{"id":1436,"title":"Parametric Assure 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/parametric-assure/claim-form.pdf","sha256":"f04daca41c62b71981ca989530cab7cbc666ad375721e9080a0a6465ddd31bfd","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to file a claim under the Parametric Assure insurance policy for losses triggered by specific parametric events.","notes":["All questions must be answered fully; use separate sheet if insufficient space","Incomplete or blank sections will cause the form to be returned","Do not dispose of or destroy damaged property without consent of surveyor/USGI","No offer or admission of liability to third parties should be made","Any communications regarding the accident must be sent to the Company immediately"],"title":"Parametric Assure Claim Form","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 contact person","type":"text","label":"Contact name","options":[],"required":false,"pdf_field":""},{"help":"Contact person's mobile number","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Contact person's email","type":"email","label":"email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"B. Policy Details","fields":[{"help":"","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. Trigger Event details","fields":[{"help":"Date of the trigger event","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Time of the trigger event with am or pm","type":"text","label":"Time am/pm","options":["am","pm"],"required":true,"pdf_field":""},{"help":"Full address 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":"Description of premises usage","type":"text","label":"Premises occupied as","options":[],"required":true,"pdf_field":""},{"help":"Specify the parametric trigger event type","type":"text","label":"Type of trigger occurred","options":[],"required":true,"pdf_field":""},{"help":"Detailed description of loss event","type":"text","label":"Describe fully circumstances of Loss, how it happened","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Damage and Claim Details","fields":[{"help":"List damaged items","type":"text","label":"Items Damaged","options":[],"required":true,"pdf_field":""},{"help":"Policy threshold value for trigger","type":"text","label":"Threshold as per Policy","options":[],"required":true,"pdf_field":""},{"help":"Measured value of the parametric trigger","type":"text","label":"Measured Trigger value","options":[],"required":true,"pdf_field":""},{"help":"Specify parametric index used for measurement","type":"text","label":"Parametric Index used (IMD rainfall index/IITK shakemap)","options":[],"required":true,"pdf_field":""},{"help":"Claim amount requested","type":"amount","label":"Amount Claimed","options":[],"required":true,"pdf_field":""},{"help":"Value of salvage recovered from damaged items","type":"text","label":"Salvage towards damaged Item, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Sign here","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 back to the Company/Surveyor immediately"],"applies_to":"Parametric Assure insurance policy claims","attachments":["Documents to be attached (list provided with the claim form)"],"declarations":["Agree to provide additional information if required and guarantee truthfulness of statements","Company may verify identity, address, facts and documents with third parties","Agree to the Company's privacy policy as amended from time to time","Acknowledged receipt of list of required documents and understand claim processing depends on submission","Declare all persons having interest in the property are disclosed and no duplicate claims exist","Consent to Company verifying identity/address/bank details through KYC registries 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/1436-parametric-assure-claim-form"}