{"id":1398,"title":"BUSINESS SHIELD (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/business-shield-policy-laghu-udyam/claims-form.pdf","sha256":"4c204af24c46b7dee9a13e40f3292720e59cacc7a194a45b5598c91e592df4dd","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to file a claim under the Business Shield (Laghu Udyam) insurance policy for loss or damage to business property.","notes":["If any detail or information is not readily available, do not delay dispatch of this form; such particulars may be sent later.","Attach copy of other insurance policy if applicable.","Use the toll free number or email for claim assistance."],"title":"BUSINESS SHIELD (LAGHU UDYAM) - CLAIM FORM","submit":{"to":"Universal Sompo General Insurance Co. Ltd. claims department","how":"e-mail or post","address":"Email: contactclaims@universalsompo.com; Toll free: 1-800-22-4030 / 1800-200-4030"},"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":"Primary address line","type":"text","label":"Address line 1","options":[],"required":null,"pdf_field":""},{"help":"Secondary address line","type":"text","label":"Address line 2","options":[],"required":null,"pdf_field":""},{"help":"City of residence","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"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":"Type of business or occupation","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":"Maximum coverage amount","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","type":"text","label":"Time / / AM / PM","options":[],"required":null,"pdf_field":""},{"help":"Location where loss happened","type":"text","label":"LOSS LOCATION Address line 1","options":[],"required":null,"pdf_field":""},{"help":"Additional location details","type":"text","label":"Address line 2","options":[],"required":null,"pdf_field":""},{"help":"City of loss location","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of loss location","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of loss location","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number at loss location","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number at loss 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No.","options":[],"required":null,"pdf_field":""},{"help":"Witness mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Witness email","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Select if authorities have been informed","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 line 1","type":"text","label":"Address Line 1","options":[],"required":null,"pdf_field":""},{"help":"Authority 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DETAILS OF OTHER INTEREST","fields":[{"help":"Indicate if insured is sole owner","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 other interested party","type":"text","label":"Name of insured interest","options":[],"required":null,"pdf_field":""},{"help":"Names of persons with interest","type":"text","label":"Person/s who has interest on property","options":[],"required":null,"pdf_field":""},{"help":"Type of interest held","type":"text","label":"His nature of interest","options":[],"required":null,"pdf_field":""},{"help":"Address line 1 of interested party","type":"text","label":"Address Line 1","options":[],"required":null,"pdf_field":""},{"help":"City of interested party","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of interested party","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of interested party","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of interested party","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of interested party","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of interested party","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. 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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/1398-business-shield-laghu-udyam-claim-form"}