{"id":1392,"title":"EVENT CANCELLATION 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/event-cancellation-insurance-policy/claim-form.pdf","sha256":"e1f399703f55fbde9d5152b3eb21b68d35977d2a4e39af4a437cc3060a44267a","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for claiming under the Event Cancellation Insurance Policy (Commercial) and is to be completed and signed by an authorized representative of the insured.","notes":["Issue of this form is not an admission of liability.","Notify the Company without delay as soon as loss or potential loss circumstances are known.","If any detail is not readily available, dispatch the form without delay and send details later.","This form must be completed and signed by an authorized representative of the insured.","The list of documents to attach is not definitive but covers most commonly requested information."],"title":"EVENT CANCELLATION INSURANCE POLICY CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"Enter the full name and address of the insured.","type":"text","label":"Name & Address:","options":[],"required":null,"pdf_field":""},{"help":"Enter the address where the event was planned.","type":"text","label":"Location Address where the Event is / was to be held:","options":[],"required":null,"pdf_field":""},{"help":"Specify the policy year or period applicable.","type":"text","label":"The policy year / period:","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No. If Yes, provide reasons below.","type":"choice","label":"Has the proposed event had to be called off (partially or wholly)?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain the reasons for cancellation.","type":"text","label":"If you answered 'Yes' to the above question, please provide reasons below","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No. If Yes, provide full details below.","type":"choice","label":"Are you planning to Postpone / Reschedule / shift location for this event?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of postponement, rescheduling or location shift.","type":"text","label":"If you answered 'Yes' to the above question, please provide full details below","options":[],"required":null,"pdf_field":""}],"filled_by":"authorized representative of the insured"},{"title":"Claims Details","fields":[{"help":"Provide the date when you first became aware of possible event changes.","type":"date","label":"When did you first become aware that the Event may have to be cancelled; abandoned; interrupted; relocated or postponed?","options":[],"required":null,"pdf_field":""},{"help":"Explain if the event was interrupted or when cancellation decision was made, including reasons.","type":"text","label":"Was the Event interrupted mid-way & reasons for such interruption? or when did you decide to cancel or abandon the Event?","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause leading to cancellation or abandonment.","type":"text","label":"Cause of loss, destruction, damage, accident or injury leading to such cancellation / abandonment of the Event?","options":[],"required":null,"pdf_field":""},{"help":"Explain if the postponed/rescheduled event format will change and how.","type":"text","label":"If the Event is Postponed or Rescheduled, will it be in a similar format as the original one? If not what changes will be made?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of additional costs to carry out the event.","type":"text","label":"Will it be possible to carry out this Event by incurring additional costs? What is the nature of such costs? Please provide full details below","options":[],"required":null,"pdf_field":""},{"help":"Estimate total losses due to event cancellation or interruption.","type":"amount","label":"What do you anticipate will be your total losses as a result of the Cancellation / Abandonment or Interruption of the Insured Event?","options":[],"required":null,"pdf_field":""},{"help":"List expenses incurred or expected for postponement or relocation.","type":"amount","label":"What Expenses have you incurred or expect to incur in order to postpone or relocate the Insured Event?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any other insurance policies covering this loss.","type":"text","label":"Is there any other Policy(ies) which will provide indemnification for this loss? If so, please provide full details","options":[],"required":null,"pdf_field":""}],"filled_by":"authorized representative of the insured"},{"title":"Documents Attached with this form","fields":[{"help":"Indicate if these documents are attached.","type":"choice","label":"Receipts for payments made and/or copies of bank statements:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if these documents are attached.","type":"choice","label":"Copies of contracts & correspondence between you & your suppliers:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if these documents are attached.","type":"choice","label":"Medical certificates and relevant supporting evidence:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if these documents are attached.","type":"choice","label":"Weather reports:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if these documents are attached.","type":"choice","label":"Photographs:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if these documents are attached.","type":"choice","label":"Screenshots and information available on social media sites that could help support your claim:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if these documents are attached.","type":"choice","label":"Copies of Risk Assessments, Accident Books & First Aid reports:","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"authorized representative of the insured"},{"title":"Declaration & Authorization","fields":[{"help":"Enter the date of signing.","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Enter the place of signing.","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Authorized official must sign here.","type":"signature","label":"Signature of the Authorized Official(s)","options":[],"required":null,"pdf_field":""},{"help":"Affix company seal here.","type":"signature","label":"Seal of the Company","options":[],"required":null,"pdf_field":""}],"filled_by":"authorized representative of the insured"}],"deadlines":[],"applies_to":"Event Cancellation Insurance Policy (Commercial)","attachments":["Receipts for payments made and/or copies of bank statements","Copies of contracts & correspondence between you & your suppliers","Medical certificates and relevant supporting evidence","Weather reports","Photographs","Screenshots and information available on social media sites that could help support your claim","Copies of Risk Assessments, Accident Books & First Aid reports"],"declarations":["I/We agree to provide additional information if required and guarantee the truthfulness of the statements.","I/We understand the Company may verify identity, address, facts and documents with third parties.","I/We have read and agree to the Company's privacy policy as amended from time to time.","I/We understand that non-submission of required documents may delay claim processing and the Company is not responsible for such delays.","I/We declare that details of all persons having interest in the property are provided and no other claim for the same loss has been made with any other insurer.","I/We consent to the Company verifying 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/1392-event-cancellation-insurance-policy-claim-form"}