{"id":1330,"title":"PEDAL CYCLE INSURANCE CLAIM FORM","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-%20Pedal%20Cycle%20Insurance_2.pdf","sha256":"3e388bc6c475ff03593c11ff805036c6e5ebf317f96e1c7838da2ca708348784","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is for filing a claim under the Pedal Cycle Insurance policy and is to be filled by the insured, claimant, or assignee in case of the insured's death.","notes":[],"title":"PEDAL CYCLE INSURANCE CLAIM FORM","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Section I (To be filled in for all claims)","fields":[{"help":"","type":"text","label":"a) Insured’s Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"b) Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"c) Age","options":[],"required":null,"pdf_field":""},{"help":"Enter your policy number","type":"text","label":"a) Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Policy coverage period","type":"text","label":"b) Period","options":[],"required":null,"pdf_field":""},{"help":"Place where policy was issued","type":"text","label":"c) Issued at","options":[],"required":null,"pdf_field":""},{"help":"Describe the accident and loss or damage to the pedal cycle","type":"text","label":"a) Details Loss or damage to Pedal cycle.","options":[],"required":null,"pdf_field":""},{"help":"Date of the accident","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Time of the accident with AM or PM","type":"text","label":"Time A.M./P.M.","options":[],"required":null,"pdf_field":""},{"help":"Place where the accident occurred","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Indicate if the accident was reported to police","type":"choice","label":"Whether reported to police Yes/ No.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of any public liability claim","type":"text","label":"b. Public Liability","options":[],"required":null,"pdf_field":""},{"help":"Details of any legal expenses incurred","type":"text","label":"c. Legal Proceedings expenses if any","options":[],"required":null,"pdf_field":""}],"filled_by":"insured / claimant / assignee"},{"title":"Declaration","fields":[{"help":"Date of signing the declaration","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured/claimant/assignee","type":"signature","label":"Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"insured / claimant / assignee"}],"deadlines":[],"applies_to":"Pedal Cycle Insurance claims","attachments":[],"declarations":["The insured/claimant declares the truth of the particulars given in the form.","If any false or untrue statement, suppression or concealment is made, the right to compensation shall be forfeited.","The insured/claimant accepts the amount as full discharge of the insurer's obligations and will indemnify the insurer against any other claims."],"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/1330-pedal-cycle-insurance-claim-form"}