{"id":1435,"title":"BUSINESS SHIELD (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/business-shield-policy-sookshma-udyam/claims-form.pdf","sha256":"47db621e91e1eee6a56ed22fe64624debab9577f9d123c6305b584fcec1bdbef","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to file a claim under the Business Shield (Sookshma Udyam) insurance policy for loss or damage to business property.","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 particulars later.","Attach copy of other insurance policy if applicable.","Use the list of documents provided with the claim form for submission requirements."],"title":"BUSINESS SHIELD (SOOKSHMA UDYAM) - CLAIM FORM","submit":{"to":"Universal Sompo General Insurance Company Limited","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","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Address of the insured","type":"text","label":"Address line 1","options":[],"required":null,"pdf_field":""},{"help":"Address of the insured","type":"text","label":"Address line 2","options":[],"required":null,"pdf_field":""},{"help":"City of the insured","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":"Type of business or occupation","type":"text","label":"Business/Occupation","options":[],"required":null,"pdf_field":""},{"help":"Policy coverage period","type":"date","label":"Period of Insurance From / To","options":[],"required":null,"pdf_field":""},{"help":"Maximum coverage amount","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":"Location where loss occurred","type":"text","label":"LOSS LOCATION Address line 1","options":[],"required":null,"pdf_field":""},{"help":"Location where loss occurred","type":"text","label":"Address line 2","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":""}],"filled_by":"insured"},{"title":"DETAILS OF THEFT","fields":[{"help":"Date when theft was discovered","type":"date","label":"Date of Discovery","options":[],"required":null,"pdf_field":""},{"help":"Details of stolen item","type":"text","label":"Item Lost (Year/Make/Model)","options":[],"required":null,"pdf_field":""},{"help":"Original cost of the item","type":"amount","label":"Original Purchase Value","options":[],"required":null,"pdf_field":""},{"help":"Date item was bought","type":"date","label":"Purchase Date","options":[],"required":null,"pdf_field":""},{"help":"Amount claimed for the item","type":"amount","label":"Value Claimed","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"WITNESS DETAILS","fields":[{"help":"Select if witness is available","type":"choice","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":"Witness address","type":"text","label":"Address Line 2","options":[],"required":null,"pdf_field":""},{"help":"City of witness","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of witness","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of witness","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of witness","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of witness","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of witness","type":"email","label":"Email","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"INFORMATION TO AUTHORITY","fields":[{"help":"Select if authorities were informed","type":"choice","label":"Have any authority been informed about Accident/ Loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"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":"Authority address","type":"text","label":"Address Line 2","options":[],"required":null,"pdf_field":""},{"help":"City of authority","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of authority","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of authority","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of authority","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of authority","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of authority","type":"email","label":"Email","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"C. DETAILS OF OTHER INSURANCE","fields":[{"help":"Select if other insurance covers the loss","type":"choice","label":"Is the Loss/damage covered under any other Insurance?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of other insurance policy","type":"text","label":"If \"Yes\", specify details and attach copy of policy","options":[],"required":null,"pdf_field":""},{"help":"Name of other insurer","type":"text","label":"Name of the Insurer","options":[],"required":null,"pdf_field":""},{"help":"Address of other insurer","type":"text","label":"Address line 1","options":[],"required":null,"pdf_field":""},{"help":"Address of other insurer","type":"text","label":"Address line 2","options":[],"required":null,"pdf_field":""},{"help":"City of other insurer","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of other insurer","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of other insurer","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of other insurer","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of other insurer","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":"Email of other insurer","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 policy","type":"amount","label":"Amount of Insurance","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"D. DETAILS OF OTHER INTEREST","fields":[{"help":"Details if sole owner","type":"text","label":"If \"Yes\", specify details","options":[],"required":null,"pdf_field":""},{"help":"Name of person with interest","type":"text","label":"Name of insured interest","options":[],"required":null,"pdf_field":""},{"help":"Names of persons with interest","type":"text","label":"Person/s who has interest on property","options":[],"required":null,"pdf_field":""},{"help":"Type of interest in property","type":"text","label":"His nature of interest","options":[],"required":null,"pdf_field":""},{"help":"Address of person with interest","type":"text","label":"Address Line 1","options":[],"required":null,"pdf_field":""},{"help":"City of person with interest","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"State of person with interest","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of person with interest","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Phone number of person with interest","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of person with interest","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Email of person with interest","type":"email","label":"Email","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"E. 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":"F. DETAILS OF OTHER INFORMATION","fields":[{"help":"Select if you want to provide additional info","type":"choice","label":"Do you wish to provide any other information?","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","type":"text","label":"Name of Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Business Shield (Sookshma Udyam) insurance claims","attachments":["Copy of other insurance policy if loss/damage is covered under other insurance","List of documents received with this claim form (as per declaration)"],"declarations":["The insured agrees to provide additional information if required and guarantees the truthfulness of the 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 the company is not responsible for delays due to non-submission of required documents.","The insured declares all persons with interest in the property are disclosed and no duplicate claims exist.","The insured consents to verification of identity/address/bank details through Central KYC Registry or UIDAI."],"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/1435-business-shield-sookshma-udyam-claim-form"}