{"id":1400,"title":"BUSINESS SHIELD - 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/claims-form.pdf","sha256":"dc9b41f35f49e9d18beb00ae9e40b02bba785e9299b8fe9d1047b01387754818","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for the insured to report and claim losses under the Business Shield insurance policy.","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 the toll free numbers or email for claim assistance.","Office use only sections are excluded from this form."],"title":"BUSINESS SHIELD - CLAIM FORM","submit":{"to":"Universal Sompo General Insurance Co. Ltd. claims department","how":"e-mail","address":"contactclaims@universalsompo.com"},"purpose":"claim","sections":[{"title":"A. 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DETAILS OF OTHER INTEREST","fields":[{"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. DETAILS OF OTHER INFORMATION","fields":[{"help":"Indicate if additional information is provided","type":"choice","label":"Do you wish to provide any other information? If \"Yes\", specify details","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Additional information details","type":"text","label":"If “Yes”, specify","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of the 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 the insured signing","type":"text","label":"Name of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Business Shield insurance claims","attachments":["copy of policy if loss/damage is covered under any other insurance","list of documents received with this claim form as mentioned in declaration"],"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 KYC registries or other modes."],"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/1400-business-shield-claim-form"}