{"id":1420,"title":"Claim Form – Universal Sompo- Bharat Griha Raksha - Plus","purpose":"claim","insurer":{"slug":"universal-sompo-general-insurance","name":"Universal Sompo General Insurance Company Limited"},"source_pdf":"https://www.universalsompo.com/assets/file/bharat-griha-raksha-plus/claim-form.pdf","sha256":"e7e933b8d29ea851ac5b98b4448f5f0bfc7fac3a4f7cc012f9bf9edab20abec3","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to file a fire claim under the Bharat Griha Raksha - Plus policy with Universal Sompo General Insurance.","notes":["All questions must be answered fully; use separate sheet if insufficient space","Do not dispose or destroy damaged property without consent of surveyor/USGI","Make no offer or admission of liability to third parties","Send any communications regarding the accident to the Company immediately"],"title":"Claim Form – Universal Sompo- Bharat Griha Raksha - Plus","submit":{"to":"Company/Surveyor","how":"Return the form immediately","address":""},"purpose":"claim","sections":[{"title":"A. The Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Tel No. Office","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"Name of alternate contact person","type":"text","label":"Contact name","options":[],"required":false,"pdf_field":""},{"help":"Mobile of alternate contact person","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Email of alternate contact person","type":"email","label":"Email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"B. Policy Details","fields":[{"help":"Policy number as per your insurance documents","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Start date of policy period","type":"date","label":"Period of Insurance","options":[],"required":true,"pdf_field":""},{"help":"End date of policy period","type":"date","label":"to","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"C. Loss Details","fields":[{"help":"Date of loss","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Time of loss with am/pm","type":"text","label":"Time","options":["am","pm"],"required":true,"pdf_field":""},{"help":"Date and time when loss was discovered","type":"text","label":"Date/Time Discovered","options":[],"required":true,"pdf_field":""},{"help":"Person who discovered the loss","type":"text","label":"By whom","options":[],"required":true,"pdf_field":""},{"help":"Exact location where loss occurred","type":"text","label":"Location/Address of Loss","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Describe how the premises is used/occupied","type":"text","label":"Premises occupied as","options":[],"required":true,"pdf_field":""},{"help":"Explain the cause and details of the loss","type":"text","label":"Describe fully circumstances of Loss, how it happened, what triggered the Loss","options":[],"required":true,"pdf_field":""},{"help":"List each damaged item with amounts as per columns","type":"table","label":"What is Lost & Extent of Loss (Attach separate sheet if more than 1 items) Item damaged Amount insured Market value at the loss Market value after the loss Salvage value Amount claimed* *Should constitute only value of the claimed item(s) without including profit of any kind","options":[],"required":true,"pdf_field":""},{"help":"Amount claimed under extra benefits if any","type":"amount","label":"Claim under Extra Benefits Rs.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"D. General","fields":[{"help":"Tick yes or no; if yes attach FIR and Fire Brigade Report","type":"yes-no","label":"Has the loss or damage been reported to the Police and Fire Brigade?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no; if yes attach meteorological report or newspaper clipping","type":"yes-no","label":"Has the loss/damage been caused due to flood, earthquake, storm or any other Act of God?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide insurer name, policy no. and copy of policy","type":"yes-no","label":"Is there any other insurance in force providing cover for this loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide date, amount and insurer name","type":"yes-no","label":"Have you ever suffered a loss or damage in the past?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick yes or no for each system","type":"yes-no","label":"Are the premises protected by a Fire Protection/Detection system? Hydrant","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Sprinkler","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Smoke Detector","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Extinguisher(s)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain if systems were activated","type":"text","label":"Were the fire protection/detection system activated during the incident","options":[],"required":false,"pdf_field":""},{"help":"If yes, provide details","type":"yes-no","label":"Did you take any measures to minimize the loss?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide details or attach separate sheet","type":"yes-no","label":"Are there any steps taken to prevent a reoccurrence?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide name, address & phone no.","type":"yes-no","label":"Was there another person, in your opinion, responsible for the loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide name, address, phone no. and enclose statement","type":"yes-no","label":"Was there any witness(es) to the incident?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide name & address of relevant parties/financial institution","type":"yes-no","label":"Is the property subject to a hire purchase or hypothecation agreement?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide details of changes/alterations","type":"yes-no","label":"Has there been any alteration in the occupation or use of the premises since the Policy was taken up?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If no, specify since when unoccupied","type":"yes-no","label":"Were the premises occupied at the time of the loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If no, provide details of other owners","type":"yes-no","label":"Are you the sole owner of the premises/property?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you responsible for repairs?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Total value of all property present","type":"amount","label":"At the time of loss, what was the total value of all property in the premises?","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Sign to declare the truthfulness of information","type":"signature","label":"Signature of Insured","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":["Form is to be returned to the Company/Surveyor immediately"],"applies_to":"Fire Claim","attachments":["Legible copy of FIR and Fire Brigade Report if loss reported to Police and Fire Brigade","Copy of report from meteorological department/newspaper clipping if loss caused by Act of God","Copy of other insurance policy if applicable","Statement from witness(es) if any","Details of steps taken to prevent reoccurrence if applicable"],"declarations":["All statements made are true and no material information is withheld","Articles/property belong to the insured and no other person has interest except as mentioned in policy","Company may verify identity, address, facts and documents with third parties","Insured agrees to the Company's privacy policy as amended from time to time","Insured has received and understood the list of documents required for claim processing","Details of all persons having interest in the property are provided as per proposal or policy endorsement","No other claim for the same loss has been made with any other insurance company","Consent is given to verify identity/address/bank details through Central KYC Registry or UIDAI or other modes"],"dropped_labels":0},"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/1420-claim-form-universal-sompo-bharat-griha-raksha-plus"}