{"id":1424,"title":"JEWELLER’S COMPREHENSIVE INSURANCE (SOOKSHMA 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/jewellers-comprehensive-sookshma-udyam/claim-form.pdf","sha256":"08aba996d34814240fe00a78ccb0e8db859059261173414fa3a6d44c0973a72b","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for insured persons to claim under the Jeweller’s Comprehensive Insurance (Sookshma Udyam) policy after a loss or damage event.","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 missing particulars later.","Use original documents as required for claim processing.","This form has 2 pages; fill all pages completely."],"title":"JEWELLER’S COMPREHENSIVE INSURANCE (SOOKSHMA UDYAM) - CLAIM FORM","submit":{"to":"Universal Sompo General Insurance Co. Ltd.","how":"","address":"Email: contactclaims@universalsompo.com\nToll 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 person or entity","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":"Business or occupation of the insured","type":"text","label":"Business/Occupation","options":[],"required":null,"pdf_field":""},{"help":"Start and end dates of the insurance coverage","type":"date","label":"Period of Insurance From / To","options":[],"required":null,"pdf_field":""},{"help":"Maximum indemnity limits under the policy","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 the loss occurred","type":"date","label":"Date of Loss","options":[],"required":null,"pdf_field":""},{"help":"Time of loss with AM or PM","type":"text","label":"Time","options":["AM","PM"],"required":null,"pdf_field":""},{"help":"Address where the loss occurred","type":"text","label":"LOSS LOCATION Address line 1","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 location","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email at loss location","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Explain how the loss or damage happened","type":"text","label":"Describe cause of Loss/Damage","options":[],"required":null,"pdf_field":""},{"help":"Date when theft was discovered","type":"date","label":"DETAILS OF THEFT Date of Discovery","options":[],"required":null,"pdf_field":""},{"help":"Details of the lost item including year, make, and model","type":"text","label":"Item Lost (Year/Make/Model)","options":[],"required":null,"pdf_field":""},{"help":"Original purchase price of the lost item","type":"amount","label":"Original Purchase Value","options":[],"required":null,"pdf_field":""},{"help":"Date when the lost item was purchased","type":"date","label":"Purchase Date","options":[],"required":null,"pdf_field":""},{"help":"Amount being claimed for the lost item","type":"amount","label":"Value Claimed","options":[],"required":null,"pdf_field":""},{"help":"Indicate if there is a witness","type":"choice","label":"Is any witness available for accident / loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Full name of the witness if available","type":"text","label":"Name of the Witness","options":[],"required":null,"pdf_field":""},{"help":"Witness address line 1","type":"text","label":"Address Line 1","options":[],"required":null,"pdf_field":""},{"help":"Witness address line 2","type":"text","label":"Address Line 2","options":[],"required":null,"pdf_field":""},{"help":"Witness city","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"Witness state","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Witness postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Witness phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Witness mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Witness email address","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Indicate 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 the authority informed","type":"text","label":"Name of the Authority","options":[],"required":null,"pdf_field":""},{"help":"Contact person at the authority","type":"text","label":"Contact Person","options":[],"required":null,"pdf_field":""},{"help":"Reference number given by the 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 address line 2","type":"text","label":"Address Line 2","options":[],"required":null,"pdf_field":""},{"help":"Authority city","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"Authority state","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Authority postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Authority phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Authority mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Authority email address","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Indicate if another insurance covers the loss","type":"choice","label":"Is the Loss/damage covered under any other Insurance?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other insurer if applicable","type":"text","label":"Name of the Insurer","options":[],"required":null,"pdf_field":""},{"help":"Other insurer address line 1","type":"text","label":"Address line 1","options":[],"required":null,"pdf_field":""},{"help":"Other insurer address line 2","type":"text","label":"Address line 2","options":[],"required":null,"pdf_field":""},{"help":"Other insurer city","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"Other insurer state","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Other insurer postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Other insurer phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Other insurer mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Other insurer email address","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Coverage period of other insurance","type":"date","label":"Period of Insurance From / To","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other insurance","type":"amount","label":"Amount of Insurance","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"C. DETAILS OF OTHER INTEREST","fields":[{"help":"Name of other person/entity having interest","type":"text","label":"Name of insured interest","options":[],"required":null,"pdf_field":""},{"help":"Names of persons having interest","type":"text","label":"Person/s who has interest on property","options":[],"required":null,"pdf_field":""},{"help":"Nature of interest in the property","type":"text","label":"His nature of interest","options":[],"required":null,"pdf_field":""},{"help":"Address line 1 of other interested person","type":"text","label":"Address Line 1","options":[],"required":null,"pdf_field":""},{"help":"City of other interested person","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of other interested person","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of other interested person","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of other interested person","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of other interested person","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of other interested person","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 you want to provide additional information","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 the form","type":"text","label":"Name of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Jeweller’s Comprehensive Insurance (Sookshma Udyam) claims","attachments":["Copy of policy if loss/damage is covered under other insurance","List of documents received with this claim form (as per declaration)"],"declarations":["I/We agree to provide additional information if required and guarantee truthfulness of the 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 have received and understood the list of documents required for claim processing and accept responsibility for delays due to non-submission.","I/We declare all persons having interest in the property are disclosed and no other claim for the same loss has been made elsewhere.","I/We consent to verification of identity/address/bank details through Central KYC Registry, UIDAI or other modes for KYC purposes."],"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/1424-jewellers-comprehensive-insurance-sookshma-udyam-claim-form"}