{"id":1433,"title":"SURETY INSURANCE POLICY- 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/surety-insurance-policy/claim-form.pdf","sha256":"59bc468f630e9ccdef34d2264eb4cb3a5b5a382c2b55c793b6c7f11274910ceb","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for submitting a claim under a Surety Insurance Policy and is to be completed and signed by the authorized person of the Insured or Claimant.","notes":["Use additional sheets if necessary to answer fully.","All payments will be made only through electronic mode as per IRDAI regulations.","KYC documents must be submitted for any claims payout.","The form must be signed by the Principal Creditor or an authorized person.","Contact details for queries: Toll free 1-800-22-4030 / 1800-200-4030, Email: contactclaims@universalsompo.com"],"title":"SURETY INSURANCE POLICY- CLAIM FORM","submit":{"to":"Universal Sompo General Insurance Co. Ltd.","how":"post / e-mail / upload","address":"Unit No. 601 & 602, 6th Floor, Reliable Tech Park, Thane- Belapur Road, Airoli, Navi Mumbai, Maharashtra - 400708; Email: contactclaims@universalsompo.com"},"purpose":"claim","sections":[{"title":"DETAILS OF INSURED","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Correspondence Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Policy number as per your insurance documents","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"If already assigned, else leave blank","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"List all persons with financial interest in the property","type":"text","label":"Name and Address of Mortgagee(s) Or other persons having financial interest in the property:","options":[],"required":null,"pdf_field":""}],"filled_by":"Insured/Claimant"},{"title":"DETAILS OF CLAIMANT / PRINCIPAL CREDITOR","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Correspondence Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Name of representative if any","type":"text","label":"Represented by (if applicable)","options":[],"required":false,"pdf_field":""},{"help":"List other insurance policies held by claimant if any","type":"text","label":"Details of any other Insurance Policies with Claimant","options":[],"required":false,"pdf_field":""}],"filled_by":"Claimant"},{"title":"CONTRACT DETAILS","fields":[{"help":"Name of the contract","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Details of the contract","type":"text","label":"Contract Details","options":[],"required":null,"pdf_field":""},{"help":"Enter contract value in Indian Rupees","type":"amount","label":"Contract Value INR.","options":[],"required":null,"pdf_field":""},{"help":"Enter bond value in Indian Rupees","type":"amount","label":"Bond Value INR.","options":[],"required":null,"pdf_field":""},{"help":"Start date of contract","type":"date","label":"Contract Period From:","options":[],"required":null,"pdf_field":""},{"help":"Amount claimed in Indian Rupees","type":"amount","label":"Claim Amount INR.","options":[],"required":null,"pdf_field":""}],"filled_by":"Claimant"},{"title":"DETAILS OF LOSS","fields":[{"help":"Explain reasons for revoking the surety bond; attach additional sheets if needed","type":"text","label":"Kindly share complete reasons for Revoking Surety Bond, along with supporting information.","options":[],"required":null,"pdf_field":""}],"filled_by":"Claimant"},{"title":"BANK DETAILS & DOCUMENTS","fields":[{"help":"Name as per bank records","type":"text","label":"Name of Bank Account Holder","options":[],"required":true,"pdf_field":""},{"help":"Your bank account number","type":"text","label":"Bank Account No","options":[],"required":true,"pdf_field":""},{"help":"Full bank name and branch","type":"text","label":"Name of Bank and Branch:","options":[],"required":true,"pdf_field":""},{"help":"If applicable","type":"text","label":"MCR Code:","options":[],"required":false,"pdf_field":""},{"help":"Indian Financial System Code for your bank branch","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Tick the type of bank account","type":"choice","label":"Account: Saving                    Current        ","options":["Saving","Current"],"required":true,"pdf_field":""},{"help":"Attach either a cancelled cheque or bank passbook copy as proof","type":"checkbox","label":"Attachments in support of Bank Details (Please tick the type of proof submitted)","options":["Cancelled Cheque","Bank Passbook copy"],"required":true,"pdf_field":""}],"filled_by":"Claimant"},{"title":"DECLARATION AND AGREEMENTS","fields":[{"help":"Read and agree to the statements a to h listed below","type":"text","label":"I/We hereby agree, affirm and declare that:","options":[],"required":true,"pdf_field":""}],"filled_by":"Claimant"},{"title":"SIGNATURE AND DATE","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the Principal Creditor or any person authorized","options":[],"required":true,"pdf_field":""}],"filled_by":"Principal Creditor or authorized person"}],"deadlines":[],"applies_to":"Surety Insurance Policy claims","attachments":["Copies of relevant documentation supporting the claim","Additional sheets if necessary for explanations","Proof of bank details: Cancelled Cheque or Bank Passbook copy","KYC documents for claims payout"],"declarations":["The information provided in this claim form is true, correct and complete.","All persons having interest in the property are disclosed as per the proposal or policy endorsements.","No similar claim has been made with any other insurance company except as disclosed.","No material information relevant to the claim has been withheld.","False or fraudulent statements or concealment of material facts will void the policy and claims.","Receipt of this form does not guarantee claim acceptance; the company may require further information.","The company may share and verify information with rating agencies or third parties for underwriting and servicing.","The claimant agrees to the company's privacy policy as available on their website.","The claimant agrees to provide additional information if required.","The company reserves the right to verify identity, address, and documents with third parties.","The claimant has received and understood the list of required documents and the consequences of non-submission.","Consent is given to verify identity and bank details through Central KYC Registry, UIDAI, or other modes for KYC."],"dropped_labels":1},"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/1433-surety-insurance-policy-claim-form"}