{"id":1339,"title":"CLAIM FORM - POULTRY 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-%20Poultry%20Insurance_2.pdf","sha256":"c271f929cb4554b38697be3320bee4ef8ec14a25dd4206dd73dcc4a60bbe0b60","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by poultry farm owners to claim insurance for dead birds under the poultry insurance policy. The form collects details about the farm, the birds, mortality, treatment, and veterinary certification.","notes":[],"title":"CLAIM FORM - POULTRY INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Farm and Owner Details","fields":[{"help":"","type":"text","label":"Name of the farm and its location","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of owner(s)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant (farm owner)"},{"title":"Bird Description and Mortality Details","fields":[{"help":"","type":"text","label":"Description of the birds","options":[],"required":null,"pdf_field":""},{"help":"Enter the number of dead birds and the claim amount","type":"number","label":"a) Number of birds dead for which claim is preferred and the amount claimed","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"b) Breed and strain of birds","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant (farm owner)"},{"title":"Illness and Treatment Details","fields":[{"help":"Date when illness was first noticed","type":"date","label":"a) When were the birds first seen ill?","options":[],"required":null,"pdf_field":""},{"help":"Date when veterinary surgeon was informed","type":"date","label":"b) When was notice sent to the Veterinary Surgeon?","options":[],"required":null,"pdf_field":""},{"help":"Dates when veterinary surgeon attended the birds","type":"text","label":"c) Dates of attendance by Veterinary Surgeon","options":[],"required":null,"pdf_field":""},{"help":"Describe treatment and preventive measures","type":"text","label":"d) Whether treatment given or not? If yes, Particulars of treatment given: What are the preventive measures taken to protect other birds?","options":[],"required":null,"pdf_field":""},{"help":"Date when deworming was performed","type":"date","label":"e) Date of deworming done","options":[],"required":null,"pdf_field":""},{"help":"Cause of death of the birds","type":"text","label":"f) CAUSE OF DEATH:","options":[],"required":null,"pdf_field":""},{"help":"Information on disease prevalence and egg yield if applicable","type":"text","label":"g) Is there any contagious or infectious disease prevalent in the flocks: or in the vicinity?--- If the birds have started laying give No. of eggs yield for the past 4 weeks","options":[],"required":null,"pdf_field":""},{"help":"Vaccination details including dates and vaccine source","type":"text","label":"h) Have all the birds been protected as per vaccination schedule against Ranikhet, Fowl pox, Mareck’s diseases? If so give dates of vaccinations done. Source of receipt of vaccine: date of receipt Brew No.","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant (farm owner)"},{"title":"Supply Sources","fields":[{"help":"Source from where chicks were procured","type":"text","label":"a) What was the source of supply of bird/s chicks?","options":[],"required":null,"pdf_field":""},{"help":"Source of feed supply","type":"text","label":"b) What was the source of supply of feed","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant (farm owner)"},{"title":"Compensation Details","fields":[{"help":"Details of compensation claimed from other sources if any","type":"text","label":"In case of any mass mortality, whether any compensation has been claimed from any other source? If so, give details of the No. of birds, amount compensated etc.","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant (farm owner)"},{"title":"Post-Mortem and Culling","fields":[{"help":"Indicate if post-mortem was done and report attached","type":"yes-no","label":"a) Whether Post-Mortem conducted? If so, is a detailed Post-Mortem report enclosed or not?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Number of birds culled till date","type":"number","label":"b) No of birds culled so far","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant (farm owner)"},{"title":"Premium Payment","fields":[{"help":"Date of premium payment","type":"date","label":"When was the premium paid?","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant (farm owner)"},{"title":"Declaration and Signature","fields":[{"help":"Date of signing the declaration","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Name and signature of a witness","type":"signature","label":"Name & Signature of Witness:","options":[],"required":null,"pdf_field":""},{"help":"Signature of the insured farm owner","type":"signature","label":"Signature of Insured.","options":[],"required":true,"pdf_field":""}],"filled_by":"claimant (farm owner)"},{"title":"Veterinary Certificate","fields":[{"help":"Veterinary surgeon's certification statement","type":"text","label":"I CERTIFY that I have this day carefully examined the carcasses of birds described in the above schedule and that the particulars, and answers to the questions are correct to the best of my knowledge and belief and the cause of death is no adverse reflection on the “Care and Management” of the insured flock.","options":[],"required":null,"pdf_field":""},{"help":"Veterinary surgeon's signature","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of veterinary certification","type":"date","label":"Date :","options":[],"required":null,"pdf_field":""},{"help":"Veterinary surgeon's qualification","type":"text","label":"Qualification","options":[],"required":null,"pdf_field":""},{"help":"Place of veterinary surgeon's practice","type":"text","label":"Station :","options":[],"required":null,"pdf_field":""},{"help":"Veterinary surgeon's name and address","type":"text","label":"Name & Address","options":[],"required":null,"pdf_field":""},{"help":"Veterinary certificate field 1","type":"text","label":"1.","options":[],"required":null,"pdf_field":""},{"help":"Veterinary certificate field 2","type":"text","label":"2.","options":[],"required":null,"pdf_field":""},{"help":"Veterinary certificate field 3","type":"text","label":"3.","options":[],"required":null,"pdf_field":""},{"help":"Veterinary certificate field 4","type":"text","label":"4.","options":[],"required":null,"pdf_field":""},{"help":"Total number of dead birds as per veterinary examination","type":"number","label":"Total No. of birds died:","options":[],"required":null,"pdf_field":""},{"help":"Mortality percentage as per veterinary examination","type":"number","label":"Percentage of mortality:","options":[],"required":null,"pdf_field":""},{"help":"Identification number of birds","type":"text","label":"Identity No.","options":[],"required":null,"pdf_field":""},{"help":"Cause of death as certified by veterinary surgeon","type":"text","label":"CAUSE OF DEATH:","options":[],"required":null,"pdf_field":""}],"filled_by":"veterinary surgeon"}],"deadlines":[],"applies_to":"poultry insurance claims for dead birds","attachments":["Attach a detailed report of P.M. done on a sample batch of carcasses"],"declarations":["The claimant warrants the truth of the statements and affirms proper treatment and care was given to the birds.","If any false statement, suppression or concealment is made, the policy shall be void and rights to recover shall be forfeited."],"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/1339-claim-form-poultry-insurance"}