{"id":2383,"title":"Sampurna Suraksha Bima – 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/Sampurna%20Suraksha%20Bima_Claim%20Form%20%281%29.pdf","sha256":"7d3e325a2a832eda038838a48eb607de54589aa6390eef9174c92353508acea7","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is used by the claimant or policyholder to file a claim under the Sampurna Suraksha Bima insurance policy for various accidental benefits.","notes":["All questions must be answered completely and accurately","If space is insufficient, attach separate signed sheets referenced to the relevant question","Appointment of legal representatives or legal proceedings require prior written consent of the company","Issuance of claim form does not imply acceptance of liability"],"title":"Sampurna Suraksha Bima – Claim Form","submit":{"to":"issuing office","how":"","address":""},"purpose":"claim","sections":[{"title":"General Details","fields":[{"help":"","type":"text","label":"Name of Primary Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Injured/Deceased Person","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship to Primary Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No. of Claimant","options":[],"required":null,"pdf_field":""},{"help":"Provide any one valid identity number","type":"text","label":"Aadhaar/PAN/DL/Voter ID No. (of Injured/Deceased person)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Profession or Occupation","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please give details of Policy under which the claim is to be reported a) Policy No:","options":[],"required":null,"pdf_field":""},{"help":"Enter policy start and end dates","type":"text","label":"Policy Period","options":[],"required":null,"pdf_field":""},{"help":"Tick all applicable primary covers","type":"checkbox","label":"Nature Of Claim - Primary Covers (Please tick applicable boxes and mention Sum Insured/Limits)","options":["Accidental Death (AD)","Permanent Total Disablement (PTD)","Permanent Partial Disablement (PPD)","Temporary Total Disablement (TTD)"],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Nature Of Claim - Optional Covers","fields":[{"help":"Tick all applicable optional covers","type":"checkbox","label":"Nature Of Claim :Optional Covers (if opted): (Please tick applicable boxes)","options":["Accident Hospital Cash - Daily Limit","Accidental Care at Home","Accidental In-patient Hospitalisation","Accidental Medical Expenses","Adventure Sports Benefit","Broken Bones/Fracture","Burns","Chauffeur Plan Benefit","Coma","Education Security Benefit","Elderly Care","EMI Protect","Emergency Air Ambulance Charges","Loan Secure","Marriage Expenses for Children","Modification of Residence/Vehicle","Orphan Support","Pet Care"],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Employment/Income Details","fields":[{"help":"For earning members","type":"text","label":"Employer Details","options":[],"required":null,"pdf_field":""},{"help":"For earning members","type":"text","label":"Designation","options":[],"required":null,"pdf_field":""},{"help":"For earning members","type":"amount","label":"Monthly Income: Rs.","options":[],"required":null,"pdf_field":""},{"help":"For earning members","type":"choice","label":"Last 3 Months Salary Slips: Attached/Not Attached","options":["Attached","Not Attached"],"required":null,"pdf_field":""},{"help":"For earning members","type":"choice","label":"Leave Certificate from Employer: Attached/Not Attached","options":["Attached","Not Attached"],"required":null,"pdf_field":""},{"help":"For self-employed","type":"text","label":"Nature of Business","options":[],"required":null,"pdf_field":""},{"help":"For self-employed","type":"choice","label":"Last 3 Years Income Tax Returns: Attached/Not Attached","options":["Attached","Not Attached"],"required":null,"pdf_field":""},{"help":"For self-employed","type":"amount","label":"Average Monthly Income: Rs.","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Accident Details","fields":[{"help":"Describe accident circumstances","type":"text","label":"Cause of Loss (Please describe the circumstances leading to the loss)","options":[],"required":null,"pdf_field":""},{"help":"Provide date and time of accident","type":"date","label":"Date and time of Accident","options":[],"required":null,"pdf_field":""},{"help":"Full address of accident location","type":"text","label":"Place of Accident (Complete Address)","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether reported to Police station","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide FIR details if reported","type":"text","label":"If Yes, provide FIR Number, Date, and Police Station Name","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Other Insurance Details","fields":[{"help":"","type":"yes-no","label":"Do you have any other accident insurance policies?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If Yes, provide details: Company Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured: Rs.","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you claimed under other policy for same incident?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Medical Details","fields":[{"help":"","type":"text","label":"Name and Address of Treating Doctor/Hospital","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of First Medical Consultation","options":[],"required":null,"pdf_field":""},{"help":"Specify inpatient or OPD","type":"text","label":"Was the treatment done in a hospital as an inpatient or as OPD (less than 24-hour admission)?","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Admission Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Discharge Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the treatment necessitated directly by the accident and not any pre-existing condition","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Number of full days hospitalized","type":"number","label":"What was the total duration of hospitalization (in completed 24-hour periods)? (For Accident Hospital Cash)","options":[],"required":null,"pdf_field":""},{"help":"Enter percentage if applicable","type":"number","label":"For Disablement Claims: PTD/PPD: Percentage of Disablement","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Claimed Amount a. Accidental Medical Expenses Rs.","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"For Accidental Care at Home: Did the insured receive Intensive Care Unit (ICU) treatment at home in India due to the accidental injury?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Number of days ICU care was continuous","type":"number","label":"Was ICU care continuous and for how many days?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was continuous nursing care provided at home by a registered nurse as prescribed by a licensed medical practitioner?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the nursing care essential and not available by other means?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Number of days nursing care provided","type":"number","label":"How many days of nursing care were given?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was continuous physiotherapy care provided at home by a certified physiotherapist as prescribed by a licensed medical practitioner?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was physiotherapy essential and unavailable elsewhere?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Number of physiotherapy sessions","type":"number","label":"How many sessions were provided?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was a single procedural nursing visit done at home for treatment of accidental injury?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the visit prescribed by the treating physician specifying the procedure?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the nurse licensed and qualified, with verifiable credentials?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify the sport activity","type":"text","label":"For Adventure Sports: Activity involved","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Professional supervision","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Commercial purpose","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"For Broken Bones/Fracture: Type of Fracture","options":["Open","Closed"],"required":null,"pdf_field":""},{"help":"Specify affected bones","type":"text","label":"Bone(s) Affected","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Medical Confirmation via X-ray/CT/MRI","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"For Burns Claims: Type of Burn","options":["Thermal","Chemical","Electrical"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Degree of Burn","options":["2nd","3rd"],"required":null,"pdf_field":""},{"help":"Percentage of body surface area","type":"number","label":"Body Surface Area Affected","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"For Chauffeur Plan Benefit: Did the insured incur daily expenses for hiring a taxi, chauffeur-driven car, or similar transport due to the injury?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Number of days transport expenses incurred","type":"number","label":"How many days were these expenses incurred?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were these transport costs necessary to maintain mobility for daily routine, work, or occupational commitments?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"For Coma Benefit: Was the insured person rendered comatose as a direct result of the accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the medical certificate confirm that the insured remained comatose for at least 7 consecutive days after the accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Number of weeks in coma","type":"number","label":"What was the total duration (in weeks) that the insured remained comatose?","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"For Education Security Cover: Number of dependent children at the time of accident","options":[],"required":null,"pdf_field":""},{"help":"Provide details for each child","type":"text","label":"Details of each dependent child (Name, Age, Class, Institution, Course)","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the course ongoing at the time of accident","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Actual tuition and hostel fees per academic year","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were any fees prepaid before the accident date?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Any refund, scholarship, or waiver provided by the institution post-event?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"number","label":"For how many uncompleted years of study is reimbursement claimed?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the dependent child continued the same course after the insured event?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"For Elderly Care: What is the full name and relationship of the dependent beneficiary to the insured person?","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"For Loan Secure/EMI Protect: Outstanding Loan Amount as on Accident Date Rs.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank/Financial Institution Details","options":[],"required":null,"pdf_field":""},{"help":"Specify loan type","type":"text","label":"Loan Type: Personal/Home/Auto/Other","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Loan Account Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"EMI Amount: Rs. per month","options":[],"required":null,"pdf_field":""},{"help":"Specify distance","type":"text","label":"For Emergency Air Ambulance: Distance to nearest hospital","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Ground transport availability","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe nature of emergency","type":"text","label":"Medical emergency nature","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"For Children Marriage Expenses: How many unmarried children did the insured person have below 30 years age at the time of the accident?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Did the child’s marriage take place after the insured person’s death or permanent disablement?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"For Modification of Residence/ Vehicle: Type of modification required","options":["Home","Vehicle","Both"],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Estimated cost for modification","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"For Orphan Support: Who has opted for Orphan Support Cover","options":["Father","Mother","Both"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"For Pet Care Cover: Are the domestic pet(s) registered under the insured person’s name?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the pet placed in a boarding facility (kennel, cattery, or approved boarding)?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Were professional pet sitter services hired to care for the pet at home or their own residence?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Number of days pet care services used","type":"number","label":"For how many days were boarding or sitter services used?","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Declaration","fields":[{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Name of claimant","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Contact information","type":"text","label":"Contact Details","options":[],"required":null,"pdf_field":""},{"help":"Signature of claimant or insured","type":"signature","label":"Claimant/Insured Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Bank Details","fields":[{"help":"Name as per bank records","type":"text","label":"Insured’s Name as per Bank Account","options":[],"required":null,"pdf_field":""},{"help":"Bank account number for claim payment","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant"},{"title":"Medical Attendant’s Statement","fields":[{"help":"","type":"text","label":"Name of the Injured / Insured Person","options":[],"required":null,"pdf_field":""},{"help":"Age or DOB","type":"text","label":"Age / Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Gender","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of Accident (DD/MM/YYYY)","options":[],"required":null,"pdf_field":""},{"help":"Time of accident","type":"text","label":"Time of Accident","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place / Location of Accident","options":[],"required":null,"pdf_field":""},{"help":"Cause as informed by claimant","type":"text","label":"Cause of Accident (as informed)","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Does the cause of accident stated by the claimant tally with your medical findings?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain discrepancy if any","type":"text","label":"If No, please specify","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nature of Injuries Sustained","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Exact Body Parts Injured","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Are the injuries solely due to this accident?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify other factors if injuries not solely due to accident","type":"text","label":"If No, specify contributing factors","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Any pre-existing condition contributing/aggravating?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of pre-existing condition","type":"text","label":"If Yes, provide 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Admission","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of Discharge","options":[],"required":null,"pdf_field":""},{"help":"Details of treatment given","type":"text","label":"Treatment Provided","options":[],"required":null,"pdf_field":""},{"help":"Details of surgeries or procedures","type":"text","label":"Procedures / Surgeries Performed","options":[],"required":null,"pdf_field":""},{"help":"Start date of bed rest","type":"date","label":"Total Confinement (Bed rest) From","options":[],"required":null,"pdf_field":""},{"help":"Start date of partial confinement","type":"date","label":"Partial Confinement From","options":[],"required":null,"pdf_field":""},{"help":"Tick applicable disability type","type":"checkbox","label":"Type of Disability","options":["TTD","TPD","PPD","PTD","None"],"required":null,"pdf_field":""},{"help":"Enter disability percentage","type":"number","label":"Disability Percentage (if applicable) %","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Estimated date for resuming normal duties","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Is claimant totally disabled from occupation?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Medical prognosis","type":"text","label":"Prognosis","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Are you the patient’s regular/family doctor?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Brief medical history if regular doctor","type":"text","label":"If Yes, brief history","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Any other doctors consulted?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of other doctors consulted","type":"text","label":"If Yes, provide details","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Was patient under influence of alcohol/drugs?","options":["Yes","No","Not Known"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Has the incident been reported to police?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Police FIR or case number","type":"text","label":"If Yes, FIR/Case No.","options":[],"required":null,"pdf_field":""},{"help":"Name of police station","type":"text","label":"Police Station","options":[],"required":null,"pdf_field":""},{"help":"Name of treating doctor","type":"text","label":"Doctor’s Name","options":[],"required":null,"pdf_field":""},{"help":"Doctor's qualification","type":"text","label":"Qualification","options":[],"required":null,"pdf_field":""},{"help":"Medical registration number","type":"text","label":"Registration No.","options":[],"required":null,"pdf_field":""},{"help":"Address of clinic or hospital","type":"text","label":"Clinic / Hospital Address","options":[],"required":null,"pdf_field":""},{"help":"Doctor's contact number","type":"phone","label":"Contact Number","options":[],"required":null,"pdf_field":""},{"help":"Date of statement","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of statement","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Doctor's signature and stamp","type":"signature","label":"Signature & Official Stamp","options":[],"required":null,"pdf_field":""}],"filled_by":"treating doctor"}],"deadlines":["The duly completed Claim Form, together with enclosures, should be submitted to the issuing office at the earliest, without undue delay"],"applies_to":"Claims under Sampurna Suraksha Bima policy including accidental death, disablement, hospitalisation, and optional covers","attachments":["Copies of all supporting documents, correspondence, and evidences substantiating the claim","Last 3 Months Salary Slips (if earning member)","Leave Certificate from Employer (if earning member)","Last 3 Years Income Tax Returns (if self-employed)","Medical certificate confirming coma duration (if applicable)","Medical confirmation via X-ray/CT/MRI (if applicable)"],"declarations":["The claimant declares that no material information relevant to the claim has been concealed, misrepresented, or withheld","The claim demand has arisen strictly in accordance with the policy terms and conditions","If any statement is false or material information suppressed, the company may reject the claim"],"dropped_labels":6},"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/2383-sampurna-suraksha-bima-claim-form"}