{"id":1395,"title":"JEWELLER’S COMPREHENSIVE (LAGHU UDYAM)- 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/jewellers-comprehensive-laghu-udhyam/claim-form.pdf","sha256":"39a6d3632717f94feaa4082cc8647b27be030a020def9ae73e23c2c2836a38fb","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to file a claim under the Jeweller’s Comprehensive Insurance - Laghu Udyam policy for loss or damage. The insured fills this form.","notes":["The issue of this form is not an admission of liability.","If any detail is not readily available, send the form without delay and provide particulars later.","Use original bills and documents as per the list provided with the claim form.","The toll free numbers for assistance are 1-800-22-4030 / 1800-200-4030."],"title":"JEWELLER’S COMPREHENSIVE (LAGHU UDYAM)- CLAIM FORM","submit":{"to":"Universal Sompo General Insurance Company Limited","how":"","address":"Email: contactclaims@universalsompo.com"},"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":""},{"help":"Name of the insured","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Address of the insured","type":"text","label":"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":"6-digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Landline phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Business or occupation of the insured","type":"text","label":"Business/Occupation","options":[],"required":null,"pdf_field":""},{"help":"Policy coverage period","type":"date","label":"Period of Insurance From / / To / /","options":[],"required":null,"pdf_field":""},{"help":"Sum insured or indemnity limit","type":"amount","label":"Limits of Indemnity under the Policy","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"B. DETAILS OF LOSS","fields":[{"help":"Date when loss occurred","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Time of loss with AM or PM","type":"text","label":"Time AM / PM","options":[],"required":null,"pdf_field":""},{"help":"Location where loss occurred","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":"Landline phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Brief description of how loss or damage happened","type":"text","label":"Describe cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Date theft was discovered","type":"date","label":"DETAILS OF THEFT Date of Discovery","options":[],"required":null,"pdf_field":""},{"help":"Details of stolen item","type":"text","label":"Item Lost (Year/Make/Model)","options":[],"required":null,"pdf_field":""},{"help":"Original purchase price of the item","type":"amount","label":"Original Purchase Value","options":[],"required":null,"pdf_field":""},{"help":"Date when item was purchased","type":"date","label":"Purchase Date","options":[],"required":null,"pdf_field":""},{"help":"Amount claimed for the item","type":"amount","label":"Value Claimed","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is any witness available for accident / loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of witness if available","type":"text","label":"If \"Yes\", specify Name of the Witness","options":[],"required":null,"pdf_field":""},{"help":"Witness address","type":"text","label":"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":"Landline phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Have any authority been informed about Accident/ Loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of authority informed","type":"text","label":"If \"Yes\", specify Name of the Authority","options":[],"required":null,"pdf_field":""},{"help":"Contact person at authority","type":"text","label":"Contact Person","options":[],"required":null,"pdf_field":""},{"help":"Reference number given by authority","type":"text","label":"Authority reference no.","options":[],"required":null,"pdf_field":""},{"help":"Authority address","type":"text","label":"Address Line 1","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address Line 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policy","options":[],"required":null,"pdf_field":""},{"help":"Name of other insurer","type":"text","label":"Name of the Insurer","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":"","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":"Landline phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Email of other insurer","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Coverage period of other insurance","type":"date","label":"Period of Insurance From / / To / /","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other insurance","type":"amount","label":"Amount of Insurance","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"C. DETAILS OF OTHER INTEREST","fields":[{"help":"Select Yes or No","type":"choice","label":"Is the insured sole owner of the proper? If \"Yes\", specify details","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of person having interest in property","type":"text","label":"Name of insured interest","options":[],"required":null,"pdf_field":""},{"help":"Name(s) of other interested persons","type":"text","label":"Person/s who has interest on property","options":[],"required":null,"pdf_field":""},{"help":"Nature of interest in property","type":"text","label":"His nature of interest","options":[],"required":null,"pdf_field":""},{"help":"Address of interested person","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":"Landline phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email address","type":"email","label":"Email","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"D. 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":"E. DETAILS OF OTHER INFORMATION","fields":[{"help":"Select Yes or No","type":"choice","label":"Do you wish to provide any other information?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Additional information if any","type":"text","label":"If “Yes”, specify","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of insured","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Name of insured signing the form","type":"text","label":"Name of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Jeweller’s Comprehensive Insurance - Laghu Udyam","attachments":["Copy of policy if loss/damage is covered under any other insurance","List of documents as received with this claim form"],"declarations":["The insured agrees to provide additional information if required and guarantees truthfulness of 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 understands that non-submission of required documents may delay claim processing.","The insured declares all persons having interest in the property are disclosed and no duplicate claims exist.","The insured consents to verification of identity/address/bank details through Central KYC Registry or UIDAI."],"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/1395-jewellers-comprehensive-laghu-udyam-claim-form"}