{"id":1368,"title":"COMMERCIAL CRIME INSURANCE 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-crime-insurance/claim-form.pdf","sha256":"0b50ae40a261bc3fa3060851eeb125c03013c9619f3af886026ce94e353bad1e","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for the insured to file a claim under their Commercial Crime Insurance policy.","notes":[],"title":"COMMERCIAL CRIME INSURANCE CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of the Insured","fields":[{"help":"","type":"text","label":"Name & Address of Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Contact Person","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the policy coverage period","type":"text","label":"Period of Policy","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Limit of Indemnity under Policy","options":[],"required":null,"pdf_field":""},{"help":"Provide details if other policies cover this incident","type":"text","label":"Do you have any other policies covering the same incident? If yes, please give details of insurer, policy no., etc.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Particulars of Claim","fields":[{"help":"Provide the date and time when the incident occurred","type":"date","label":"Date and time of occurrence","options":[],"required":null,"pdf_field":""},{"help":"Specify the location of the incident","type":"text","label":"Place of occurrence","options":[],"required":null,"pdf_field":""},{"help":"Explain what happened in detail","type":"text","label":"Describe the events of the circumstance of Claim","options":[],"required":null,"pdf_field":""},{"help":"Date when you first learned about the claim event","type":"date","label":"On which date did you first become aware of the circumstance of the Claim?","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated claim amount and details","type":"amount","label":"What is the estimated amount of Claim and breakup? Any comments on the above","options":[],"required":null,"pdf_field":""},{"help":"Attach copies of investigation or enquiry reports if applicable","type":"text","label":"Have you conducted any internal investigations / police / regulatory authorities’ enquiries conducted? - If yes, please provide copies of relevant reports of enquiries along with correspondence exchanged","options":[],"required":null,"pdf_field":""},{"help":"Provide details and attach related legal documents if any","type":"text","label":"Has there been any demand, suit or legal proceeding related to this incident that has been made against the Insured by any third party? If yes, please give all details. Also attach the notices and correspondence","options":[],"required":null,"pdf_field":""},{"help":"Mention if claim was reported to other insurers","type":"text","label":"Has this claim been reported under any other Policy?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration by Insured","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign here to confirm declaration","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Commercial Crime Insurance claims","attachments":["Copies of relevant reports of enquiries along with correspondence exchanged","Notices and correspondence related to any demand, suit or legal proceeding"],"declarations":["The insured agrees to provide additional information if required and guarantees the truthfulness of the statements.","The 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 acknowledges receipt of a list of required documents and understands that non-submission may delay claim processing.","The insured declares that all persons having interest in the property are disclosed and no similar claim has been made with any other insurer except as disclosed.","The insured consents to verification of identity/address proof and 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/1368-commercial-crime-insurance-claim-form"}