{"id":1035,"title":"ORIENTAL MEDICLAIM INSURANCE POLICY (INDIVIDUAL) 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/4_Oriental_Mediclaim_Insurance_Policy_Individual_PROPOSAL_FORM_PDF_d58a93daae.pdf","sha256":"f6b44e5e8f4febfa4a37203ad2b8f0984471ee60ae8c28da5ee367809fb352f2","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals proposing to purchase the Oriental Mediclaim Insurance Policy (Individual) to provide personal, health, and insurance history details required for underwriting the policy.","notes":["Fill the proposal form and self declaration form in block letters and in duplicate.","Attach two stamp size photographs of each person proposed to be insured.","Persons above 55 years must undergo pre-insurance medical checkup at company’s listed diagnostic centre; 50% of cost reimbursed after acceptance.","Use original documents for hospitalization and surgery details attachments.","In case of death claims, beneficiary name, relationship, and legal status must be mentioned.","Claims are payable to proposer; in case of proposer’s death, claims payable to nominee declared in this form.","Proposal form can be completed by a witness if proposer cannot read/write English; witness must sign and declare having explained contents.","Agent declaration must be completed by the agent explaining the proposal form contents to the proposer."],"title":"ORIENTAL MEDICLAIM INSURANCE POLICY (INDIVIDUAL) PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter full name with appropriate title","type":"text","label":"NAME OF THE PROPOSER : Mr. / Mrs. / Miss","options":[],"required":true,"pdf_field":""},{"help":"Provide full postal address, phone numbers and email","type":"text","label":"ADDRESS & TELEPHONE NO. / MOBILE NO. / E-MAIL ADDRESS:","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile No","options":[],"required":true,"pdf_field":""},{"help":"Enter landline phone number if any","type":"phone","label":"Ph.No","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E-mail","options":[],"required":false,"pdf_field":""},{"help":"Enter PAN number as issued by Income Tax Authorities","type":"text","label":"PERMANENT ACCOUNT NO. (ISSUED BY INCOME-TAX AUTHORITIES):","options":[],"required":true,"pdf_field":""},{"help":"Provide family physician's contact details","type":"text","label":"NAME - ADDRESS & TELEPHONE NO OF FAMILY PHYSICIAN","options":[],"required":false,"pdf_field":""},{"help":"Family physician's phone number","type":"phone","label":"Ph.No","options":[],"required":false,"pdf_field":""},{"help":"Family physician's mobile number","type":"phone","label":"Mobile No","options":[],"required":false,"pdf_field":""},{"help":"Enter monthly income in rupees","type":"amount","label":"MONTHLY INCOME:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Persons Proposed to be Insured","fields":[{"help":"Fill details for each person: Name, Relationship, Sex (M/F), Whether dependent on proposer, Date of Birth, Age (in completed years), Occupation, Sum Insured (Rs), If opted, Personal Accident (PA) Sum Insured (Rs) Y/N","type":"table","label":"NAME OF THE PERSON(S) PROPOSED TO BE INSURED AND RELATIONSHIP WITH THE PROPOSER.","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Voluntary Co-Payment","fields":[{"help":"Select if opting for voluntary co-payment and percentage","type":"choice","label":"VOLUNTARY CO-PAYMENT OPTED: IF YES, 10% / 20%","options":["Yes - 10%","Yes - 20%","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Past Hospitalization / Illness / Disease / Injury Details","fields":[{"help":"Provide details: Name of proposed person, Name of insurer, Type of policy, Policy number, Policy period, Details of hospitalization/disease/injury","type":"table","label":"DETAILS OF ANY HOSPITALIZATION / ILLNESS / DISEASE/ INJURY IN THE PAST (whether or not insurance existed)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Hospitalization / Illness / Disease / Injury in Past 4 Years","fields":[{"help":"Provide details: Name of proposed person, Name of insurer, Policy no., Sum Insured, Period, Details of hospitalization/disease/injury","type":"table","label":"DETAILS OF ANY HOSPITALISATION / ILLNESS/DISEASE/INJURY AT PRESENT OR IN THE PAST 4 YEARS (whether or not insurance existed)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance Refusal / Cancellation Details","fields":[{"help":"Provide details: Name of proposed person, Refusal by insurer & reasons, Cancellation of policy/denial of renewal by insurer & reasons","type":"table","label":"HAS THE PROPOSER OR ANY OF THE MEMBERS OF THE FAMILY PROPOSED BEEN REFUSED INSURANCE FOR HEALTH COVER / POLICY CANCELLED / RENEWAL DENIED. IF SO DETAILS THEREOF:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"TPA Service Opt Out","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Do you wish to opt out of TPA Service?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposed Insurance Period","fields":[{"help":"Enter proposed start date of insurance","type":"date","label":"PROPOSED DATE & PERIOD OF INSURANCE (DD MM YYYY) FROM","options":[],"required":true,"pdf_field":""},{"help":"Enter proposed end date of insurance","type":"date","label":"To","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Nomination","fields":[{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Print name of proposer","type":"text","label":"Name of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter name and relationship of nominee","type":"text","label":"Nomination: In the event of my death, I nominate (Name & Relationship with the Insured)","options":[],"required":false,"pdf_field":""},{"help":"Enter date and place of nomination","type":"text","label":"Dated this... Day of... 200...","options":[],"required":false,"pdf_field":""},{"help":"Witness signature and details","type":"signature","label":"Signature of Witness: Name and address","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Self Declaration Form","fields":[{"help":"Enter full name","type":"text","label":"Name of the Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter age in years","type":"number","label":"Age (in completed years)","options":[],"required":true,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of birth","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Sex","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"Enter full address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Enter telephone number","type":"phone","label":"Telephone No.","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E-mail ID","options":[],"required":false,"pdf_field":""},{"help":"Provide details of photo ID or ration card","type":"text","label":"Identification Document Details:(Photo ID Proof / Ration Card)","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Have you Noticed sudden decrease or increase in your weight in past six months Yes / No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of recent medical visits","type":"text","label":"Have you visited a doctor /hospital /healthcare unit for evaluation or treatment in recent past if yes, give details:","options":[],"required":false,"pdf_field":""},{"help":"Provide hospitalization details and attach documents","type":"text","label":"Give Details of hospitalization (Attach Copy of discharge card and doctors consultation notes and investigations copy):","options":[],"required":false,"pdf_field":""},{"help":"Provide surgery name or operated part","type":"text","label":"Past surgical details: Name of surgery or part operated","options":[],"required":false,"pdf_field":""},{"help":"Enter date of surgery","type":"date","label":"Date of operation:","options":[],"required":false,"pdf_field":""},{"help":"Indicate if fully cured and provide details","type":"yes-no","label":"Completely cured YES / NO, give details","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Print name","type":"text","label":"Name of the person proposed to be insured","options":[],"required":true,"pdf_field":""},{"help":"Enter date","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"each proposed person"}],"deadlines":[],"applies_to":"Individual Mediclaim Insurance Policy proposals","attachments":["Two stamp size photographs of each person proposed to be insured","Copy of discharge card and doctors consultation notes and investigations copy (if hospitalization or surgery details are provided)"],"declarations":["The proposer declares that all statements and particulars are true and complete to the best of their knowledge.","The information provided will form the basis of the insurance policy and the policy will be effective only after full premium payment.","The proposer will notify any change in occupation or health after submission but before acceptance.","The proposer consents to the company seeking medical information from doctors, hospitals, employers, and other insurers for underwriting and claim settlement.","The proposer authorizes the company to share proposal and medical information with government and regulatory authorities.","The proposer declares that all information in the self declaration form is true and understands that untrue information may affect coverage and claims."],"dropped_labels":1},"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/1035-oriental-mediclaim-insurance-policy-individual-proposal-form"}