{"id":1317,"title":"CLAIM FORM - BHAGYASHREE CHILD WELFARE","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/Rural%20%26%20Social%20-%20Bhagyashree%20Child%20Welfare%20Policy.pdf","sha256":"0206f56df8e986fa6cbfee3b1c6502c2b076112deeb08a2be63476792619c2d6","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for claiming benefits under the Bhagyashree Child Welfare Policy and is filled by the policyholder (parent/guardian) and hospital authorities.","notes":["Enclose birth certificate with the form.","Section II is to be filled by hospital authorities only."],"title":"CLAIM FORM - BHAGYASHREE CHILD WELFARE","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"SECTION I (TO BE FILLED IN FOR ALL CLAIMS)","fields":[{"help":"","type":"text","label":"Insured’s Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Attach birth certificate","type":"date","label":"Date of birth (enclose birth certificate)","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the school where the insured is studying","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Class of study","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Father","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation of Father","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age of Father","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Mother","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation of Mother","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age of Mother","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Policy period start date","type":"date","label":"Period From","options":[],"required":null,"pdf_field":""},{"help":"Policy period end date","type":"date","label":"to","options":[],"required":null,"pdf_field":""},{"help":"Place where policy was issued","type":"text","label":"Issued at","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of deceased","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"Describe accident details","type":"text","label":"Particulars of Accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of Accident","options":[],"required":null,"pdf_field":""},{"help":"Time of accident","type":"text","label":"Time of Accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place of Accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether reported to police Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Police Station case number if reported","type":"text","label":"P. S. case No.","options":[],"required":false,"pdf_field":""},{"help":"Explain cause of death","type":"text","label":"Details of cause of death","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether parent removed to hospital immediately after accident","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Hospital address if parent was taken there","type":"text","label":"If yes, address of the hospital","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have any other similar policy? Yes/ No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other insurer if applicable","type":"text","label":"If yes, Name of the company","options":[],"required":false,"pdf_field":""},{"help":"Other policy number if applicable","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Duration of other policy","type":"text","label":"Period _ yrs From","options":[],"required":false,"pdf_field":""},{"help":"End date of other policy","type":"date","label":"to","options":[],"required":false,"pdf_field":""},{"help":"Issuing office of other policy","type":"text","label":"Issuing office at","options":[],"required":false,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Signature of witness","type":"signature","label":"Signature of witness","options":[],"required":null,"pdf_field":""},{"help":"Signature of policyholder","type":"signature","label":"Signature of the Parent/Guardian","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder (parent/guardian)"},{"title":"SECTION II (TO BE FILLED IN BY HOSPITAL AUTHORITIES)","fields":[{"help":"","type":"text","label":"Name and address of the hospital","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of admission","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of death","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of death","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Extent of injuries","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of postmortem","options":[],"required":null,"pdf_field":""},{"help":"Date of hospital authority signature","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Hospital stamp","type":"signature","label":"Rubber Stamp of Hospital","options":[],"required":null,"pdf_field":""},{"help":"Signature of hospital authority","type":"signature","label":"Signature of the Competent Authority Of Hospital/Nursing Home","options":[],"required":null,"pdf_field":""}],"filled_by":"hospital authorities"}],"deadlines":[],"applies_to":"Bhagyashree Child Welfare Policy claims","attachments":["birth certificate"],"declarations":["The issue of this form is not to be taken as an Admission of liability.","The policyholder declares the truth of the statements and that no other Bhagyashree Child Welfare Policy has been taken for other female children.","False or fraudulent statements or concealment will void the policy and forfeit rights to recover."],"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/1317-claim-form-bhagyashree-child-welfare"}