{"id":2385,"title":"Claim Form - Marine Hull Insurance Policy","purpose":"claim","insurer":{"slug":"universal-sompo-general-insurance","name":"Universal Sompo General Insurance Company Limited"},"source_pdf":"https://www.universalsompo.com/assets/file/marine-hull-policy/claim-form.pdf","sha256":"4e5ce24e5ace82bc70afdc291a70b698037216e8445efa48b1d5c03534915dac","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured or claimant to report and claim for loss or damage under a Marine Hull Insurance Policy.","notes":["Answer all questions; if not applicable, write 'N/A'.","Do not dispose of damaged property until inspection is done and company is informed.","Use additional pages if space is insufficient.","Attach relevant documents and photographs to support the claim.","The claim form issuance is not an admission of liability by the insurer."],"title":"Claim Form - Marine Hull Insurance Policy","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy Details","fields":[{"help":"Enter your Marine Hull Insurance Policy number","type":"text","label":"Policy Number","options":[],"required":true,"pdf_field":""},{"help":"Enter the office that issued the policy","type":"text","label":"Issuing Office","options":[],"required":false,"pdf_field":""},{"help":"Enter any relevant terms and conditions","type":"text","label":"Terms and Conditions","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured for Hull and Machinery","type":"amount","label":"Sum Insured (H&M)","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured for Freight","type":"amount","label":"Sum Insured (Freight)","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured for Disbursement","type":"amount","label":"Sum Insured (Disbursement)","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Insured’s/Claimant’s Details","fields":[{"help":"Enter full name of insured or claimant","type":"text","label":"Name of Insured/Claimant","options":[],"required":true,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Enter city name","type":"text","label":"City","options":[],"required":false,"pdf_field":""},{"help":"Enter state name","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Enter postal pincode","type":"number","label":"Pincode","options":[],"required":false,"pdf_field":""},{"help":"Enter private phone number","type":"phone","label":"Private Phone Number","options":[],"required":false,"pdf_field":""},{"help":"Enter business phone number","type":"phone","label":"Business Phone Number","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter fax number","type":"phone","label":"Fax Number","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"Describe your business or operation briefly","type":"text","label":"Brief description of Business/Office/Industry/Operation","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Details of Person in Charge at Time of Accident","fields":[{"help":"Enter full name of person in charge","type":"text","label":"Name","options":[],"required":false,"pdf_field":""},{"help":"Enter address of person in charge","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Enter private phone number","type":"phone","label":"Private Phone Number","options":[],"required":false,"pdf_field":""},{"help":"Enter business phone number","type":"phone","label":"Business Phone Number","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"Describe relationship to insured","type":"text","label":"Relationship to the Insured (if applicable)","options":[],"required":false,"pdf_field":""},{"help":"Enter age of person in charge","type":"number","label":"Age","options":[],"required":false,"pdf_field":""},{"help":"Enter license number of person in charge","type":"text","label":"License Number","options":[],"required":false,"pdf_field":""},{"help":"Enter duration license has been held","type":"text","label":"How long has license been held?","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has license ever been endorsed or suspended, or the person in-charge been convicted of any maritime offence?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if license was endorsed/suspended or person convicted","type":"text","label":"If yes, please give full details","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Details of Loss/Accident","fields":[{"help":"Enter date of loss in DD/MM/YYYY format","type":"date","label":"Date of Loss","options":[],"required":true,"pdf_field":""},{"help":"Enter time of loss with AM/PM","type":"text","label":"Time of Loss","options":[],"required":false,"pdf_field":""},{"help":"Enter location where loss occurred","type":"text","label":"Loss Location","options":[],"required":false,"pdf_field":""},{"help":"Describe weather conditions at time of loss","type":"text","label":"Weather conditions","options":[],"required":false,"pdf_field":""},{"help":"Tick all applicable purposes","type":"checkbox","label":"For what purpose was vessel being used at time of accident? Please (✔) where applicable","options":["Hire","Business","Pleasure Racing","Road transit","Passenger carrying"],"required":false,"pdf_field":""},{"help":"Enter Y or N if vessel was licensed for the above use","type":"text","label":"Was licensed for above? (please mention Y or N)","options":[],"required":false,"pdf_field":""},{"help":"Describe seaworthiness of vessel before loss","type":"text","label":"Was the vessel seaworthy in all respects before commencement of the ill-fated voyage or immediately before the casualty?","options":[],"required":false,"pdf_field":""},{"help":"Enter date or time of last repair","type":"text","label":"When was the vessel last repaired?","options":[],"required":false,"pdf_field":""},{"help":"Describe repair work done","type":"text","label":"What was the repair work carried out?","options":[],"required":false,"pdf_field":""},{"help":"Describe accident details; attach sketch if needed","type":"text","label":"Explain fully how accident occurred (sketch may be attached)","options":[],"required":false,"pdf_field":""},{"help":"Describe damage and attach photos if possible","type":"text","label":"Details description of loss (please describe the loss in detail, what part of the vessel was damaged and how extensive was the damage - please attach photographs of affected parts or part prior to any repairs)","options":[],"required":false,"pdf_field":""},{"help":"Enter estimated speed","type":"text","label":"Estimated speed of vessel at the time of loss","options":[],"required":false,"pdf_field":""},{"help":"Enter estimated loss amount in rupees","type":"amount","label":"Estimated loss (in Rs)","options":[],"required":false,"pdf_field":""},{"help":"Indicate if repair quotation is obtained and attach it","type":"text","label":"Have quotation for repair been obtained? If yes, please attach the quotation","options":[],"required":false,"pdf_field":""},{"help":"Describe any preventive actions taken","type":"text","label":"Preventive measures taken to avoid/reduce loss or damage","options":[],"required":false,"pdf_field":""},{"help":"Provide location for vessel inspection","type":"text","label":"Where can the vessel be inspected?","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Damage To / By Third Parties (Persons and Property)","fields":[{"help":"Select Yes or No","type":"choice","label":"In your opinion was the accident your person in-charge’s fault?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Explain why it was the person in-charge's fault","type":"text","label":"If so, a) Why?","options":[],"required":false,"pdf_field":""},{"help":"State if any claims have been made","type":"text","label":"Have any claims been made on you?","options":[],"required":false,"pdf_field":""},{"help":"State who was to blame if not person in-charge","type":"text","label":"If not, a) Who was to blame?","options":[],"required":false,"pdf_field":""},{"help":"State if person admitted liability","type":"text","label":"Did such person admit any liability?","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Particulars Relating to Third Party Claims (Persons and Property)","fields":[{"help":"Enter registration number of other vessel","type":"text","label":"Reg. No","options":[],"required":false,"pdf_field":""},{"help":"Enter owner(s) name and address of other vessel","type":"text","label":"Owner(s) name and address","options":[],"required":false,"pdf_field":""},{"help":"Enter name and address of person in charge of other vessel","type":"text","label":"Person in-charge’s name and address","options":[],"required":false,"pdf_field":""},{"help":"Describe damage to other vessel","type":"text","label":"Nature of damage to other vessel","options":[],"required":false,"pdf_field":""},{"help":"Enter estimated repair cost for other vessel","type":"amount","label":"Estimated repair cost","options":[],"required":false,"pdf_field":""},{"help":"Describe damage to other property","type":"text","label":"Description of property damage","options":[],"required":false,"pdf_field":""},{"help":"Enter estimated repair cost for other property","type":"amount","label":"Estimated repair cost","options":[],"required":false,"pdf_field":""},{"help":"Enter injured person's contact details","type":"text","label":"Name, address, telephone no","options":[],"required":false,"pdf_field":""},{"help":"Enter injured person's age","type":"number","label":"Age","options":[],"required":false,"pdf_field":""},{"help":"Describe injuries sustained","type":"text","label":"Nature of injuries","options":[],"required":false,"pdf_field":""},{"help":"Enter hospital or doctor treating injured person","type":"text","label":"Name of hospital and/or doctor","options":[],"required":false,"pdf_field":""},{"help":"Provide remarks on injured person's condition","type":"text","label":"Remarks as to condition","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Witnesses Details","fields":[{"help":"Enter name of passenger","type":"text","label":"Passengers in insured's vessel: Name","options":[],"required":false,"pdf_field":""},{"help":"Enter address of passenger","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Enter phone number of passenger","type":"phone","label":"Phone no","options":[],"required":false,"pdf_field":""},{"help":"Enter fax number of passenger","type":"phone","label":"Fax no","options":[],"required":false,"pdf_field":""},{"help":"Enter email of passenger","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Were passengers fare paying?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter name of independent witness","type":"text","label":"Independent witnesses: Name","options":[],"required":false,"pdf_field":""},{"help":"Enter address of independent witness","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Enter phone number of independent witness","type":"phone","label":"Phone no","options":[],"required":false,"pdf_field":""},{"help":"Enter fax number of independent witness","type":"phone","label":"Fax no","options":[],"required":false,"pdf_field":""},{"help":"Enter email of independent witness","type":"email","label":"Email","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Information to Authority","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Has the loss been reported to an Authority?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter name of authority reported to","type":"text","label":"If yes, name the Authority to the same was reported","options":[],"required":false,"pdf_field":""},{"help":"Explain why loss was not reported","type":"text","label":"If no, please provide reasons for such non-reporting","options":[],"required":false,"pdf_field":""},{"help":"Enter report or reference number","type":"text","label":"Information Report Number/ Authority’s Reference Number","options":[],"required":false,"pdf_field":""},{"help":"Enter date of reporting","type":"date","label":"Date of Reporting","options":[],"required":false,"pdf_field":""},{"help":"Enter name of reporting officer","type":"text","label":"Officer’s name","options":[],"required":false,"pdf_field":""},{"help":"Enter officer's number","type":"text","label":"Number","options":[],"required":false,"pdf_field":""},{"help":"Enter officer's station","type":"text","label":"Stationed at","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Any action taken or to be taken?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter against whom action is taken","type":"text","label":"If “Yes”, against whom?","options":[],"required":false,"pdf_field":""},{"help":"Describe action taken or to be taken","type":"text","label":"What action?","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Details of Other Insurances","fields":[{"help":"Select Yes or No","type":"choice","label":"Is the loss / damage covered under any other Insurance?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of other insurance and attach copy","type":"text","label":"If 'Yes', specify details and attach a copy of the policy of the same","options":[],"required":false,"pdf_field":""},{"help":"Enter name of other insurer","type":"text","label":"Name of Insurer","options":[],"required":false,"pdf_field":""},{"help":"Enter address of other insurer","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Enter contact details of other insurer","type":"text","label":"Contact Details","options":[],"required":false,"pdf_field":""},{"help":"Enter policy number of other insurance","type":"text","label":"Policy Number","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured under other insurance","type":"amount","label":"Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Enter start date of other insurance","type":"date","label":"Period of Insurance (time policy) From","options":[],"required":false,"pdf_field":""},{"help":"Enter voyage start port for other insurance","type":"text","label":"If Voyage policy (specify ports) From","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Details of Other Interests","fields":[{"help":"Select Yes or No","type":"choice","label":"Is the Insured sole owner of the property?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify other owners or interests","type":"text","label":"If No, please specify","options":[],"required":false,"pdf_field":""},{"help":"Enter names of persons with interest in property","type":"text","label":"Person(s) who has/have interest on property","options":[],"required":false,"pdf_field":""},{"help":"Enter name of assignee if applicable","type":"text","label":"Name the assignee, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"insured/claimant"},{"title":"Declaration","fields":[{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":false,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured/claimant"}],"deadlines":[],"applies_to":"Marine Hull Insurance Policy claims","attachments":["Original Insurance Policy / Certificate of Insurance duly endorsed","Details/Bills of incidental expenses incurred","Damage Certificate / Short Landing Certificate / Non-delivery Certificate in original","Copies of correspondence exchanged with carriers / port authorities along with response","Survey report","Any other documents to substantiate the loss which you may want to attach"],"declarations":["I/We agree to provide additional information if required and guarantee truthfulness of statements.","I/We understand the company may verify identity, address, facts and documents with third parties.","I/We have read and agree to the company's privacy policy as amended from time to time.","I/We understand that non-submission of required documents may delay claim processing.","I/We declare all persons having interest in the property are disclosed and no duplicate claims exist.","I/We consent to verification of identity/address/bank details through Central KYC Registry or UIDAI or other modes."],"dropped_labels":10},"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/2385-claim-form-marine-hull-insurance-policy"}