{"id":1402,"title":"CLAIM FORM FOR CONTRACTOR ALL RISK INSURANCE (RETAIL)","purpose":"claim","insurer":{"slug":"universal-sompo-general-insurance","name":"Universal Sompo General Insurance Company Limited"},"source_pdf":"https://www.universalsompo.com/assets/file/contractors-all-risk-insurance-retail/claim-form.pdf","sha256":"edb6b6fa350b7851283edeebdba6bd9415eac6165d8a64a3c61a84cc0319b9cc","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to file a claim under the Contractors All Risk Insurance (Retail) policy for loss or damage to insured property.","notes":["If any detail is not readily available, do not delay dispatch of the form; such particulars may be sent later.","The issue of this form is not an admission of liability.","Use original documents as required for claim processing.","Contact toll free numbers 1-800-22-4030 / 1800-200-4030 for assistance."],"title":"CLAIM FORM FOR CONTRACTOR ALL RISK INSURANCE (RETAIL)","submit":{"to":"Universal Sompo General Insurance Co. Ltd.","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":""}],"filled_by":"insured"},{"title":"B. DETAILS OF LOSS","fields":[{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Specify time and select AM or PM","type":"text","label":"Time","options":["AM","PM"],"required":null,"pdf_field":""},{"help":"Address 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":false,"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":"","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"Briefly describe how the loss or damage occurred","type":"text","label":"Describe cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Estimated monetary value of loss","type":"amount","label":"Estimated Loss (Rs.)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"WITNESS DETAILS","fields":[{"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":false,"pdf_field":""},{"help":"Witness address","type":"text","label":"Address line 1","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address line 2","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"INFORMATION TO AUTHORITY","fields":[{"help":"Name of authority informed","type":"text","label":"If \"Yes\", specify Name of the Authority","options":[],"required":false,"pdf_field":""},{"help":"Contact person at authority","type":"text","label":"Contact Person","options":[],"required":false,"pdf_field":""},{"help":"Reference number given by authority","type":"text","label":"Authority reference no.","options":[],"required":false,"pdf_field":""},{"help":"Authority address","type":"text","label":"Address line 1","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address line 2","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"C. DETAILS OF OTHER INSURANCE","fields":[{"help":"Select Yes or No","type":"choice","label":"Is the Loss/damage covered under any other Insurance? If \"Yes\", specify details and attach copy of policy","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other insurer if applicable","type":"text","label":"Name of the Insurer","options":[],"required":false,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Limits of indemnity under other policy","type":"text","label":"Limits of Indemnity under the Policy","options":[],"required":false,"pdf_field":""},{"help":"Start date of other insurance","type":"date","label":"Period of Insurance From","options":[],"required":false,"pdf_field":""},{"help":"End date of other insurance","type":"date","label":"To","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"D. DETAILS OF OTHER INTEREST","fields":[{"help":"Name of other interested party","type":"text","label":"Name","options":[],"required":false,"pdf_field":""},{"help":"Address of other interested party","type":"text","label":"Address line 1","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address line 2","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"E. DETAILS OF DAMAGED PROPERTY","fields":[{"help":"Address of damaged property","type":"text","label":"Address line 1","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address line 2","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"G. DETAILS OF OTHER INFORMATION","fields":[{"help":"Select Yes or No and provide details if No","type":"choice","label":"Is the insured sole owner of the property? If \"No\", specify details","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Additional information if any","type":"text","label":"Do you wish to provide any other information? If \"Yes\", specify","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Place where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Contractors All Risk Insurance (Retail)","attachments":["Copy of other insurance policy if loss/damage is covered under any other insurance","List of documents received with this claim form as mentioned"],"declarations":["All statements made on this form are true and no material information is withheld.","The company may verify identity, address, facts and documents with third parties.","The claimant agrees to the company's privacy policy as amended from time to time.","The claimant has received and understood the list of required documents and is responsible for timely submission.","All persons having interest in the property are disclosed as per policy and no duplicate claims have been made.","Consent is given to verify identity/address/bank details through Central KYC Registry, UIDAI or other modes for KYC."],"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/1402-claim-form-for-contractor-all-risk-insurance-retail"}