{"id":1396,"title":"BANKERS INDEMNITY – 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/bankers-indemnity-laghu-udyam/claim-form.pdf","sha256":"b2dfb3ca4234e63ad7c4f3afae45f327e2e8305a3b3620c560159da99e313e93","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to file a claim under the Banker’s Indemnity – Laghu Udyam insurance policy for losses covered under various sections such as loss of money, burglary, fire, and others.","notes":["The issue of this form is not an admission of liability.","Please answer all relevant questions fully.","Employee particulars are required where employee involvement is indicated.","The form includes sections for various types of losses; tick the relevant section(s)."],"title":"BANKERS INDEMNITY – LAGHU UDYAM CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured’s Particulars and Claim Details","fields":[{"help":"","type":"text","label":"Insuring Office (Address)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim Sr. No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No","options":[],"required":null,"pdf_field":""},{"help":"Enter the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Contact number of insured","type":"phone","label":"Telephone 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":"Full mailing address","type":"text","label":"Address for Correspondence","options":[],"required":null,"pdf_field":""},{"help":"Contact number","type":"phone","label":"Telephone","options":[],"required":null,"pdf_field":""},{"help":"Insured's profession or occupation","type":"text","label":"Profession/Occupation","options":[],"required":null,"pdf_field":""},{"help":"Address of the bank premises related to the claim","type":"text","label":"Full address of Bank’s premises in respect of which the claim is lodged","options":[],"required":null,"pdf_field":""},{"help":"Tick the applicable section(s) for the claim","type":"checkbox","label":"The claim pertains to losses covered under : Pl tick the relevant Section","options":["Loss of Money and Securities","Fire and Allied Perils-Building & Contents","Burglary","Plate Glass and Neon/Glow Sign Board","Electronic Equipment Insurance","Personal Accident","Public Liability"],"required":null,"pdf_field":""},{"help":"Describe if loss occurred during transit","type":"text","label":"Is the loss whilst the money/securities were in transit. Please give details of the loss","options":[],"required":null,"pdf_field":""},{"help":"Specify cause of loss","type":"text","label":"Is the alleged loss due to Burglary, theft, infidelity of the employee or any other reason? Please specify","options":[],"required":null,"pdf_field":""},{"help":"Provide details if loss involves forgery or alteration","type":"text","label":"Is the loss due to forgery/Alteration. Please give details","options":[],"required":null,"pdf_field":""},{"help":"Details related to hypothecated goods or postal losses","type":"text","label":"Provide details in respect of losses due to hypothecated goods, registered postal sending, appraisers","options":[],"required":null,"pdf_field":""},{"help":"Date and time of the felony","type":"text","label":"On what date and between what hour was the felony committed","options":[],"required":null,"pdf_field":""},{"help":"Details of discovery or suspicion","type":"text","label":"Please state when and under what circumstances the discovery took place or the suspicion was aroused","options":[],"required":null,"pdf_field":""},{"help":"Amount of loss","type":"amount","label":"(a) What is the quantum of loss","options":[],"required":null,"pdf_field":""},{"help":"Date loss occurred","type":"date","label":"(b) When did it take place","options":[],"required":null,"pdf_field":""},{"help":"Date loss was discovered","type":"date","label":"(c) When was it discovered","options":[],"required":null,"pdf_field":""},{"help":"Details of employee involved","type":"text","label":"(d) Employee Particulars(required where employee in involved)","options":[],"required":null,"pdf_field":""},{"help":"Employee's role during loss","type":"text","label":"1. In what capacity was the employee acting at the time of loss","options":[],"required":null,"pdf_field":""},{"help":"Date of last audit finding","type":"date","label":"2. On what date were his accounts last checked and found incorrect by auditors","options":[],"required":null,"pdf_field":""},{"help":"Prosecution status and date","type":"text","label":"3. Has the prosecution been instituted. If so, on what date","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Employee Related Details","fields":[{"help":"Employee suspension or dismissal details","type":"text","label":"4. Has the employee been suspended or dismissed. If so, on what date","options":[],"required":null,"pdf_field":""},{"help":"Salary or commission due and recovery status","type":"text","label":"5. What salary or commission was then due to him. Has it been realised","options":[],"required":null,"pdf_field":""},{"help":"Other securities or guarantees from employee","type":"text","label":"6. Has the employer got any other security or guarantee from the employee","options":[],"required":null,"pdf_field":""},{"help":"Departmental enquiry details and outcome","type":"text","label":"8. Has any departmental enquiry made against the employee. If so, what has been the outcome of this enquiry","options":[],"required":null,"pdf_field":""},{"help":"Police station name where informed","type":"text","label":"9. Has the police been informed. Please give the name of the Police Station","options":[],"required":null,"pdf_field":""},{"help":"Total amount of loss","type":"amount","label":"10. Amount of loss","options":[],"required":null,"pdf_field":""},{"help":"Details of other insurance policies if any","type":"text","label":"11. Is there any other policy in force in respect of the risk from which the loss is alleged. Give the number of policy, name of the company and its underwriting office","options":[],"required":null,"pdf_field":""},{"help":"Indicate if handwriting expert was consulted","type":"yes-no","label":"12. Did you seek the assistance of reliable handwriting expert to satisfy yourselves that the signature was actually false and was not genuine","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Additional relevant information","type":"text","label":"13. Any other relevant particulars that you wish to give","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured claimant","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Losses covered under Banker’s Indemnity – Laghu Udyam policy sections including Loss of Money and Securities, Fire and Allied Perils, Burglary, Plate Glass and Neon/Glow Sign Board, Electronic Equipment Insurance, Personal Accident, Public Liability","attachments":["List of documents as received with this claim form"],"declarations":["The insured guarantees the truthfulness of the statements and understands that false or fraudulent statements may lead to policy cancellation and loss of claim rights.","The company may verify identity, address, facts, and documents with third parties or service providers.","The insured agrees to the company's privacy policy as available on the website and its amendments.","The insured acknowledges receipt of the 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 other claim for the same loss has been made to any other insurer.","The insured consents to verification of identity/address/bank details through Central KYC Registry, UIDAI, or other modes for KYC purposes."],"dropped_labels":2},"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/1396-bankers-indemnity-laghu-udyam-claim-form"}