{"id":1294,"title":"Householder’s 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/Householders%20claim%20form.pdf","sha256":"67a2936bd72839d0e4bac4071874bf34842424030a0e7457b02f3d9820707cf6","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to claim insurance for loss or damage under the Householder’s Policy due to fire or accident.","notes":[],"title":"Householder’s 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":"Fill details for each policy involved in the fire accident","type":"table","label":"Please give following details pertaining to all the Policies involved in fire accident : Policy Number, Risk Location, Sum Insured, Estimated amount of loss Rs.","options":[],"required":null,"pdf_field":""},{"help":"Specify the insurance coverage period","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Provide the exact 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 or damage happened","type":"text","label":"Nature and Cause of Loss (Please describe the circumstances leading to the loss)","options":[],"required":null,"pdf_field":""},{"help":"Mention if any other insurance covers 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 interested parties if applicable","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 the loss was reported to Police and Fire Brigade","type":"choice","label":"Whether Loss intimated to i) Police ii) Fire Brigade","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Previous Claims","fields":[{"help":"","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":"Provide details of previous claims if any","type":"text","label":"If so, give details reg : a) Cause b) Date of incident c) Claim Number d) Policy Issuing Office e) Amount of claim paid / Outstanding Rs.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"Sign and date the form","type":"signature","label":"I hereby declare that the particulars furnished above are true and correct to the best of my knowledge.","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"PLACE-","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"DATE-","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Householder’s insurance policies involving fire accidents","attachments":[],"declarations":["The insured declares that the particulars furnished are true and correct to the best of their knowledge."],"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/1294-householders-insurance-claim-form"}