{"id":1309,"title":"CLAIM FORM FOR UNIHOME CARE 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/Unihome%20Care%20Claim%20Form.pdf","sha256":"8bf876f031ad2a22b679efa332b8d0f46558b931d0a0803f65340f9f5020bd97","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person or borrower to claim insurance benefits under the Unihome Care Policy for loss on house property or accidental death. It is filled by the insured person or nominee and the financial institution official.","notes":[],"title":"CLAIM FORM FOR UNIHOME CARE POLICY","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured and Policy Details","fields":[{"help":"","type":"text","label":"BRANCH / DIVISIONAL OFFICE :","options":[],"required":null,"pdf_field":""},{"help":"Enter the policy number","type":"text","label":"Polocy No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the claim number if available","type":"text","label":"Claim No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the name and address of the financier or bank","type":"text","label":"Name and address of the insured (financier / Bank)","options":[],"required":null,"pdf_field":""},{"help":"Enter the insured's address","type":"text","label":"Address of the Insured","options":[],"required":null,"pdf_field":""},{"help":"Enter the name of the insured person or borrower","type":"text","label":"Name of the Insured person / borrower","options":[],"required":null,"pdf_field":""},{"help":"Enter the permanent address","type":"text","label":"a) Permanent Address of the Insured person / borrower","options":[],"required":null,"pdf_field":""},{"help":"Enter the address of the house property","type":"text","label":"b) Address of the house property.","options":[],"required":null,"pdf_field":""},{"help":"Enter the occupation","type":"text","label":"a) Occupation of the Insured person / borrower","options":[],"required":null,"pdf_field":""},{"help":"Enter age or date of birth","type":"date","label":"b) Age / Date of birth","options":[],"required":null,"pdf_field":""},{"help":"Enter the insurance period","type":"text","label":"Period Insurance","options":[],"required":null,"pdf_field":""},{"help":"Enter the total loan amount disbursed","type":"amount","label":"Total Amount of Loan Disbursed to this borrower","options":[],"required":null,"pdf_field":""},{"help":"Enter sum insured for house and person","type":"amount","label":"Sum Insured :  A)    House B)     Person","options":[],"required":null,"pdf_field":""},{"help":"Enter outstanding loan amount as on date of loss or accident","type":"amount","label":"Amount of Loan outstanding as on date of loss / accident.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured person / nominee"},{"title":"Claim Details for Loss on House Property","fields":[{"help":"Enter date and time when loss occurred","type":"date","label":"a) Date and time of loss","options":[],"required":null,"pdf_field":""},{"help":"Describe the cause or nature of the loss","type":"text","label":"b) Cause / Nature of Loss","options":[],"required":null,"pdf_field":""},{"help":"Provide details of reporting or reasons for not reporting","type":"text","label":"c) Has the loss has been reported to fire brigade / police ? If so give details If not give reasons for the same.","options":[],"required":null,"pdf_field":""},{"help":"Provide complete details of the extent of loss","type":"text","label":"d) Extent of Loss (Complete details)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured person / nominee"},{"title":"Claim Details for Accidental Death","fields":[{"help":"Enter date and time of accident","type":"date","label":"a) Date and time of accident","options":[],"required":null,"pdf_field":""},{"help":"Enter place where accident occurred","type":"text","label":"b) Place of accident","options":[],"required":null,"pdf_field":""},{"help":"Describe the accident fully","type":"text","label":"c) Full description of accident","options":[],"required":null,"pdf_field":""},{"help":"Provide names and addresses of witnesses","type":"text","label":"d) Name & Address (s) of witness to accident","options":[],"required":null,"pdf_field":""},{"help":"State if deceased had infirmity and details if any","type":"text","label":"e) Was the deceased free from infirmity at the time of accident? If not give particulars.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if deceased was under influence","type":"yes-no","label":"f) Was the deceased under the influence of drugs or drink at the time of accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if deceased was involved in criminal activity","type":"yes-no","label":"g) Was the deceased under any law breaking activity with criminal intent at the time of accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Confirm if death was directly due to accident","type":"yes-no","label":"h) Is the claimant satisfied that the death was directly due to the accident.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter hospital or nursing home details","type":"text","label":"i) Give the name and address of the Hospital / Nursing where the deceased was treated after the accident.","options":[],"required":null,"pdf_field":""},{"help":"Attach original death certificate, postmortem certificate, and FIR/Panchanama","type":"attachment","label":"j) Please enclose the originals of i. Death certificate ii. Postmortem Certificate iii. FIR / Panchanama relating to accident","options":[],"required":true,"pdf_field":""}],"filled_by":"insured person / nominee"},{"title":"Declaration and Signatures","fields":[{"help":"Sign to confirm correctness of information","type":"signature","label":"we / i confirm that the above facts / statements are correct to the best of our knowledge and belief.","options":[],"required":true,"pdf_field":""},{"help":"Signature of insured person or nominee","type":"signature","label":"Signature of the Insured person/Nominee","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"PLACE:","options":[],"required":null,"pdf_field":""},{"help":"Signature of financial institution official","type":"signature","label":"Signature of Insured Official of financial institution.","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"DATE:","options":[],"required":true,"pdf_field":""}],"filled_by":"insured person / nominee and financial institution official"}],"deadlines":[],"applies_to":"claims under Unihome Care Policy","attachments":["Death certificate","Postmortem Certificate","FIR / Panchanama relating to accident"],"declarations":["The insured confirms that the facts and statements provided are correct to the best of their knowledge and belief."],"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/1309-claim-form-for-unihome-care-policy"}