{"id":1372,"title":"UNIVERSAL SOMPO – CONTRACTUAL LIABILITY 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/contractual-liability/claim-form.pdf","sha256":"3bba4aae81eef1c10c73c5a6e2bd65d4e1de4413bd3e732680f95d3e70cd1e65","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to file a claim under the Universal Sompo Contractual Liability insurance policy.","notes":["If any detail or information is not readily available, do not delay dispatch of this form; such particulars may be sent later.","The issue of this form is not to be taken as an admission of liability."],"title":"UNIVERSAL SOMPO – CONTRACTUAL LIABILITY CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"A. INSURED","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":"insured"},{"title":"B. DETAILS OF LOSS","fields":[{"help":"Format: DD/MM/YYYY","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Specify time and select AM or PM","type":"text","label":"Time","options":["AM","PM"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"LOSS LOCATION Address line 1","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address line 2","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Briefly describe the cause","type":"text","label":"Describe cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Estimated amount in Indian Rupees","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"C. DETAILS OF OTHER INSURANCE","fields":[{"help":"","type":"text","label":"Limits of Indemnity under the Policy","options":[],"required":null,"pdf_field":""},{"help":"Start date of insurance period (DD/MM/YYYY)","type":"date","label":"Period of Insurance From","options":[],"required":null,"pdf_field":""},{"help":"End date of insurance period (DD/MM/YYYY)","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of other insurer or insured","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Name of other insurer","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Address of other insurer","type":"text","label":"Address line 1","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address line 2","options":[],"required":null,"pdf_field":""},{"help":"Phone number of other insurer","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of other insurer","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of other insurer","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No and provide details if Yes","type":"yes-no","label":"Is the Loss/damage covered under any other Insurance? If \"Yes\", specify details and attach copy of policy","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other insurer if applicable","type":"text","label":"Name of the Insurer","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"E. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"Columns: Claim Year, Claim Description, Amount Rs.","type":"table","label":"Claims lodged during the preceding 3 years","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"F. DETAILS OF OTHER INFORMATION","fields":[{"help":"Select Yes or No and provide details if No","type":"yes-no","label":"Is the insured sole owner of the property? If \"No\", specify details","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No and provide details if Yes","type":"yes-no","label":"Do you wish to provide any other information? If \"Yes\", specify","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing (DD/MM/YYYY)","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured","type":"signature","label":"Signature","options":[],"required":null,"pdf_field":""},{"help":"Full name of the insured","type":"text","label":"Name of Insured","options":[],"required":null,"pdf_field":""},{"help":"Address of insured","type":"text","label":"Address line 1","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Contractual Liability insurance claims","attachments":["Additional details can be attached with annexure to this claim form.","Attach copy of policy if loss/damage is covered under any other insurance."],"declarations":["The claimant declares all information is true and no material information is withheld.","The company may verify identity, address, facts and documents with third parties.","The claimant agrees to the company's privacy policy as amended from time to time.","The claimant understands that non-submission of required documents may delay claim processing.","The claimant declares details of all persons having interest in the property are provided and no duplicate claims exist.","The claimant consents to verification of identity/address/bank details through Central KYC Registry or UIDAI or other modes."],"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/1372-universal-sompo-contractual-liability-claim-form"}