{"id":1324,"title":"CLAIM FORM - CALF 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-%20Calf%20%28Livestock%29%20Insurance_2.pdf","sha256":"897fea30258e7186d436467c155f47b17f7a477b2c9ea1dc453aae21d274ee73","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for the insured person to claim insurance for a calf or livestock under the Calf Insurance policy. The insured fills this form to report the loss and provide details about the animal and circumstances.","notes":["The issue of this form is not an admission of liability.","The form should be completed without delay and forwarded directly to the company."],"title":"CLAIM FORM - CALF INSURANCE","submit":{"to":"United India Insurance Company Limited","how":"send the completed form without delay","address":""},"purpose":"claim","sections":[{"title":"Insured and Animal Details","fields":[{"help":"Enter your insurance policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Enter claim number if known","type":"text","label":"Claim No.","options":[],"required":false,"pdf_field":""},{"help":"Enter your full name as per policy","type":"text","label":"Name of Insured (in full):","options":[],"required":true,"pdf_field":""},{"help":"Enter your full postal address","type":"text","label":"Address:","options":[],"required":true,"pdf_field":""},{"help":"Enter your occupation","type":"text","label":"Occupation:","options":[],"required":false,"pdf_field":""},{"help":"Describe the animal type","type":"text","label":"Description (State whether cow, buffalo, etc.)","options":[],"required":true,"pdf_field":""},{"help":"Enter the animal's identification tag number","type":"text","label":"Identification Tag No.","options":[],"required":true,"pdf_field":""},{"help":"Enter the animal's color","type":"text","label":"Colour","options":[],"required":false,"pdf_field":""},{"help":"Enter species and breed of the animal","type":"text","label":"Species & Breed","options":[],"required":false,"pdf_field":""},{"help":"Specify sex and reproductive status if female, plus distinguishing marks","type":"text","label":"Sex (If female whether pregnant calf at foot, freshly calved or heifer) colour & full distinguishing marks","options":[],"required":false,"pdf_field":""},{"help":"Enter the animal's exact age in years","type":"number","label":"Exact age in years","options":[],"required":false,"pdf_field":""},{"help":"Enter milk yield before illness if applicable","type":"text","label":"Milk yield prior to illness","options":[],"required":false,"pdf_field":""},{"help":"Enter the animal's value in rupees before illness","type":"amount","label":"Value prior to illness Rs.","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Illness and Death","fields":[{"help":"Enter the date when animal was first noticed ill","type":"date","label":"When was the animal first seen ill?","options":[],"required":true,"pdf_field":""},{"help":"Enter the date when veterinarian was informed","type":"date","label":"When was notice sent to Veterinarian?","options":[],"required":true,"pdf_field":""},{"help":"Enter dates of first and last veterinary visits","type":"text","label":"When first and last seen by Veterinarian?","options":[],"required":true,"pdf_field":""},{"help":"Enter date of veterinary attendance","type":"date","label":"Date of attendance:","options":[],"required":true,"pdf_field":""},{"help":"Provide full name and address of the attending vet","type":"text","label":"Name and address of Veterinary Surgeon who attended?","options":[],"required":true,"pdf_field":""},{"help":"Specify place, date and time of death","type":"text","label":"Place of death, with date and hour:","options":[],"required":true,"pdf_field":""},{"help":"Describe cause of death","type":"text","label":"Cause of death:","options":[],"required":true,"pdf_field":""},{"help":"Explain how disease caused death if applicable","type":"text","label":"If from disease, how do you account for it?","options":[],"required":false,"pdf_field":""},{"help":"Describe accident details and responsible person","type":"text","label":"If from accident, how did it occur and who was in-charge?","options":[],"required":false,"pdf_field":""},{"help":"Provide operation details and surgeon's name if applicable","type":"text","label":"If operated upon recently, state nature & data, also name of Surgeon:","options":[],"required":false,"pdf_field":""},{"help":"State the animal's last use or purpose","type":"text","label":"Purpose for which used or employed when last at work:","options":[],"required":false,"pdf_field":""},{"help":"Select whether you bred or bought the animal","type":"choice","label":"Did you breed or buy the animal?","options":["Breed","Buy"],"required":false,"pdf_field":""},{"help":"Enter date of last calving if female","type":"date","label":"Date of last calving:","options":[],"required":false,"pdf_field":""},{"help":"Specify if animal is dry or pregnant and pregnancy stage","type":"text","label":"State whether the animal is dry or pregnant. If pregnant what is the stage of pregnancy?","options":[],"required":false,"pdf_field":""},{"help":"Enter the amount claimed in rupees","type":"amount","label":"Amount of claim: Rs.","options":[],"required":true,"pdf_field":""},{"help":"Indicate if ear tag is enclosed","type":"yes-no","label":"Is the Ear tag of the animal enclosed? Yes / No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if animal has other insurance","type":"yes-no","label":"Is the animal insured elsewhere?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of other compensation sources if any","type":"text","label":"Are you receiving compensation from any other source? If so from whom:","options":[],"required":false,"pdf_field":""},{"help":"Describe injury or disease details if animal alive","type":"text","label":"a) If animal has not died, describe the nature of injury/ disease and state when it occurred and its duration:","options":[],"required":false,"pdf_field":""},{"help":"State if injury/disease caused permanent incapacity","type":"text","label":"b) Has this injury/ disease resulted in permanent incapacity to conceive or yield milk, or breed or for purpose of use mentioned in the proposal?","options":[],"required":false,"pdf_field":""},{"help":"Describe actions taken to prevent permanent incapacity","type":"text","label":"c) What steps were taken by you after the injury/disease was noticed to prevent the permanent incapacity to conceive or yield milk or breed or for the purpose of use mentioned in the proposal?","options":[],"required":false,"pdf_field":""},{"help":"Enter date of premium payment","type":"date","label":"When was premium paid?","options":[],"required":false,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration and Signature","fields":[{"help":"Enter date of signing","type":"date","label":"Date :","options":[],"required":true,"pdf_field":""},{"help":"Provide name and signature of witness","type":"signature","label":"Name & Signature of Witness:","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Insured.","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Veterinary Certificate","fields":[{"help":"Fill in owner name, place, date of death and attendance period","type":"text","label":"I hereby certify that the animal described below, the property of Mr/Mrs./Miss------------------- of ------------- died on the ------------------------- of ------------20  and that I attended the said animal from the -------------- day of -----------  until the ------------- day of --------- 20","options":[],"required":true,"pdf_field":""},{"help":"Describe animal type","type":"text","label":"Description (State whether cow, buffalo etc)","options":[],"required":true,"pdf_field":""},{"help":"Enter animal's ID tag number","type":"text","label":"Identification / Tag No.","options":[],"required":true,"pdf_field":""},{"help":"Enter species and breed","type":"text","label":"Species & Breed","options":[],"required":false,"pdf_field":""},{"help":"Specify sex, reproductive status, color and marks","type":"text","label":"Sex (if female Whether Pregnant calf at foot, freshly calved or heifer) colour & full distinguishing marks","options":[],"required":false,"pdf_field":""},{"help":"Enter exact age","type":"number","label":"Exact age in years","options":[],"required":false,"pdf_field":""},{"help":"Enter height of animal","type":"text","label":"Height","options":[],"required":false,"pdf_field":""},{"help":"Enter value before illness","type":"amount","label":"Value prior to illness","options":[],"required":false,"pdf_field":""},{"help":"Indicate if post-mortem was done","type":"yes-no","label":"Did you make a post-mortem? If so, give detailed report on reverse of the form","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"State cause of death","type":"text","label":"Cause of death","options":[],"required":true,"pdf_field":""},{"help":"Explain disease cause if applicable","type":"text","label":"If from disease, how do you account to it?","options":[],"required":false,"pdf_field":""},{"help":"Describe accident location and injuries","type":"text","label":"If from accident, where did it occur and nature of injuries sustained","options":[],"required":false,"pdf_field":""},{"help":"Provide operation details if applicable","type":"text","label":"If from an operation, give date and nature of operation","options":[],"required":false,"pdf_field":""},{"help":"Confirm if animal received proper care","type":"yes-no","label":"Had the animal had every care and attention?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Confirm examination and identification","type":"yes-no","label":"Did you examine for Insurance and do you identify the animal?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe injury/disease if animal alive","type":"text","label":"a) If animal has not died, describe the nature of injury / disease and state when it occurred and its duration.","options":[],"required":false,"pdf_field":""},{"help":"State if injury/disease caused permanent incapacity","type":"text","label":"b) Has the injury/disease resulted in permanent incapacity to conceive or yield milk or breed or for the purpose for which it is intended?","options":[],"required":false,"pdf_field":""},{"help":"Describe treatment given","type":"text","label":"a) Did you treat the animal for the injury/disease? And if so, what was the nature of treatment given to prevent the permanent incapacity to conceive or yield milk or breed or the purpose for which it is intended?","options":[],"required":false,"pdf_field":""},{"help":"Veterinary surgeon's signature","type":"signature","label":"Signature:","options":[],"required":true,"pdf_field":""},{"help":"Veterinary surgeon's qualification","type":"text","label":"Qualification:","options":[],"required":true,"pdf_field":""},{"help":"Date of certificate signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Veterinary surgeon's name and address","type":"text","label":"Name & Address:","options":[],"required":true,"pdf_field":""}],"filled_by":"veterinary surgeon"}],"deadlines":["Return this form duly completed within 14 days of the loss"],"applies_to":"Calf Insurance (Livestock Insurance)","attachments":["Ear tag of the animal","Necessary documents as required by the company","Post-mortem report if applicable"],"declarations":["The insured warrants the truth of all statements and affirms proper treatment and care were given to the animal.","If any false statement or concealment is made, the policy shall be void and rights to recover forfeited.","The veterinary surgeon warrants the truth of answers and that no material information has been withheld."],"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/1324-claim-form-calf-insurance"}