{"id":1319,"title":"Claim Form – Aquaculture (Shrimp / Prawn) 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/Rural%20%26%20Social%20-%20Aquaculture%20%28Shrimp%20%26%20Prawn%29%20Insurance_1.pdf","sha256":"fb006d909bcd10d59a27a5c8b5f1c1273648d58a4fa4d2242d4f96bae4ae480b","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for insured persons to claim insurance for loss or damage related to aquaculture projects involving shrimp or prawn. The policyholder or claimant fills it.","notes":["The issue of this form does not constitute admission of liability.","The insurance is based on the principle of indemnity only and subject to policy terms and conditions.","All claims must be based upon the actual value of the items insured at the time of event excluding any value addition.","Attach original purchase documents and bills for feed.","If insurance is effected with other companies, attach copies of such policies."],"title":"Claim Form – Aquaculture (Shrimp / Prawn) Insurance","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Insured Details","fields":[{"help":"Enter your insurance policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"If known, enter the claim number","type":"text","label":"Claim No.","options":[],"required":false,"pdf_field":""},{"help":"Enter the full name of the insured person or entity","type":"text","label":"a) Name of insured:","options":[],"required":true,"pdf_field":""},{"help":"Enter the full address of the insured","type":"text","label":"b) Address","options":[],"required":true,"pdf_field":""},{"help":"Enter the business or occupation related to the insured project","type":"text","label":"c) Business / Occupation","options":[],"required":true,"pdf_field":""},{"help":"List any other persons with interest in the insured property","type":"text","label":"d) Name of other persons having an Interest in the property","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder / claimant"},{"title":"Details of Insurance","fields":[{"help":"List all policy numbers including those with other companies","type":"text","label":"Policy No.(s)","options":[],"required":true,"pdf_field":""},{"help":"Enter the sum insured amount in rupees","type":"amount","label":"Sum Insured Rs.","options":[],"required":true,"pdf_field":""},{"help":"Enter the start date of the policy period","type":"date","label":"Period From","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder / claimant"},{"title":"Details of the Project Affected in the Claim","fields":[{"help":"Enter the project name and its location","type":"text","label":"(a) Name and Location of the Project","options":[],"required":true,"pdf_field":""},{"help":"Provide revenue survey numbers and village name","type":"text","label":"(b) Revenue Survey numbers and Village","options":[],"required":true,"pdf_field":""},{"help":"Enter total project area in hectares","type":"number","label":"(c) Total Area (in hectares)","options":[],"required":true,"pdf_field":""},{"help":"Enter water spread area in hectares","type":"number","label":"(d) Water Spread Area (in hectares)","options":[],"required":true,"pdf_field":""},{"help":"List identity numbers of affected ponds or tanks","type":"text","label":"(e) Identity No/s. of the Pond/s / Tank/s affected in the claim","options":[],"required":true,"pdf_field":""},{"help":"Enter total affected pond/tank area in hectares","type":"number","label":"(f) Total area of the Ponds / Tanks affected in the claim (in hectares)","options":[],"required":true,"pdf_field":""},{"help":"Provide number and species of post larvae stocked","type":"text","label":"(g) Total No. of the post larvae and Variety / Species stocked in each Pond / Tank affected in the claim","options":[],"required":true,"pdf_field":""},{"help":"Enter the stocking dates","type":"date","label":"(h) Date/s of stocking","options":[],"required":true,"pdf_field":""},{"help":"Provide age of post larvae at stocking","type":"text","label":"(i) Age of post larvae stocked in each Pond / Tank affected in the claim","options":[],"required":true,"pdf_field":""},{"help":"Enter the harvest date","type":"date","label":"(j) Date of Harvest","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder / claimant"},{"title":"Scope of Cover and Maintenance Procedures","fields":[{"help":"Specify which sections of the policy are opted (I, II, III)","type":"text","label":"a) Scope of cover opted:","options":[],"required":true,"pdf_field":""},{"help":"Describe maintenance procedures followed","type":"text","label":"b) Give an account of 'Firm Maintenance' procedures followed by you.","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder / claimant"},{"title":"Details of Loss / Event","fields":[{"help":"Enter the time and date when the loss or event occurred","type":"date","label":"a) Time & Date of Loss / Event","options":[],"required":true,"pdf_field":""},{"help":"Describe the cause of the loss or event","type":"text","label":"b) Cause of Loss / Event","options":[],"required":true,"pdf_field":""},{"help":"Describe the policy item affected","type":"text","label":"c) Item of Policy effected (given description)","options":[],"required":true,"pdf_field":""},{"help":"Provide a detailed description of the event","type":"text","label":"d) Describe in detail the total event giving rise to the claim","options":[],"required":true,"pdf_field":""},{"help":"Indicate if the loss was reported to authorities","type":"yes-no","label":"e) Has the event / loss been reported to Police or other Authorities?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify the policy section number covering the loss","type":"text","label":"f) Section No. under which the Loss / Event is covered","options":[],"required":true,"pdf_field":""},{"help":"Indicate if loss is due to any policy exclusions","type":"yes-no","label":"g) Whether the loss is due to any of the Exclusions in the Policy – viz., Predators, competitors, weed fish, dangerous insects, asphyxia, loss of production, diseases such as Black Gill, Soft-shell, Muscle Necrosis, Crumbled Tails, Fouling Organisms (Zoothanium Sp., Epistylis Sp. etc.,) or Plankton Blooms ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe preventive measures taken","type":"text","label":"h) Details of preventive steps taken to avert the loss","options":[],"required":true,"pdf_field":""},{"help":"Enter shrimp/prawn density per square meter","type":"number","label":"i) Density of shrimp / prawn per square meter in the Pond/s / Tank/s affected in the claim","options":[],"required":true,"pdf_field":""},{"help":"Provide details of culture stages in affected ponds/tanks","type":"text","label":"j) What are the Stages of Culture in the different Pond/s / Tank/s affected in the claim ? Please furnish full details.","options":[],"required":true,"pdf_field":""},{"help":"Provide previous harvest dates and natural mortality percentage","type":"text","label":"k) Date/s of previous harvest in the affected Pond/s / Tanks. What is the natural mortality percentage upto the stage of culture in the Pond/s / Tank/s affected in the claim ?","options":[],"required":true,"pdf_field":""},{"help":"Enter population percentage just before loss/event","type":"number","label":"l) What is the percentage of population of the shrimp / prawn in the Pond/s / Tank/s affected in the claim just prior to the occurrence of the loss / event ?","options":[],"required":true,"pdf_field":""},{"help":"Provide details of compliance with official guidelines","type":"text","label":"Have you complied with the guidelines recommended by the Government Authorities, Officials of the Fisheries Department, Research Institutes, Fisheries College etc., before and during the occurrence of the loss / event ? Please furnish details of compliance.","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder / claimant"},{"title":"Extent of Loss and Supporting Documents","fields":[{"help":"Describe extent of loss and attach purchase documents and feed bills","type":"text","label":"Extent of Loss (as more particularly described in the Statement overleaf) along with the purchase documents and bills for the feed upto the stage at which the loss / event has occurred.","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder / claimant"},{"title":"Declaration and Signature","fields":[{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Insured / Claimant","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder / claimant"},{"title":"Details of Claim for Property Lost / Destroyed or Damaged","fields":[{"help":"Enter item number of the policy","type":"text","label":"Item Number of Policy","options":[],"required":true,"pdf_field":""},{"help":"Describe the affected, lost, destroyed or damaged property","type":"text","label":"Description of Affected / Lost Property","options":[],"required":true,"pdf_field":""},{"help":"Enter the value of the property at the time of loss","type":"amount","label":"Value at the time of event / lost Rs.","options":[],"required":true,"pdf_field":""},{"help":"Enter salvage value deduction if applicable","type":"amount","label":"Deduction for value of salvage, wherever applicable Rs.","options":[],"required":false,"pdf_field":""},{"help":"Enter net amount claimed after deductions","type":"amount","label":"Net Amount Claimed Rs.","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder / claimant"}],"deadlines":["Please return this form duly completed within 14 days of the loss together with the relevant documents."],"applies_to":"Aquaculture (Shrimp / Prawn) Insurance policies","attachments":["Copies of policies if insurance is effected with other companies","Purchase documents and bills for the feed up to the stage at which the loss/event has occurred"],"declarations":["The statements made in the claim form are true to the best of the claimant's knowledge and belief.","No material information bearing upon the claim has been withheld."],"dropped_labels":1},"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/1319-claim-form-aquaculture-shrimp-prawn-insurance"}