{"id":1039,"title":"Proposal Form- Overseas Mediclaim Policy- Employment and Study","purpose":"proposal","insurer":{"slug":"oriental-insurance","name":"The Oriental Insurance Company Limited"},"source_pdf":"https://oicl-cms-media.s3.ap-south-1.amazonaws.com/11_PROPOSAL_FORM_E_and_S_PDF_PDF_d754c0c70e.pdf","sha256":"be5726bdf076f781b7fdee1cdc39cf252d7f3c637be8fedd2acd2feb76c34c49","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is for Indian citizens aged 18 to 60 who are temporarily going abroad for education, research, or temporary employment to apply for Overseas Mediclaim insurance. The proposer fills it.","notes":["Use block letters to fill the form.","Answer all medical history questions with Yes or No; a dash is not sufficient.","Attach original medical reports if required.","Medical examination by a doctor with M.D. degree is required if over 40 years and traveling to USA/Canada or if medical history indicates substandard risk.","Separate proposal forms must be completed for spouse or child accompanying the proposer.","Prohibition of rebates applies as per Section 41 of the Insurance Act 1938."],"title":"Proposal Form- Overseas Mediclaim Policy- Employment and Study","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Personal Details","fields":[{"help":"Write your full name in block letters","type":"text","label":"Name (Mr. / Mrs./ Miss/ Master)","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Sex: Male / Female","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"DD/MM/YY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Your age in years","type":"number","label":"Age","options":[],"required":true,"pdf_field":""},{"help":"Feet, inches and centimeters","type":"text","label":"Height","options":[],"required":true,"pdf_field":""},{"help":"Pounds and kilograms","type":"text","label":"Weight","options":[],"required":true,"pdf_field":""},{"help":"Your passport number","type":"text","label":"Passport No.","options":[],"required":true,"pdf_field":""},{"help":"Date passport was issued","type":"date","label":"Date of Issue","options":[],"required":true,"pdf_field":""},{"help":"Select the visa type you hold","type":"choice","label":"Type of Visa Held: F1 / J1 / H1 / Any other","options":["F1 (Student)","J1 (Research)","H1 (Temporary Employment)","Any other"],"required":true,"pdf_field":""},{"help":"Specify the visa state type","type":"text","label":"State Type","options":[],"required":true,"pdf_field":""},{"help":"If applicable, provide policy number and passport number","type":"text","label":"Is the Proposed Person a spouse or child of an Insured Person (participant), if so state Policy Number of Insured Person and Passport No. of Participant.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Address and Contact Details","fields":[{"help":"Full residential address in India","type":"text","label":"Your address in India","options":[],"required":true,"pdf_field":""},{"help":"Telephone number at your Indian address","type":"phone","label":"Tel No.","options":[],"required":false,"pdf_field":""},{"help":"Name of your next of kin","type":"text","label":"Your Next to Kin (Mr. / Mrs./ Miss)","options":[],"required":true,"pdf_field":""},{"help":"Relationship to next of kin","type":"text","label":"Relationship","options":[],"required":true,"pdf_field":""},{"help":"Address of next of kin","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Telephone number of next of kin","type":"phone","label":"Tel No.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Country and Institution Details","fields":[{"help":"Country where you will study or work","type":"text","label":"Country of Studying or Posting","options":[],"required":true,"pdf_field":""},{"help":"Your address abroad","type":"text","label":"Address in country of studying or posting","options":[],"required":true,"pdf_field":""},{"help":"Telephone number at foreign address","type":"phone","label":"Tel No.","options":[],"required":false,"pdf_field":""},{"help":"Name and address of your institution or employer abroad","type":"text","label":"Name and Address of School / work place you are attending","options":[],"required":true,"pdf_field":""},{"help":"Telephone number of school or workplace","type":"phone","label":"Tel No.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Studies / Research / Employment","fields":[{"help":"Describe your planned activities abroad","type":"text","label":"Brief details of nature of future studies / research and activities /or employment /employment to be undertaken","options":[],"required":true,"pdf_field":""},{"help":"Name and address of your sponsor in India","type":"text","label":"Name and address of Indian Sponsor","options":[],"required":false,"pdf_field":""},{"help":"Relationship to Indian sponsor","type":"text","label":"Relationship","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance Period","fields":[{"help":"Specify the insurance coverage period","type":"text","label":"Period of Insurance required","options":[],"required":true,"pdf_field":""},{"help":"Start date of insurance (DD/MM/YY)","type":"date","label":"Commencement Date","options":[],"required":true,"pdf_field":""},{"help":"Number of months abroad","type":"number","label":"Total period of months that you are intending to study/work in the country of study / posting","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Medical History","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"Are you in good health and free from physical defect or infirmity?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Do you ordinarily enjoy good health?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No and provide details if Yes","type":"yes-no","label":"Have you ever suffered from: a. any nervous or mental condition, fainting episode, blackout fit or paralysis of any kind?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Have you any intention of engaging in winter sports or any other sports or pastimes rendering you liable to personal injury?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide any other relevant information","type":"text","label":"Are there any additional facts affecting the proposed insurance which should be disclosed to insurers?","options":[],"required":false,"pdf_field":""},{"help":"Provide contact details of your doctor in India","type":"text","label":"Name and address of usual medical physician in India","options":[],"required":false,"pdf_field":""},{"help":"Telephone number of your physician","type":"phone","label":"Tel No.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Medical Report Attachment","fields":[{"help":"Attach medical report if applicable","type":"attachment","label":"Please attach a copy of your medical report, if any, which was required for Entry Visa or Application to Study.","options":[],"required":false,"pdf_field":""},{"help":"Provide detailed medical history if applicable","type":"text","label":"If your answer is YES to any of the questions 6.3 (c) to (f), please give full details with dates","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Proposer","fields":[{"help":"Date of signing (DD/MM/YY)","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Parent or Guardian (if under 18 or residing with parents)","fields":[{"help":"Date of signing (DD/MM/YY)","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Parent or guardian signature","type":"signature","label":"Signature of Parent (or Guardian)","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"parent or guardian"},{"title":"Declaration by Employer (if posted overseas by Indian Employer)","fields":[{"help":"Date of signing (DD/MM/YY)","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Signature of authorized employer official","type":"signature","label":"Employer’s competent official’s signature","options":[],"required":true,"pdf_field":""},{"help":"Name of employer official","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Designation of employer official","type":"text","label":"Designation","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Company seal","type":"attachment","label":"Seal","options":[],"required":true,"pdf_field":""}],"filled_by":"employer official"},{"title":"Undertaking by Proposer","fields":[{"help":"Sign to agree to refund medical expenses if not payable","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Date of signing (DD/MM/YY)","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Medical Examination (to be completed by a Doctor with M.D. degree)","fields":[{"help":"Doctor to provide medical history","type":"text","label":"History","options":[],"required":true,"pdf_field":""},{"help":"Doctor to provide details","type":"text","label":"Any past history of disease, Operation, accidents, investigations etc.","options":[],"required":true,"pdf_field":""},{"help":"Doctor to provide findings","type":"text","label":"General Examination","options":[],"required":true,"pdf_field":""},{"help":"Doctor to provide findings","type":"text","label":"Systemic Examination","options":[],"required":true,"pdf_field":""},{"help":"Doctor to answer","type":"text","label":"Does the abnormality represent a current illness or disease which may possibly be expected to require medical treatment during proposer’s forthcoming trip?","options":[],"required":true,"pdf_field":""},{"help":"Doctor to answer","type":"text","label":"Does the proposer now or did he/she in the past require medication for this abnormality?","options":[],"required":true,"pdf_field":""},{"help":"Doctor to describe treatment","type":"text","label":"Please describe any treatment taken by the proposer in the past or being taken at present","options":[],"required":true,"pdf_field":""},{"help":"Doctor to provide opinion","type":"text","label":"Do you consider that the proposer is fit to travel anywhere abroad, due account being taken of the stress of air travel adversely affecting his medical condition?","options":[],"required":true,"pdf_field":""},{"help":"Doctor to provide test results","type":"text","label":"Does the Fasting Blood and Urine Sugar, Urine Strip Test show any Sugar?","options":[],"required":true,"pdf_field":""},{"help":"Doctor to sign","type":"signature","label":"Signature of Doctor","options":[],"required":true,"pdf_field":""},{"help":"Doctor's full name","type":"text","label":"Name of Doctor","options":[],"required":true,"pdf_field":""},{"help":"Doctor's qualifications","type":"text","label":"Qualifications","options":[],"required":true,"pdf_field":""},{"help":"Doctor's address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Doctor's telephone number","type":"phone","label":"Tel No.","options":[],"required":true,"pdf_field":""}],"filled_by":"doctor"}],"deadlines":[],"applies_to":"persons in the age group of 18 – 60 years temporarily outside India for education, research, or temporary posting","attachments":["Copy of your medical report, if any, which was required for Entry Visa or Application to Study","Company seal (if employer signs)","Electrocardiogram (if applicable)"],"declarations":["The proposer declares that all statements are true and complete and consents to medical information being obtained.","The proposer agrees that this proposal forms the basis of the insurance contract and accepts the policy terms.","If under 18 or residing with parents, a parent or guardian must confirm the information by signing.","If posted overseas by an Indian employer, an authorized official must confirm the information by signing.","The proposer undertakes to refund medical expenses paid by the insurer if found not payable under policy terms.","If unable to sign or if circumstances change before insurance start date, the proposer must inform the insurer."],"dropped_labels":7},"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/1039-proposal-form-overseas-mediclaim-policy-employment-and-study"}