Qualification","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Designation & Address","options":[],"required":null,"pdf_field":""}],"filled_by":"State Fisheries Department authority"}],"deadlines":["This form should be completed without delay and forwarded to the Company along with the Claim Form."],"applies_to":"Inland Fresh Water Fishery Insurance Policy (Commercial) claims","attachments":["Bills supporting the Amount of Claim (input Cost)","List of documents received with the claim form"],"declarations":["The insured agrees to provide additional information if required and guarantees the truthfulness of the statements.","The Company reserves the right to 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 documents required for claim processing and acknowledges that delays due to non-submission are not the Company's responsibility.","The insured declares that details of all persons having interest in the property are provided and no other claim for the same loss has been made elsewhere.","The insured consents to verification of identity/address/bank details through Central KYC Registry, UIDAI or other modes for KYC purposes."],"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/1367-inland-fresh-water-fishery-insurance-policy-claim-form"}