{"id":1326,"title":"CLAIM FORM – ELEPHANT 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-%20Elephant%20Insurance_1.pdf","sha256":"9b7406e249e2e87b809311889643f0d45adcf69aba1eab2df6049951a22ffd5b","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to claim insurance for an elephant under the Elephant Insurance policy from United India Insurance Company.","notes":["The issue of this form is not to be construed as an admission of liability."],"title":"CLAIM FORM – ELEPHANT INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Policy and Insured 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":"Full name of the insured person","type":"text","label":"Name of Insured (in full):","options":[],"required":null,"pdf_field":""},{"help":"Full postal address of the insured","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"Occupation of the insured","type":"text","label":"Occupation:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Description of Animal Claimed For","fields":[{"help":"Description of the animal","type":"text","label":"Description","options":[],"required":null,"pdf_field":""},{"help":"Animal's identification tag number","type":"text","label":"Identification Tag No.","options":[],"required":null,"pdf_field":""},{"help":"Colour of the animal","type":"text","label":"Colour","options":[],"required":null,"pdf_field":""},{"help":"Species and breed of the animal","type":"text","label":"Species & Breed","options":[],"required":null,"pdf_field":""},{"help":"Sex and reproductive status if female","type":"text","label":"Sex (If female whether pregnant calf at foot, freshly calved or heifer)","options":[],"required":null,"pdf_field":""},{"help":"Colour and any distinguishing marks on the animal","type":"text","label":"Colour & full distinguishing marks","options":[],"required":null,"pdf_field":""},{"help":"Age of the animal in years","type":"number","label":"Exact age in years","options":[],"required":null,"pdf_field":""},{"help":"Value of the animal before illness in rupees","type":"amount","label":"Value prior to illness Rs.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Illness, Treatment and Death","fields":[{"help":"Date when animal was first noticed ill","type":"date","label":"When was the animal first seen ill?","options":[],"required":null,"pdf_field":""},{"help":"Date when veterinarian was informed","type":"date","label":"When was notice sent to Veterinarian?","options":[],"required":null,"pdf_field":""},{"help":"Dates when veterinarian first and last attended the animal","type":"text","label":"When first and last seen by Veterinarian?","options":[],"required":null,"pdf_field":""},{"help":"Date of veterinarian attendance","type":"date","label":"Date of attendance:","options":[],"required":null,"pdf_field":""},{"help":"Name and address of the attending veterinary surgeon","type":"text","label":"Name and address of Veterinary Surgeon who attended?","options":[],"required":null,"pdf_field":""},{"help":"Place, date and time of animal's death","type":"text","label":"Place of death, with date and hour:","options":[],"required":null,"pdf_field":""},{"help":"Cause of death of the animal","type":"text","label":"Cause of death:","options":[],"required":null,"pdf_field":""},{"help":"Explanation if death was due to disease","type":"text","label":"If from disease, how do you account for it?","options":[],"required":null,"pdf_field":""},{"help":"Details of accident and person in charge","type":"text","label":"If from accident, how did it occur and who was in-charge?","options":[],"required":null,"pdf_field":""},{"help":"Details of recent operation and surgeon's name","type":"text","label":"If operated upon recently, state nature & data, also name of Surgeon:","options":[],"required":null,"pdf_field":""},{"help":"Purpose of animal's use at last work","type":"text","label":"Purpose for which used or employed when last at work:","options":[],"required":null,"pdf_field":""},{"help":"State whether animal was bred or purchased","type":"text","label":"Did you breed or buy the animal?","options":[],"required":null,"pdf_field":""},{"help":"Amount claimed in rupees","type":"amount","label":"Amount of claim: Rs.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if ear tag is enclosed","type":"choice","label":"Is the Ear tag of the animal enclosed? Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if animal is insured with another insurer","type":"yes-no","label":"Is the animal insured elsewhere?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if receiving compensation from other sources","type":"yes-no","label":"Are you receiving compensation from any other source?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other source of compensation","type":"text","label":"If so from whom:","options":[],"required":null,"pdf_field":""},{"help":"Description of injury or disease if animal is alive","type":"text","label":"If animal has not died, describe the nature of injury/disease and state when it occurred and its duration:","options":[],"required":null,"pdf_field":""},{"help":"Date of premium payment","type":"date","label":"When was premium paid?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details if Mahot is Covered","fields":[{"help":"Name and age of the Mahot","type":"text","label":"Name & Age of Mahot.","options":[],"required":null,"pdf_field":""},{"help":"Date and time when accident occurred","type":"text","label":"Date & time of accident","options":[],"required":null,"pdf_field":""},{"help":"Details of the accident","type":"text","label":"Description of accident.","options":[],"required":null,"pdf_field":""},{"help":"Description of injuries sustained","type":"text","label":"Nature of injury sustained","options":[],"required":null,"pdf_field":""},{"help":"Name of doctor or hospital providing treatment","type":"text","label":"Name of the Doctor / Hospital from whom treatment for injury was taken.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if injury caused death or disablement and attach required documents","type":"yes-no","label":"Has the injury resulted in death or permanent total / partial disablement? If so, death certificate, Police report, Post-mortem report (if applicable) and medical certificate in the case of disablement to be attached.","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details if Third Party Liability is Covered","fields":[{"help":"Date, time and place of the accident","type":"text","label":"Date hour and place of accident","options":[],"required":null,"pdf_field":""},{"help":"Detailed cause of the accident","type":"text","label":"Cause of accident (Full information)","options":[],"required":null,"pdf_field":""},{"help":"Description of injuries or damages caused","type":"text","label":"Nature and extent of injury or damage","options":[],"required":null,"pdf_field":""},{"help":"Details of injured persons","type":"text","label":"Name, address and age of injured person/s","options":[],"required":null,"pdf_field":""},{"help":"Details of bodily injuries sustained","type":"text","label":"Particulars of accidental bodily injury of the injured","options":[],"required":null,"pdf_field":""},{"help":"Owner details of damaged property","type":"text","label":"Name and address of owner of third party property damaged","options":[],"required":null,"pdf_field":""},{"help":"Indicate if injured person is your employee","type":"yes-no","label":"Is he / she in your service","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Compensation details expected from you","type":"text","label":"Details of compensation expected","options":[],"required":null,"pdf_field":""},{"help":"Details of any claim communication received","type":"text","label":"Has any communication, verbal or written made to you for any claim from third party? If so, give particulars.","options":[],"required":null,"pdf_field":""},{"help":"Details of any compromise settlement","type":"text","label":"Details of compromise made if any.","options":[],"required":null,"pdf_field":""},{"help":"Date and person who reported the accident","type":"text","label":"When and by whom was the accident reported to you?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if accident was reported to authorities","type":"yes-no","label":"Has the accident been reported to Policy or Public Authority?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of witnesses to the accident","type":"text","label":"Name/s and address/es of the witnesses to the accident.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Signatures","fields":[{"help":"Date of signing","type":"date","label":"Date :","options":[],"required":null,"pdf_field":""},{"help":"Name and signature of witness","type":"signature","label":"Name & Signature of Witness:","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured person","type":"signature","label":"Signature of Insured.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured and witness"}],"deadlines":[],"applies_to":"Elephant Insurance claims","attachments":["Ear tag of the animal (if enclosed)","Death certificate (if injury resulted in death)","Police report (if applicable)","Post-mortem report (if applicable)","Medical certificate in case of disablement"],"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 will be forfeited."],"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/1326-claim-form-elephant-insurance"}