{"id":1297,"title":"JEWELLER’S BLOCK 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/Jewellers%20Block%20Claim%20form.pdf","sha256":"088dbca49d3b847c63a0eceecf451cc410e034c53772ed06bfe26a7c78fece7a","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for the insured person to claim loss of diamonds under a jeweller's block insurance policy.","notes":[],"title":"JEWELLER’S BLOCK CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claim 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":"Write your full name and address","type":"text","label":"Name & Address of the Insured (In full)","options":[],"required":null,"pdf_field":""},{"help":"Specify the date/time the diamonds were present","type":"text","label":"When were the diamonds at the time of the loss?","options":[],"required":null,"pdf_field":""},{"help":"Explain the reason the diamonds were at the location","type":"text","label":"For what purpose were they there?","options":[],"required":null,"pdf_field":""},{"help":"Provide details of last sighting including place and person","type":"text","label":"When and where the missing diamonds were last seen and by whom?","options":[],"required":null,"pdf_field":""},{"help":"State date, time and manner of discovering the loss","type":"text","label":"On what day and what hour and how did you first discover the loss?","options":[],"required":null,"pdf_field":""},{"help":"Describe the circumstances in detail","type":"text","label":"Give full particulars of the circumstances of the loss.","options":[],"required":null,"pdf_field":""},{"help":"Name the police station and attach a copy of the police report","type":"text","label":"At which police Station the loss has been reported (Please attach a copy of give full details of the report made)","options":[],"required":null,"pdf_field":""},{"help":"State ownership details if not sole owner","type":"text","label":"Are you the sole Owner of the lost Diamonds? If not, state your exact Interest and that of any other person or persons, if any","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any other insurance on the diamonds","type":"text","label":"Is these any other Insurance on the diamonds? It so, give full particulars","options":[],"required":null,"pdf_field":""},{"help":"Mention any previous similar losses","type":"text","label":"Have you ever sustained any loss of the same before","options":[],"required":null,"pdf_field":""},{"help":"State the value of each diamond","type":"amount","label":"What was the value of each Diamonds?","options":[],"required":null,"pdf_field":""},{"help":"Provide purchase date and seller details; attach invoice copy","type":"text","label":"When were the diamonds purchased and From whom (a copy of the Invoice Bill should be attached)","options":[],"required":null,"pdf_field":""},{"help":"Optional additional information","type":"text","label":"Any other Remarks","options":[],"required":false,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"INSURED’S SIGNATURE","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"DATE","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Jeweller’s block insurance claims for lost diamonds","attachments":["Copy of police report","Copy of the Invoice Bill"],"declarations":[],"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/1297-jewellers-block-claim-form"}