{"id":1442,"title":"UNIVERSAL SOMPO -  BHARAT  LAGHU UDYAM SURAKSHA 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/bharat-laghu-udyam-suraksha/claim-form.pdf","sha256":"6d7d8bc2361883601145ffeaae80097e920b2d1477de9d08d4c15aa46d621519","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for filing a fire insurance claim under the Bharat Laghu Udyam Suraksha policy by the insured person or entity.","notes":["All questions must be answered fully; use separate sheet if insufficient space","If any sections are incomplete or blank, the form will be returned for completion","Do not dispose or destroy damaged property without consent of surveyor/USGI","Make no offer or admission of liability to third parties","Send any communications regarding the accident immediately to the Company","Use original documents as required for claim processing","Contact details for assistance: Toll free 1-800-22-4030 / 1800-200-4030, Email: contactus@universalsompo.com"],"title":"UNIVERSAL SOMPO -  BHARAT  LAGHU UDYAM SURAKSHA 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":"","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":"","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""},{"help":"Enter start and end dates","type":"date","label":"Period of Insurance","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":"Include am or pm","type":"text","label":"Time","options":[],"required":true,"pdf_field":""},{"help":"Date and time when 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":"","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 how premises are used","type":"text","label":"Premises occupied as","options":[],"required":true,"pdf_field":""},{"help":"Provide detailed description","type":"text","label":"Describe fully circumstances of Loss, how it happened, what triggered the Loss","options":[],"required":true,"pdf_field":""},{"help":"Columns: Item damaged, Amount insured, Market value at loss, Market value after the loss, Salvage value, Amount claimed (only value of claimed items without profit)","type":"table","label":"What is Lost & Extent of Loss (Attach separate sheet if more than 1 items)","options":[],"required":true,"pdf_field":""},{"help":"Enter amount if applicable","type":"amount","label":"Claim under Extra Benefits Rs.","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"D. General","fields":[{"help":"Attach FIR and Fire Brigade Report if yes","type":"choice","label":"Has the loss or damage been reported to the Police and Fire Brigade?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach meteorological report or newspaper clipping if yes","type":"choice","label":"Has the loss/damage been caused due to flood, earthquake, storm or any other Act of God","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide insurer name, policy no. and copy of policy","type":"choice","label":"Is there any other insurance in force providing cover for this loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide date, amount of loss and insurer name","type":"choice","label":"Have you ever suffered a loss or damage in the past?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Are the premises protected by a Fire Protection/Detection system? Hydrant","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Sprinkler","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Smoke Detector","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Extinguisher(s)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide details","type":"choice","label":"Did you take any measures to minimize the loss?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide details (attach separate sheet if needed)","type":"choice","label":"Are there any steps taken to prevent a reoccurrence?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide name, address & phone no.","type":"choice","label":"Was there another person, in your opinion, responsible for the loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide name, address, phone no. and enclose statement","type":"choice","label":"Was there any witness(es) to the incident?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide name & address of relevant parties/financial institution","type":"choice","label":"Is the property subject to a hire purchase or hypothecation agreement?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide details of changes/alterations","type":"choice","label":"Has there been any alteration in the occupation or use of the premises since the Policy was taken up?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If not, specify since when unoccupied","type":"choice","label":"Were the premises occupied at the time of the loss or damage?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If not, provide details of other owners","type":"choice","label":"Are you the sole owner of the premises/property?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Are you responsible for repairs?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","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","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 to the Company/Surveyor immediately"],"applies_to":"Fire Claim Form","attachments":["legible copy of FIR and Fire Brigade Report if loss reported to Police and 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 any","list of documents as received with this claim form"],"declarations":["All statements made on this form are true and no material information is withheld","The articles/property belong to the insured and no other person has interest except as mentioned in the policy","Claim may be refused if information is untrue, inaccurate or concealed","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 has received and understood the list of documents required for claim processing","Details of all persons having interest in the property are provided as per proposal or policy endorsement","No other claim for the same or similar loss has been made with any other insurance company","Consent is given to verify identity/address/bank details through Central KYC Registry or UIDAI or other modes"],"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/1442-universal-sompo-bharat-laghu-udyam-suraksha-claim-form"}