{"id":1287,"title":"Notification of Loss or Damage for Electronic Equipment Insurance","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/Electronic%20Equipment%20Insurance.pdf","sha256":"203c808ffebaf34a501d5200f728993f23075e54610f921005ba29839ef49cd9","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is for the policyholder to notify the insurer about loss or damage to electronic equipment covered under the policy.","notes":["If more than one scheduled item is affected, complete one form per item.","Please enclose copies of repair estimates with detailed cost breakdown."],"title":"Notification of Loss or Damage for Electronic Equipment Insurance","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured and Loss Details","fields":[{"help":"","type":"text","label":"Name and Address of Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Location of the object","options":[],"required":null,"pdf_field":""},{"help":"Policy period or coverage period","type":"text","label":"Period","options":[],"required":null,"pdf_field":""},{"help":"Date when insurer was first informed","type":"date","label":"When was notice first given to the Insurer?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are there any witnesses ? o Yes o No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of witnesses if any","type":"text","label":"If so, please give names, Professions and addresses.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Damaged Item Details","fields":[{"help":"Specify item number and sum insured as per policy schedule","type":"text","label":"Which item was damaged? Item No. in Specification of Policy Schedule Sum insured","options":[],"required":null,"pdf_field":""},{"help":"As per manufacturer's plate","type":"text","label":"Name of manufacturer, type of machine","options":[],"required":null,"pdf_field":""},{"help":"Exact year and serial number from manufacturer's plate","type":"text","label":"Year of manufacture, serial number (Please give full details as on manufacturer's plate).","options":[],"required":null,"pdf_field":""},{"help":"Technical details of the damaged item","type":"text","label":"Description of damaged Item (capacity, r.p.m., Weight, etc.)","options":[],"required":null,"pdf_field":""},{"help":"Details of coverage scope","type":"text","label":"Scope of cover","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Damage Cause and Additional Details","fields":[{"help":"Describe cause and attach supporting documents","type":"text","label":"How did the damage occur and what was the probable cause ? Please attach sketches, photos, etc.","options":[],"required":null,"pdf_field":""},{"help":"Attach loss report if applicable","type":"attachment","label":"Where damage to EDP systems is involved, please furnish a loss report drawn up by the maintenance firm or supplier","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Repair and Liability Details","fields":[{"help":"Details of repair arrangements and estimated time","type":"text","label":"How will the damaged items be repaired, by whom and where? Please indicate estimated Repair period.","options":[],"required":null,"pdf_field":""},{"help":"Estimated cost of repairs","type":"amount","label":"What are the estimated repair costs?","options":[],"required":null,"pdf_field":""},{"help":"Details of fault and witnesses if any","type":"text","label":"In the event of third parties having caused the loss Who was to blame for the loss? (please give the full address of witnesses).","options":[],"required":null,"pdf_field":""},{"help":"Name and bank account number for indemnity payment","type":"text","label":"Who is authorized to receive the indemnity? Bank Account No.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration","fields":[{"help":"Sign the form","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Electronic Equipment Insurance","attachments":["sketches, photos, etc.","loss report drawn up by the maintenance firm or supplier (if damage to EDP systems)","copy(copies) of repair estimate(s) showing breakdown into material costs, labour charges - including man-hours worked - and freight charges"],"declarations":["The policyholder declares to have answered the questions conscientiously and truthfully.","The policyholder is liable and fully responsible for the correctness and completeness of the statement."],"dropped_labels":6},"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/1287-notification-of-loss-or-damage-for-electronic-equipment-insurance"}