{"id":1415,"title":"Claim Form - Boiler and Pressure Plant Insurance Policy (Retail)","purpose":"claim","insurer":{"slug":"universal-sompo-general-insurance","name":"Universal Sompo General Insurance Company Limited"},"source_pdf":"https://www.universalsompo.com/assets/file/boiler-pressure-plant-insurance-retail/claim-form.pdf","sha256":"3b602a9d7920bec69abe8258333cf2ce477b71c4266457bf4f4ae0dd7259b65e","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to file a claim under the Boiler and Pressure Plant Insurance Policy (Retail).","notes":["If any detail or information is not readily available, do not delay dispatch of this form; such particulars may be sent later.","Attach copies of relevant documents as specified.","Use accurate and truthful information to avoid cancellation of policy or claim rejection.","Contact toll free 1-800-22-4030 or helpline 022-26748600 for assistance."],"title":"Claim Form - Boiler and Pressure Plant Insurance Policy (Retail)","submit":{"to":"Universal Sompo General Insurance Company Ltd. Claims Department","how":"e-mail or post","address":"Email: contactclaims@universalsompo.com"},"purpose":"claim","sections":[{"title":"A. INSURED","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","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":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Business/Occupation","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":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Enter start and end date of insurance period","type":"date","label":"Period of Insurance From _ _ /_ _ /_ _ _ _ To _ _ /_ _ /_ _ _ _","options":[],"required":null,"pdf_field":""},{"help":"Specify the indemnity limits as per policy","type":"text","label":"Limits of Indemnity under the Policy","options":[],"required":null,"pdf_field":""},{"help":"Enter your policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"If known, enter claim number","type":"text","label":"Claim No.","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/PM","type":"text","label":"Time","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":"","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Briefly describe how the loss or damage happened","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":"Indicate if there is a witness","type":"yes-no","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":"","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"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":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 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":"","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"C. DETAILS OF OTHER INSURANCE","fields":[{"help":"Indicate if other insurance covers the loss","type":"yes-no","label":"Is the Loss/damage covered under any other Insurance?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide other insurer details","type":"text","label":"If \"Yes\", specify details and attach copy of policy","options":[],"required":null,"pdf_field":""},{"help":"Name of other insurance company","type":"text","label":"Name of the Insurer","options":[],"required":null,"pdf_field":""},{"help":"Other insurer 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":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy No.","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":"Start and end date of other insurance","type":"date","label":"Period of Insurance From  _ _/_ _/_ _ _ _ To _ _/_ _/_ _ _ _","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other policy","type":"amount","label":"Amount of Insurance","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"D. DETAILS OF OTHER INTEREST","fields":[{"help":"Indicate ownership status","type":"yes-no","label":"Is the insured sole owner of the property?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of other interested parties","type":"text","label":"If \"No\", specify details","options":[],"required":null,"pdf_field":""},{"help":"Describe your interest in the property","type":"text","label":"Nature of Insured interest","options":[],"required":null,"pdf_field":""},{"help":"Name of other interested persons","type":"text","label":"Person/s who has interest on property","options":[],"required":null,"pdf_field":""},{"help":"Nature of their interest","type":"text","label":"His nature of interest","options":[],"required":null,"pdf_field":""},{"help":"Address of other interested person","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":"","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"E. DETAILS OF DAMAGED BOILER / PRESSURE PLANT","fields":[{"help":"Describe the boiler or pressure plant","type":"text","label":"Description and Capacity of Boiler & Pressure Plant","options":[],"required":null,"pdf_field":""},{"help":"Manufacturer name and year","type":"text","label":"Manufactured by and Year of Make","options":[],"required":null,"pdf_field":""},{"help":"Date when guarantee expires","type":"date","label":"Date of expiry of manufacturer's guarantee","options":[],"required":null,"pdf_field":""},{"help":"Replacement cost in rupees","type":"amount","label":"Cost of replacement of the affected item by a new item of same description Rs.","options":[],"required":null,"pdf_field":""},{"help":"Date when repairs were done","type":"date","label":"Date of such repairs","options":[],"required":null,"pdf_field":""},{"help":"Select repair method","type":"choice","label":"Will the damaged plant be repaired","options":["Departmentally","Outside Firm"],"required":null,"pdf_field":""},{"help":"Name of repair firm if applicable","type":"text","label":"If by outside firm, name of the firm","options":[],"required":null,"pdf_field":""},{"help":"Repair firm 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":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Repair firm phone number","type":"phone","label":"Phone no.","options":[],"required":null,"pdf_field":""},{"help":"Name of AMC company","type":"text","label":"If “Yes”, please provide a copy of the contract and give below details : Name of company","options":[],"required":null,"pdf_field":""},{"help":"AMC company 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":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"AMC company phone number","type":"phone","label":"Phone no.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if previous repairs done","type":"yes-no","label":"Has the Plant undergone any repairs for damages previously","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if changes will be made during repairs","type":"yes-no","label":"Will any alterations / improvements be made to design / construction or material when repairs are carried out","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain alterations or improvements planned","type":"text","label":"If “Yes”, please explain in detail","options":[],"required":null,"pdf_field":""},{"help":"Indicate if other property damaged","type":"yes-no","label":"Are existing building / properties damaged at the time of occurrence?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe damage and estimate value","type":"text","label":"If “Yes”, give details alongwith estimated value of damages","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"F. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"Provide claim year, description and amount in Rs. for previous claims","type":"table","label":"Claims lodged during the preceding 3 years","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"G. DETAILS OF OTHER INFORMATION","fields":[{"help":"Indicate if you want to provide additional info","type":"yes-no","label":"Do you wish to provide any other information?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide other relevant information","type":"text","label":"If \"Yes\", specify","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Location 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 person signing","type":"text","label":"Name of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Boiler and Pressure Plant Insurance Policy (Retail)","attachments":["Copy of other insurance policy if loss covered under other insurance","Copy of Annual Maintenance Contract if plant covered under AMC","Estimate of repairs / replacements for previous repairs"],"declarations":["I/We agree to provide additional information if required and guarantee truthfulness of statements.","I/We understand the company may verify identity, address, facts and documents with third parties.","I/We have read and agree to the company's privacy policy at www.universalsompo.com.","I/We understand that non-submission of required documents may delay claim processing and the company is not responsible for such delays.","I/We declare all persons having interest in the property are disclosed and no duplicate claims have been made.","I/We consent to verification of identity/address/bank details through Central KYC Registry or UIDAI or other modes."],"dropped_labels":3},"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/1415-claim-form-boiler-and-pressure-plant-insurance-policy-retail"}