{"id":1274,"title":"BURGLARY INSURANCE - CLAIM FORM","purpose":"claim","insurer":{"slug":"united-india-insurance","name":"United India Insurance Company Limited"},"source_pdf":"https://uiic.co.in/web/sites/default/files/Policy-Document/Burglary%20Insurance%20Claim%20Form.pdf","sha256":"98671a279a5dde73f28435ae6c557693d70eb484dfc772acd97ea89c19171e4d","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for the insured person to claim insurance for loss or damage due to burglary. The policyholder fills it out.","notes":["The issue of this form does not constitute admission of liability.","Specify overleaf the articles stolen and property, if any, damaged."],"title":"BURGLARY INSURANCE - CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured and Loss Details","fields":[{"help":"","type":"text","label":"Policy  No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Claim  No.","options":[],"required":null,"pdf_field":""},{"help":"Full name of the insured person","type":"text","label":"a) Name of the Insured (in full)","options":[],"required":null,"pdf_field":""},{"help":"Address of the insured","type":"text","label":"b) Address:","options":[],"required":null,"pdf_field":""},{"help":"Type of business of the insured","type":"text","label":"c) Business:","options":[],"required":null,"pdf_field":""},{"help":"Address and occupancy details of the premises where loss happened","type":"text","label":"State address of the premises at which the loss occurred. How was the said premises occupied?","options":[],"required":null,"pdf_field":""},{"help":"Date and time when the loss occurred","type":"date","label":"a) Date and time of loss:","options":[],"required":null,"pdf_field":""},{"help":"Date/time of discovery and name of person who discovered the loss","type":"text","label":"b) When discovered and by whom?","options":[],"required":null,"pdf_field":""},{"help":"Details of how entry or exit was made","type":"text","label":"a) How was entry to / exit from the premises effected?","options":[],"required":null,"pdf_field":""},{"help":"Specify the part of premises affected","type":"text","label":"b) Which portion of the premises was effected by the entry or exit?","options":[],"required":null,"pdf_field":""},{"help":"Describe how the loss happened; list stolen or damaged items on the back","type":"text","label":"c) Give brief details of how exactly the loss occurred. (Specify overleaf the articles stolen and property, if any, damaged)","options":[],"required":null,"pdf_field":""},{"help":"Details of police complaint and attach a copy","type":"text","label":"a) Has a complaint been lodged with the police? if so, by whom and when and at which Police Station? Attach a copy of the Police complaint.","options":[],"required":null,"pdf_field":""},{"help":"If no complaint lodged, do so immediately and provide copy","type":"text","label":"b) If not, this may be done immediately and a copy thereof furnished to the Company","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"a) Were the premises occupied at the time of loss?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date and time premises were last occupied if unoccupied at loss","type":"date","label":"b) If not, on what date and at what hour were they last occupied?","options":[],"required":null,"pdf_field":""},{"help":"Duration premises have been unoccupied since policy start or renewal","type":"text","label":"c) For how long have the premises been unoccupied since the policy was effected or last renewed?","options":[],"required":null,"pdf_field":""},{"help":"Details of any suspected person","type":"text","label":"Is any body suspected of theft? If so, state full details","options":[],"required":null,"pdf_field":""},{"help":"Ownership details of property and premises","type":"text","label":"a) Is the Insured the sole owner of i) The property lost or damaged? ii) The premises?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"b) Is the Insured responsible for repairs to the premises?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Total value of property at loss time","type":"amount","label":"a) State the total value of property upon the premises at the time of loss.","options":[],"required":null,"pdf_field":""},{"help":"Insurance amount and insurer names on the property","type":"text","label":"b) State the amount of the insurance upon such property and name(s) of the Insurer (s)","options":[],"required":null,"pdf_field":""},{"help":"Details of any other insurance covering this loss","type":"text","label":"Is there any other Insurance against the present loss under any other policy? If so, give full particulars.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Place where form is signed","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date :","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured person","type":"signature","label":"Signature of insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":["Please return the form duly completed within Fourteen days of the loss together with the relevant vouchers etc."],"applies_to":"burglary insurance claims","attachments":["copy of the Police complaint"],"declarations":["The particulars given are true and correct in every respect.","The articles and property described belong to the person(s) named with no other interest."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"mayfair.claims@mayfairwecare.com","label":"Overseas Mediclaim Claims Email","level":null,"hours":null,"applies_to":"travel","source_url":"https://uiic.co.in/web/product/overseas-travel-insurance/OMP-for-Business-and-Holiday","quote":"/\nContact Details\nMedical Emergency\nGeneral Queries\nGrievances and Escalations\nEmail ID\nmayfairassist@mayfairwecare.com\nmayfair.claims@mayfairwecare.com\ninfo@mayfairwecare.com[AJ1]\nPolicy pays through below plans:\n1. OMP - Policy : B - Worldwide - Excluding USA & Canada -","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"mayfairassist@mayfairwecare.com","label":"Overseas Mediclaim Medical Emergency Email","level":null,"hours":null,"applies_to":"travel","source_url":"https://uiic.co.in/web/product/overseas-travel-insurance/OMP-for-Business-and-Holiday","quote":"://www.mayfairwecare.com/contact/\nContact Details\nMedical Emergency\nGeneral Queries\nGrievances and Escalations\nEmail ID\nmayfairassist@mayfairwecare.com\nmayfair.claims@mayfairwecare.com\ninfo@mayfairwecare.com[AJ1]\nPolicy pays through below plans:\n1. OMP - Policy : B - Wor","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"18004190133","label":"Overseas Mediclaim Policy Toll-Free Number (India)","level":null,"hours":null,"applies_to":"travel","source_url":"https://uiic.co.in/web/product/overseas-travel-insurance/OMP-for-Business-and-Holiday","quote":"l - Free Number\nUnited States: 18888811701 United Kingdom: 08083045211 Canada: 18885192693 Singapore: 8003211710 India: 18004190133 For Other Country Specific Local Contact Numbers, please visit https://www.mayfairwecare.com/contact/\nWebsite\nhttps://w","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"18888811701","label":"Overseas Mediclaim Policy Toll-Free Number (United States)","level":null,"hours":null,"applies_to":"travel","source_url":"https://uiic.co.in/web/product/overseas-travel-insurance/OMP-for-Business-and-Holiday","quote":"ss\nTower D, 4th Floor, IBC Knowledge Park, 4/1 Bannerghatta Road, Bangalore - 560 029\nToll - Free Number\nUnited States: 18888811701 United Kingdom: 08083045211 Canada: 18885192693 Singapore: 8003211710 India: 18004190133 For Other Country Specific Loc","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"08083045211","label":"Overseas Mediclaim Policy Toll-Free Number (United Kingdom)","level":null,"hours":null,"applies_to":"travel","source_url":"https://uiic.co.in/web/product/overseas-travel-insurance/OMP-for-Business-and-Holiday","quote":"nowledge Park, 4/1 Bannerghatta Road, Bangalore - 560 029\nToll - Free Number\nUnited States: 18888811701 United Kingdom: 08083045211 Canada: 18885192693 Singapore: 8003211710 India: 18004190133 For Other Country Specific Local Contact Numbers, please v","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"18885192693","label":"Overseas Mediclaim Policy Toll-Free Number (Canada)","level":null,"hours":null,"applies_to":"travel","source_url":"https://uiic.co.in/web/product/overseas-travel-insurance/OMP-for-Business-and-Holiday","quote":"annerghatta Road, Bangalore - 560 029\nToll - Free Number\nUnited States: 18888811701 United Kingdom: 08083045211 Canada: 18885192693 Singapore: 8003211710 India: 18004190133 For Other Country Specific Local Contact Numbers, please visit https://www.may","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"8003211710","label":"Overseas Mediclaim Policy Toll-Free Number (Singapore)","level":null,"hours":null,"applies_to":"travel","source_url":"https://uiic.co.in/web/product/overseas-travel-insurance/OMP-for-Business-and-Holiday","quote":"lore - 560 029\nToll - Free Number\nUnited States: 18888811701 United Kingdom: 08083045211 Canada: 18885192693 Singapore: 8003211710 India: 18004190133 For Other Country Specific Local Contact Numbers, please visit https://www.mayfairwecare.com/contact","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"18001236889","label":"General Contact Number","level":null,"hours":null,"applies_to":"all","source_url":"https://uiic.co.in/web/","quote":"Links\nCustomer Portal\nKYC Process\nFacebook\nInstagram\nYoutube\nTwitter\nOffice Locator\nIntermediary Portal\nDigi Locker\ntel:18001236889","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/united-india-insurance/1274-burglary-insurance-claim-form"}