{"id":1286,"title":"COMMON 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/United%20Bharat%20Griha%20Raksha%20Policy%20%281%29.pdf","sha256":"0e804021f58514f54acb2a83b785898bfcaf0a70801a909694e4e15fe039ebc4","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim for losses under fire insurance policies issued by United India Insurance Co. Ltd.","notes":[],"title":"COMMON INSURANCE CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details and Policy Information","fields":[{"help":"","type":"text","label":"Name and Address of Insured","options":[],"required":null,"pdf_field":""},{"help":"Provide all policy numbers related to the fire accident","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Describe the risk covered under each policy","type":"text","label":"Risk Covered","options":[],"required":null,"pdf_field":""},{"help":"Location of the insured property","type":"text","label":"Location","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under each policy","type":"amount","label":"Sum Insured","options":[],"required":null,"pdf_field":""},{"help":"Estimated loss amount due to fire","type":"amount","label":"Estimated amount of Loss","options":[],"required":null,"pdf_field":""},{"help":"Policy coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Date and time when the loss occurred","type":"date","label":"Date and Time of Loss","options":[],"required":null,"pdf_field":""},{"help":"Describe how the loss happened","type":"text","label":"Nature and Cause of Loss (Please describe the circumstances leading to the loss)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Additional Information","fields":[{"help":"Mention other insurance policies covering the same risk","type":"text","label":"Give details of insurance with any other insurance company on the risk involved in fire/accident","options":[],"required":null,"pdf_field":""},{"help":"Explain ownership and other interests in the property","type":"text","label":"If insured is not sole owner, the nature of his/their interest in the property and details of other interests","options":[],"required":null,"pdf_field":""},{"help":"Indicate if police were informed","type":"yes-no","label":"Whether loss intimated to: 8.1. Police","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"State if previous claims were made on this property","type":"yes-no","label":"Was any claim reported in the past on the same property during current policy period.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Cause of previous claim","type":"text","label":"If so, give details regarding: 10.1. Cause","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Location 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":"Sign the form","type":"signature","label":"Signature of Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"United Bharat Griha Raksha (UBGR), United Value Griha Raksha (UVGR), United Bharat Sookshma Udyam Suraksha (UBSUS), United Bharat Laghu Udyam Suraksha (UBLUS) & United Value Udyam Suraksha (UVUS) Policies","attachments":[],"declarations":["The particulars furnished are true and correct to the best of my knowledge."],"dropped_labels":5},"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/1286-common-insurance-claim-form"}