{"id":1275,"title":"Claim Form – Baggage Insurance Policy","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/baggage%20Claim%20Form.pdf","sha256":"311a9fa506265fc7261f8bb04703fddee5016be97c6a11be30e645529776c367","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to notify and claim for physical loss or damage to baggage under the baggage insurance policy.","notes":[],"title":"Claim Form – Baggage Insurance Policy","submit":{"to":"Office Address as printed on the form","how":"","address":""},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address for correspondence","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Contact Number","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Loss","fields":[{"help":"Provide the exact date and time when the loss occurred","type":"date","label":"Date and Time of loss","options":[],"required":true,"pdf_field":""},{"help":"Specify the location where the loss happened","type":"text","label":"Place of loss","options":[],"required":true,"pdf_field":""},{"help":"Describe what happened and how the loss occurred","type":"text","label":"Nature and cause of loss","options":[],"required":true,"pdf_field":""},{"help":"Indicate if the loss was reported to the police","type":"yes-no","label":"If suspected due to theft or pilferage, was it reported to the Police Yes/ No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide police station address if reported","type":"text","label":"If ‘Yes’ please give the address of the Police Station","options":[],"required":false,"pdf_field":""},{"help":"Explain why the loss was not reported to police","type":"text","label":"If ‘No’ please give reason why","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Loss and Travel Details","fields":[{"help":"Enter the total amount claimed for the loss","type":"amount","label":"Amount of loss sustained ( In Rs)","options":[],"required":true,"pdf_field":""},{"help":"List each item lost or damaged with date of purchase, description, and sum claimed","type":"table","label":"Particulars of Baggage Date of purchase Full description of Item Sum claimed","options":[],"required":true,"pdf_field":""},{"help":"Provide travel start and end dates","type":"date","label":"Traveling from / / to / /","options":[],"required":true,"pdf_field":""},{"help":"Specify the mode of travel (e.g. air, train, bus)","type":"text","label":"Mode of Travel, please specify","options":[],"required":true,"pdf_field":""},{"help":"Indicate if the baggage was with a common carrier when loss occurred","type":"yes-no","label":"Did the loss / damage occur whilst in custody of common carrier? Yes/ No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Name of the carrier if applicable","type":"text","label":"If yes please provide the carrier name","options":[],"required":false,"pdf_field":""},{"help":"Indicate if open delivery was taken from the carrier","type":"yes-no","label":"Was the Open Delivery of Baggage (for damages) taken from Carrier? Yes/ No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Confirm if carrier was notified immediately and provide copy if yes","type":"yes-no","label":"Was the Carrier immediately notified on notice of loss / damage? If “Yes”, please provide a copy. If not, this must be done immediately. Yes/ No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if a claim was made against the carrier and provide copy if yes","type":"yes-no","label":"Has a formal claim been made against the carrier? If “Yes”, please provide a copy. If not, please do so without delay. Yes/ No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"State any compensation amount received from the carrier","type":"amount","label":"Details of Compensation received from Carrier, if any","options":[],"required":false,"pdf_field":""},{"help":"Indicate if other insurance covers the loss and provide details","type":"yes-no","label":"Is the Loss/damage covered under any other Insurance? If \"Yes\", specify details as below, also provide the policy copy Yes/ No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Name of other insurer if applicable","type":"text","label":"Name of the Insurer","options":[],"required":false,"pdf_field":""},{"help":"Period of other insurance policy","type":"text","label":"Period of insurance","options":[],"required":false,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy number","options":[],"required":false,"pdf_field":""},{"help":"Sum insured under other insurance","type":"amount","label":"Amount of Insurance (in Rs)","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration by Insured","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing the form","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form here","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Baggage Insurance Policy claims for physical loss or damage","attachments":["Copy of police report if loss reported to police","Copy of notice to carrier if loss/damage occurred in custody of common carrier","Copy of formal claim made against carrier if applicable","Copy of other insurance policy if loss/damage covered under other insurance"],"declarations":["The information given in this claim form is true, correct and complete.","All persons having interest in the property are disclosed as per the proposal or policy endorsement.","No similar claim has been made with any other insurance company except as disclosed.","False or fraudulent statements or concealment of material information will void the policy and forfeit claims.","Receipt of this form or documents does not mean acceptance of the claim; the company may require further information."],"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/1275-claim-form-baggage-insurance-policy"}