{"id":1034,"title":"Mediclaim Insurance Policy (Group) Proposal Form","purpose":"proposal","insurer":{"slug":"oriental-insurance","name":"The Oriental Insurance Company Limited"},"source_pdf":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/5_Mediclaim_Insurance_Policy_Group_Proposal_form_c35036bec4.pdf","sha256":"dcd27b6850ca7a4d4467be5722da22e293f72cdcc8a522eea35a650b05c253c2","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (usually an employer or group administrator) to apply for group mediclaim insurance coverage for employees and their families.","notes":["Complete details of each person to be covered must be furnished.","Non-disclosure, misrepresentation, fraud or non-cooperation will nullify the cover.","The questions in the proposal form are indicative; all relevant information must be provided.","Use the attached Annexure 1 format to list employees and their family members to be insured.","Attach additional sheets if space is insufficient in Annexure 1.","The policy is available with minimum sum insured of Rs 50,000 and specified multiples as per policy.","The proposal is not effective until accepted by the company and premium is fully paid."],"title":"Mediclaim Insurance Policy (Group) Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Intermediary Details","fields":[{"help":"","type":"text","label":"Name of the Intermediary:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile Number:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""}],"filled_by":"intermediary"},{"title":"Proposer’s Details","fields":[{"help":"","type":"text","label":"Name of the Proposer (As per the Id Card)","options":[],"required":true,"pdf_field":""},{"help":"Include Landmark/Area/City/Town, District, State, Pin","type":"text","label":"Address (Permanent)","options":[],"required":true,"pdf_field":""},{"help":"Include Landmark/Area/City/Town, District, State, Pin","type":"text","label":"Address for Correspondence","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"Email Id","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Landline/Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN Card No","options":[],"required":false,"pdf_field":""},{"help":"Goods and Services Tax Number","type":"text","label":"GST No (If applicable)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Brief Details of the Proposer’s Business","fields":[{"help":"Provide brief description of the business","type":"text","label":"BRIEF DETAILS OF THE PROPOSER’S BUSINESS","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Number of Persons to be Covered","fields":[{"help":"Attach the list of persons to be covered as per the format attached vide ANNEXURE 1","type":"number","label":"TOTAL NUMBER OF PERSONS TO BE COVERED","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured","fields":[{"help":"Choose sum insured amount as per policy limits on individual or family floater basis","type":"choice","label":"SUM INSURED","options":["Minimum Rs 50,000 and in multiples of Rs 25,000 up to Rs 2,00,000","Beyond Rs 2,00,000 in multiples of Rs 50,000 up to Rs 5,00,000"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Group Eligibility Confirmation","fields":[{"help":"","type":"choice","label":"Please Confirm whether all eligible members of the Group/ Association/ Institution/ Corporate Body are proposed for Insurance?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Facts Affecting Insurance","fields":[{"help":"Disclose any relevant facts affecting risk","type":"text","label":"Are there any additional facts affecting the proposed Insurance, which should be disclosed to insurer? If yes, Please give details below:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposed Period of Insurance","fields":[{"help":"Start date of insurance coverage","type":"date","label":"FROM","options":[],"required":true,"pdf_field":""},{"help":"End date of insurance coverage","type":"date","label":"TO","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Pre-existing Diseases Declaration","fields":[{"help":"","type":"yes-no","label":"Is the insured or any of the family members, proposed to be covered under this insurance, suffering from any pre-existing diseases.","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"I have given explicit information of such sickness/disease/injury sustained in the above columns where the information has been sought.","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide full details of pre-existing diseases if applicable","type":"text","label":"If Yes, Please give complete details of such pre existing diseases.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposer Declaration and Consent","fields":[{"help":"Sign to declare all information is true and consent given","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Vernacular Declaration","fields":[{"help":"If proposer cannot read/write English, witness fills this","type":"text","label":"Name of the Witness","options":[],"required":false,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Witness","options":[],"required":false,"pdf_field":""},{"help":"If proposer cannot sign, thumb impression can be used","type":"signature","label":"Thumb Impression/Signature of the Proposer","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":false,"pdf_field":""}],"filled_by":"witness"},{"title":"Agent Declaration","fields":[{"help":"","type":"text","label":"Name of the Agent","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Agent Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Agent","options":[],"required":true,"pdf_field":""}],"filled_by":"agent"},{"title":"Annexure 1 - List of Employees Proposed for Insurance","fields":[{"help":"Columns: Sr. No., Name of the Employee/Member, Worker/Employee code or Number, Names of Employee’s/Member’s family members to be covered, Relationship of the dependant members to the Employee/Member, Age/Date of Birth, Gender (M/F/TG), Sum Insured. Attach additional sheets if needed.","type":"table","label":"List of Employees Proposed for Insurance","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Group Mediclaim Insurance Policy","attachments":["List of persons to be covered as per the format attached vide ANNEXURE 1"],"declarations":["The proposer declares that all information given is true and complete to the best of their knowledge.","The policy will be based on the information provided and will come into force only after full premium payment.","The proposer will notify the company of any changes in occupation or health before acceptance of risk.","The proposer consents to the company seeking medical and insurance information for underwriting and claims.","Pre-existing diseases disclosed will be permanently excluded from coverage as per policy clause 6.","The proposer authorizes sharing of proposal and medical information with regulatory authorities.","Section 41 of Insurance Act prohibits rebates and non-compliance may lead to fines.","If proposer cannot read/write English, a witness must confirm the proposer understands the form.","The agent declares having explained the proposal form contents and consequences of untrue information."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"1800118485","label":"Toll free","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/Happy_Family_Floater_2021_policy_wordings_04ad8fa002.pdf","quote":"company through\nWebsite: www.orientalinsurance.org.in Toll free: 1800118485 Or 011- 33208485 E-mail: csd@orientalinsurance.co.in\nInsured person may also approach the grievance cell at any of the","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"011- 33208485","label":"Customer Care Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/Happy_Family_Floater_2021_policy_wordings_04ad8fa002.pdf","quote":"company through\nWebsite: www.orientalinsurance.org.in Toll free: 1800118485 Or 011- 33208485 E-mail: csd@orientalinsurance.co.in\nInsured person may also approach the grievance cell at any of the company’s branche","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Customer Service Department 4th Floor, Agarwal House Asaf Ali Road, New Delhi-110002","label":"Grievance Officer address","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/Happy_Family_Floater_2021_policy_wordings_04ad8fa002.pdf","quote":"with the redressal of grievance through one of the above methods, insured person may contact the grievance officer at: Customer Service Department 4th Floor, Agarwal House Asaf Ali Road, New Delhi-110002. For updated details of grievance officer, kindly refer the link https://orientalinsurance.org.in/documents/10182/76050","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004","label":"Insurance Ombudsman Hyderabad","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the policy document\nOffice Details | Jurisdiction of Office Union Territory, District) | HYDERABAD - Shri N. Sankaran Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra Pradesh, Telangana, Yanam and part of Territory","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001","label":"Insurance Ombudsman Ahmedabad","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the policy document\nOffice Details | Jurisdiction of Office Union Territory, District) | HYDERABAD - Shri N. Sankaran Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra Pradesh, Te","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Office of the Insurance Ombudsman, Jeevan Nidhi - II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005","label":"Insurance Ombudsman Jaipur","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the policy document\nOffice Details | Jurisdiction of Office Union Territory, District) | HYDERABAD - Shri N. Sankaran Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra Pra","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Office of the Insurance Ombudsman, Jeevan Soudha Building, PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru - 560 078","label":"Insurance Ombudsman Bengaluru","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the policy document\nOffice Details | Jurisdiction of Office Union Territory, District) | HYDERABAD - Shri N. Sankaran Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra Pradesh, Telangana, Yanam and part of Territory of","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College,M.G.Road, Ernakulam - 682 011","label":"Insurance Ombudsman Ernakulam","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the policy document\nOffice Details | Jurisdiction of Office Union Territory, District) | HYDERABAD - Shri N. Sankaran Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra Pradesh, Telangana, Yanam a","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir, Bhopal – 462 011","label":"Insurance Ombudsman Bhopal","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the policy document\nOffice Details | Jurisdiction of Office Union Territory, District) | HYDERABAD - Shri N. Sankaran Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra Pradesh, Telangana","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072","label":"Insurance Ombudsman Kolkata","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the policy document\nOffice Details | Jurisdiction of Office Union Territory, District) | HYDERABAD - Shri N. Sankaran Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001","label":"Insurance Ombudsman Lucknow","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the policy document\nOffice Details | Jurisdiction of Office Union Territory, District) | HYDERABAD - Shri N. Sankaran Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra Pradesh, Telanga","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17 - D, Chandigarh - 160 017","label":"Insurance Ombudsman Chandigarh","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the policy document\nOffice Details | Jurisdiction of Office Union Territory, District) | HYDERABAD - Shri N. Sankaran Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra Pradesh, Telangana,","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Office of the Insurance Ombudsman, 3rd Floor, Jeevan SevaAnnexe, S. V. Road, Santacruz (W), Mumbai - 400 054","label":"Insurance Ombudsman Mumbai","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the policy document\nOffice Details | Jurisdiction of Office Union Territory, District) | HYDERABAD - Shri N. Sankaran Office of the Insurance Ombudsman, 6- 2-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra Prad","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"csd@orientalinsurance.co.in","label":"Customer Care Department email","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"e remains unaddressed, the insured person may contact the Officer, Customer Care Department, Head Office or email us at csd@orientalinsurance.co.in. OMBUDSMAN: The Insured person can also approach the office of Insurance Ombudsman of the respective area/region for re","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"040 – 23312122","label":"Insurance Ombudsman Hyderabad Tel.","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"-46, 1st floor, \"Moin Court\", Lane Opp. Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.: 040 – 23312122 Email: bimalokpal.hyderabad@cioins.co.in | Andhra Pradesh, Telangana, Yanam and part of Territory of Pondicherry.\nAHMED","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"079 - 25501201/02/05/06","label":"Insurance Ombudsman Ahmedabad Tel.","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"ice of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001. Tel.: 079 - 25501201/02/05/06 Email: bimalokpal.ahmedabad@cioins.co.i n | Gujarat, Dadra & Nagar Haveli, Daman and Diu. | JAIPUR - Shri Rajiv Dutt Sh","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"0141- 2740363/2740798","label":"Insurance Ombudsman Jaipur Tel.","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"arma Office of the Insurance Ombudsman, Jeevan Nidhi - II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005. Tel.: 0141- 2740363/2740798 Email: bimalokpal.jaipur@cioins.co.in | Rajasthan.\nBENGALURU - Mr Vipin Anand Office of the Insurance Ombudsman, Jeevan","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"080 - 26652048 / 26652049","label":"Insurance Ombudsman Bengaluru Tel.","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"oudha Building, PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru - 560 078. Tel.: 080 - 26652048 / 26652049 Email: bimalokpal.bengaluru@cioins.co.in | Karnataka. | ERNAKULAM - Shri G. Radhakrishnan Office of the Insurance Ombud","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"0484 - 2358759","label":"Insurance Ombudsman Ernakulam Tel.","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"ance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College,M.G.Road, Ernakulam - 682 011. Tel.: 0484 - 2358759 Email: bimalokpal.ernakulam@cioins.co.in | Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry.\nBHOPAL -","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"0755 - 2769201 / 2769202","label":"Insurance Ombudsman Bhopal Tel.","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir, Bhopal – 462 011. Tel.: 0755 - 2769201 / 2769202 Email: bimalokpal.bhopal@cioins.co.in | Madhya Pradesh, Chattisgarh. | KOLKATA - Ms Kiran Sahdev Office of the Insuranc","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"033 - 22124339 / 22124341","label":"Insurance Ombudsman Kolkata Tel.","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"n Sahdev Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072. Tel.: 033 - 22124339 / 22124341 Email: bimalokpal.kolkata@cioins.co.in | West Bengal, Sikkim, Andaman & Nicobar Islands.\nBHUBANESHWAR - Shri Manoj Kuma","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"0522 - 4002082 / 3500613","label":"Insurance Ombudsman Lucknow Tel.","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"f the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001. Tel.: 0522 - 4002082 / 3500613 Email: bimalokpal.lucknow@cioins.co.in | Some Districts of Uttar Pradesh\nTel.: 0522 - 4002082 / 3500613 Email: bimalokp","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"0172 - 4646394 / 2706468","label":"Insurance Ombudsman Chandigarh Tel.","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"nath Ghosh (excluding Gurugram, Faridabad,\n& 103, 2nd Floor, Batra Building, Sector 17 - D, Chandigarh - 160 017. Tel.: 0172 - 4646394 / 2706468 Email: bimalokpal.chandigarh@cioins.co.i n | Sonepat and | Road, Santacruz (W), Mumbai - 400 054. Tel.: 022 - 69038800/","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"022 - 69038800/27/29/31/32/33","label":"Insurance Ombudsman Mumbai Tel.","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/2_UAV_UDAN_Policy_Wordings_1_9c60e6776b.pdf","quote":"46394 / 2706468 Email: bimalokpal.chandigarh@cioins.co.i n | Sonepat and | Road, Santacruz (W), Mumbai - 400 054. Tel.: 022 - 69038800/27/29/31/32/33 Email: bimalokpal.mumbai@cioins.co.in | Navi Mumbai & Thane.\nBahadurgarh), Himachal Pradesh, Union Territories of Jammu","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"https://orientalinsurance.org.in/documents/10182/7605007/List+of+Nodal+Officer+.pdf/992a7f9baef7-5cac- c613-ffc05d578a3e","label":"List of Nodal Officer","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/Happy_Family_Floater_2021_policy_wordings_04ad8fa002.pdf","quote":"h Floor, Agarwal House Asaf Ali Road, New Delhi-110002. For updated details of grievance officer, kindly refer the link https://orientalinsurance.org.in/documents/10182/7605007/List+of+Nodal+Officer+.pdf/992a7f9baef7-5cac- c613-ffc05d578a3e\n\nOffice Details | Jurisdiction of Office (Union Territory, District)\nAHMEDABAD – Office of the Insurance Ombudsman, 2nd","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"https://orientalinsurance.org.in/grievance-redressal","label":"Grievance Officer details","level":null,"hours":null,"applies_to":"all","source_url":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/Gramin_Health_Bima_Policy_Group_Policy_Wordings_04092026_33b6ab9ee1.pdf","quote":"Office Complex, Kidwai Nagar East, New Delhi - 110023. For updated details of grievance officer, Kindly refer the link: https://orientalinsurance.org.in/grievance-redressal\n\ngrievance through the above methods, they may also approach the office of the Insurance Ombudsman for their respective","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/oriental-insurance/1034-mediclaim-insurance-policy-group-proposal-form"}