{"id":1441,"title":"STANDARD FIRE AND SPECIAL PERILS POLICY (COMMERCIAL) 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/standard-fire-special-perils/claim-form.pdf","sha256":"861ae45e7648f4a10775a5e7e144240b6d7109714c3cca49e4052bd327a4a9cf","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is for filing a fire and special perils insurance claim under a commercial policy. It is filled by the insured policyholder who has suffered loss or damage.","notes":["All questions must be answered fully; use separate sheets if needed.","Do not dispose of or destroy damaged property without consent of surveyor/USGI.","The issue or acceptance of this form is not an admission of liability by USGI.","Make no offer or admission of liability to third parties.","Send any communications regarding the accident to the company immediately."],"title":"STANDARD FIRE AND SPECIAL PERILS POLICY (COMMERCIAL) CLAIM FORM","submit":{"to":"Company/Surveyor","how":"immediately return the form to the Company/Surveyor","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":"","type":"text","label":"Contact name","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"B. Policy Details","fields":[{"help":"Policy number as per your insurance documents","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Start date of policy coverage","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""},{"help":"End date of policy coverage","type":"date","label":"to","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"C. Loss Details","fields":[{"help":"Date of loss","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Time of loss with am/pm","type":"text","label":"Time","options":[],"required":true,"pdf_field":""},{"help":"When the loss was discovered","type":"text","label":"Date/Time Discovered","options":[],"required":true,"pdf_field":""},{"help":"Person who discovered the loss","type":"text","label":"By whom","options":[],"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":"","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Describe the use of the premises","type":"text","label":"Premises occupied as","options":[],"required":true,"pdf_field":""},{"help":"Explain the incident in detail","type":"text","label":"Describe fully circumstances of Loss, how it happened, what caused the Loss","options":[],"required":true,"pdf_field":""},{"help":"List each damaged item with values as columns","type":"table","label":"What is Lost & Extent of Loss (Attach separate sheet if more than 1 item) Item damaged Amount insured Market value at the time of loss Market value after the loss Salvage value Amount claimed*","options":[],"required":true,"pdf_field":""},{"help":"Amount claimed under extra benefits if any","type":"amount","label":"Claim under Extra Benefits Rs.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"D. General","fields":[{"help":"Tick yes or no","type":"yes-no","label":"Has the loss or damage been reported to the Police/Fire Brigade? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach FIR or Fire Brigade report if applicable","type":"attachment","label":"If yes, please attach a legible copy of FIR/Fire Brigade Report","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Has the loss/damage been caused due to flood, earthquake, storm or any other Act of God? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach relevant report if applicable","type":"attachment","label":"If yes, please attach a copy of report from the meteorological dept/newspaper clipping","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Is there any other insurance in force providing cover for this loss or damage? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide insurer details and attach policy copy","type":"text","label":"If yes, please provide name of Insurer(s), policy no. and copy of Policy","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Have you ever suffered a loss or damage in the past? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of past losses","type":"text","label":"If yes, please provide Date, Amount of Loss and Name of Insurer","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no for each system and describe activation","type":"text","label":"Are the premises protected by a Fire Protection/Detection system? Hydrant Yes No Sprinkler Yes No Smoke Detector Yes No Extinguisher(s) Yes No Was the same activated during the incident","options":[],"required":true,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Did you take any measures to minimize the loss? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe measures taken","type":"text","label":"If yes, please provide details of the same","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Are there any steps taken to prevent a reoccurrence? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe preventive steps","type":"text","label":"If yes, please provide details (please attach separate sheet if required)","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Was there another person, in your opinion, responsible for the loss or damage? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of responsible person","type":"text","label":"If yes, please provide name, address & phone no.","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Was there any witness(es) to the incident? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide witness details and attach statement","type":"text","label":"If yes, please provide name, address, phone no. and enclose statement from the witness","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Is the property subject to a hire purchase or hypothecation agreement? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of financial institution","type":"text","label":"If yes, please provide name & address of relevant parties/financial institution","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Has there been any alteration in the occupation or use of the premises since the Policy was taken up? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe changes in occupation","type":"text","label":"If yes, please provide details of changes/alterations in occupation","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Were the premises occupied at the time of the loss or damage? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Date since premises were unoccupied","type":"date","label":"If not, unoccupied since","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Are you the sole owner of the premises/property? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of other owners","type":"text","label":"If not, please provide details of other interested parties","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Are you responsible for repairs? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Total value of property at loss time","type":"amount","label":"At the time of loss, what was the total value of all property in the premises?","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","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":[],"applies_to":"Standard Fire and Special Perils Policy (Commercial)","attachments":["Legible copy of FIR/Fire Brigade Report if loss reported to Police/Fire Brigade","Copy of report from meteorological department/newspaper clipping if loss caused by Act of God","Copy of other insurance policy if applicable","Statement from witness if applicable","List of documents as received with this claim form"],"declarations":["The insured guarantees the truthfulness of the statements and understands that false or fraudulent statements may lead to policy cancellation and loss of claim rights.","The company may verify identity, address, facts, and documents with third parties or service providers.","The insured agrees to the company's privacy policy as available on their website.","The insured understands the list of required documents and that delays may occur if requirements are not met.","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 official registries 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/1441-standard-fire-and-special-perils-policy-commercial-claim-form"}