{"id":1431,"title":"DIGITAL PROTECTION 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/digital-protection/claim Form.pdf","sha256":"a0ceec0957a01c7a76155c9eb9b856ab2a3d7efa96ef0249176157c8bc94a1c7","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim under the Digital Protection insurance policy for losses due to cyber attacks.","notes":["Use the toll free numbers 1800-22-4030, 1800-200-4030 or email contactclaims@universalsompo.com for assistance.","The privacy policy is available at www.universalsompo.com.","Attach all required documents as listed in section 11.","The form is three pages long."],"title":"DIGITAL PROTECTION CLAIM FORM","submit":{"to":"Universal Sompo General Insurance Co. Ltd","how":"Courier","address":"Unit No- 601 & 602 A Wing, 6th Floor, Reliable Tech Park, Cloud City Campus; Thane- Belapur Road, Airoli- 400708"},"purpose":"claim","sections":[{"title":"Details of the Insured","fields":[{"help":"","type":"text","label":"Name of the insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of insured with Pin code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nature of Occupation","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Contact person","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid phone number","type":"phone","label":"Contact Number","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"FAX No","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Policy Details","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Enter the start and end dates of the policy period","type":"text","label":"Policy Period","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Any other insurance policy applicable to said notification","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If other insurance policy is applicable, provide policy holder name","type":"text","label":"Policy holder name","options":[],"required":null,"pdf_field":""},{"help":"Period of the other insurance policy","type":"text","label":"Period of insurance","options":[],"required":null,"pdf_field":""},{"help":"Type of the other insurance policy","type":"text","label":"Type of policy","options":[],"required":null,"pdf_field":""},{"help":"Name of the other insurer","type":"text","label":"Insurer's Name","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Description of Loss","fields":[{"help":"Date when the loss occurred","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Time when the loss occurred","type":"text","label":"Time","options":[],"required":null,"pdf_field":""},{"help":"Place where the loss occurred","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Describe how the cyber attack happened","type":"text","label":"Circumstances of the cyber attack:","options":[],"required":null,"pdf_field":""},{"help":"Date or time when the loss was discovered","type":"text","label":"When was loss discovered?","options":[],"required":null,"pdf_field":""},{"help":"Explain the cause and control measures","type":"text","label":"What is the supposed cause of Cyber attack? What measures were taken to control the situation","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Coverage particulars triggered","fields":[{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Theft of Funds","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Identity Theft","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Data Restoration / Malware Decontamination","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Cyber Bullying, Cyber Stalking and Loss of Reputation","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Cyber Extortion","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Online Shopping","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Online Sales","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Social Media and Media Liability","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Network Security Liability","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Privacy Breach and Data Breach Liability","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Privacy Breach and Data Breach by Third Party","options":[],"required":null,"pdf_field":""},{"help":"Indicate if directly paid by 1st party or incurred by insured","type":"text","label":"Smart Home Cover","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Police Reporting","fields":[{"help":"Select Yes or No","type":"choice","label":"Was the said matter reported to Police","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide FIR details if reported","type":"text","label":"Details of FIR (First Information Report)","options":[],"required":null,"pdf_field":""},{"help":"Explain reason if not reported to police","type":"text","label":"No, if no than why","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss and Payment Details","fields":[{"help":"Provide estimated loss amount","type":"amount","label":"Details of the projected loss? Estimated claim?","options":[],"required":null,"pdf_field":""},{"help":"Provide payment details if any","type":"text","label":"Whether any payment has been made by you to the claimant/plaintiff, if so please share details and return deductible amount","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"List of documents attached","fields":[{"help":"List attached documents","type":"text","label":"1","options":[],"required":false,"pdf_field":""},{"help":"List attached documents","type":"text","label":"2","options":[],"required":false,"pdf_field":""},{"help":"List attached documents","type":"text","label":"3","options":[],"required":false,"pdf_field":""},{"help":"List attached documents","type":"text","label":"4","options":[],"required":false,"pdf_field":""},{"help":"List attached documents","type":"text","label":"5","options":[],"required":false,"pdf_field":""},{"help":"List attached documents","type":"text","label":"6","options":[],"required":false,"pdf_field":""},{"help":"List attached documents","type":"text","label":"7","options":[],"required":false,"pdf_field":""},{"help":"List attached documents","type":"text","label":"8","options":[],"required":false,"pdf_field":""},{"help":"List attached documents","type":"text","label":"9","options":[],"required":false,"pdf_field":""},{"help":"List attached documents","type":"text","label":"10","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured or authorized person","type":"signature","label":"Authorised Signatory","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Digital Protection insurance policy claims","attachments":["List of documents attached as per section 11"],"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 and the company is not responsible for such delays.","The insured declares all persons having interest in the property are disclosed and no duplicate claims have been made.","The insured consents to verification of identity/address/bank details through Central KYC Registry or UIDAI or other modes for KYC purposes."],"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/1431-digital-protection-claim-form"}