{"id":1338,"title":"CLAIM FORM - RAJRAJESWARI MAHILA KALYAN YOJNA","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-%20Rajarajeshwari%20Mahila%20Kalyan%20Yojna_1.pdf","sha256":"32b1cec4d48e72ee0327cb423b3423dfff0d4a2d1429418d82da5136909feaa3","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for filing a claim under the Rajrajeswari Mahila Kalyan Yojna policy. It is filled by the claimant and hospital authorities.","notes":[],"title":"CLAIM FORM - RAJRAJESWARI MAHILA KALYAN YOJNA","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":"","type":"number","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Marital status","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Husband (if married)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation of husband","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"His Age","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If not married, name of the nominee","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age of the nominee","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Start date of policy period","type":"date","label":"Period From","options":[],"required":null,"pdf_field":""},{"help":"End date of policy period","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/injured","options":[],"required":null,"pdf_field":""},{"help":"Describe the accident details","type":"text","label":"Particulars of Accident","options":[],"required":null,"pdf_field":""},{"help":"Date and time when accident occurred","type":"date","label":"Date and time of Accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place of Accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If removed to hospital, name of the hospital","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Do you have any other RMK policy? Yes/ No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If yes, Name of the company","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 yrs 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":"Fill details if claim relates to divorce proceedings","type":"text","label":"Claim in case of Divorce proceedings","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Legal proceedings initiated by","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the court","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of filing the case","options":[],"required":null,"pdf_field":""},{"help":"Attach certified copy of decree","type":"date","label":"Date of decree","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Advocate and his address","options":[],"required":null,"pdf_field":""},{"help":"Attach documentary evidence","type":"amount","label":"Legal expenses incurred","options":[],"required":null,"pdf_field":""},{"help":"Fill details below","type":"text","label":"Details of Loss/Damage of household goods/personal effects","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of loss/damage","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"In case of burglary/theft, whether FIR has been lodged","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"List items lost or damaged and their amounts","type":"table","label":"Items lost/damaged Amount. Rs.","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you the sole owner of the property lost/damaged","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of witness","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Claimant","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"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 signing","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":"","type":"signature","label":"Signature of the Competent Authority","options":[],"required":null,"pdf_field":""}],"filled_by":"hospital authorities"}],"deadlines":[],"applies_to":"claims under Rajrajeswari Mahila Kalyan Yojna","attachments":["Certified copy of decree (if divorce proceedings)","Documentary evidence of legal expenses (if any)"],"declarations":["The issue of this form is not to be taken as an Admission of liability.","I/we declare that the statements made are true to the best of my/our knowledge and belief.","If any false or fraudulent statements or concealment is made, the policy shall be void and rights to recover shall 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/1338-claim-form-rajrajeswari-mahila-kalyan-yojna"}