{"id":1902,"title":"Portability Form","purpose":"service","insurer":{"slug":"shriram-general-insurance","name":"Shriram General Insurance Company Limited"},"source_pdf":"https://cdn.shriramgi.com/webassets/download/health-form/Health_Portability_Form_part_1.pdf","sha256":"2305b8d6f929d16e35319bde25de2f4fca546f93149441d8bfdefba6072faea2","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by a policyholder to request portability of their health insurance policy from an existing insurer to Shriram General Insurance Company Limited.","notes":["Enclose photocopy of the existing policy documents.","Fill only details of members who want to port.","Use the specified date format DD/MM/YYYY."],"title":"Portability Form","submit":{"to":"","how":"","address":""},"purpose":"service","sections":[{"title":"Personal Details of Policyholder/Insured","fields":[{"help":"","type":"text","label":"Name of the Policy Holder/Insured(s):","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"Enter years and months","type":"number","label":"Age:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the policyholder/insured:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of the Existing Insurer","fields":[{"help":"","type":"text","label":"Name of the existing insurer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the product proposed/intend to take","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured Proposed","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether Cumulative Bonus to be converted to an enhanced sum insured","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select one","type":"choice","label":"Type of Policy","options":["Individual","Floater"],"required":null,"pdf_field":""},{"help":"Fill details for each member who wants to port","type":"table","label":"Give only those of the members who want porting-out (Name of person, Gender M/F/TG, Aadhar No., Pan No., Member ID under expiring policy, Date of Birth, Completed Age in years, Sum insured under the expiring policy, Cumulative Bonus, Claims experience, No of years of continuous coverage including that under the expiring policy)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Details of the Proposed Insurance","fields":[{"help":"","type":"text","label":"Name of the product proposed/intend to take","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured Proposed","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether Cumulative Bonus to be converted to an enhanced sum insured","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Reason(s) for Portability","fields":[{"help":"Tick all applicable reasons","type":"checkbox","label":"Reason(s) for Portability","options":["Service problem","Product is not suitable.","Dissatisfied with existing insurer","Policy servicing by current insurer is not good.","Price is better","Delay in policy issuance","Renewal notices not received.","Wider coverage available with new insurer","Claim not handled properly.","Delay in claim settlements","Existing agent not providing service.","Premium rates with existing insurer is high/costly","Wrong repudiation of claims by current insurer","Wrong deductions in claims/Claims settled for less amounts","Any Other"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Number of Family Members to be Included in the Policy to be Ported","fields":[{"help":"","type":"number","label":"NO. OF FAMILY MEMBER TO BE INCLUDED IN THE POLICY TO BE PORTED:","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declarations and Signature","fields":[{"help":"Format: DD/MM/YYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Policy Holder","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Part II - Pre Existing Disease (PED) Exclusions","fields":[{"help":"Select Yes or No","type":"choice","label":"Whether the Pre Existing Disease (PED) exclusions/ time bound exclusions have longer exclusion period than the existing policy:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Write your consent statement as per the form","type":"text","label":"If Yes, please give written consent to the declaration below:","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Policy Holder","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"health insurance portability","attachments":["Photocopy of the existing policy documents"],"declarations":["I agree to observe the additional waiting period for the specified diseases/treatments if the exclusion period is longer than the previous policy.","I will communicate any changes in member details, health status, or claims after this application before policy inception."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"1800-300-30000","label":"Customer Service Helpline number","level":1,"hours":null,"applies_to":"all","source_url":"https://www.shriramgi.com/grievance-redressal-mechanism","quote":"@shriramgi.com\nor you can also register your complaint at\nBima Bharosa Portal\nCall our Customer Service Helpline number 1800-300-30000 / 1800-103-3009 to report your grievance.\nOur senior citizen customers can reach us through the dedicated channel below","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-103-3009","label":"Customer Service Helpline number","level":1,"hours":null,"applies_to":"all","source_url":"https://www.shriramgi.com/grievance-redressal-mechanism","quote":"you can also register your complaint at\nBima Bharosa Portal\nCall our Customer Service Helpline number 1800-300-30000 / 1800-103-3009 to report your grievance.\nOur senior citizen customers can reach us through the dedicated channel below to service them","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"gro@shriramgi.com","label":"Grievance Redressal Officer email","level":1,"hours":null,"applies_to":"all","source_url":"https://www.shriramgi.com/grievance-redressal-mechanism","quote":"al Officer at your nearest Shriram General Insurance\nBranch\n.\nYou can also write to us from your registered email ID at\ngro@shriramgi.com\nor you can also register your complaint at\nBima Bharosa Portal\nCall our Customer Service Helpline number 1800-300-30000","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-103-3009","label":"Grievance Cell No","level":null,"hours":null,"applies_to":"all","source_url":"https://cdn.shriramgi.com/webassets/download/policy-wordings/bd1c8925-acbd-4587-b36f-32bf85af43a5_Marine%20Cargo%20Insurance_%20Policy%20Wording.pdf","quote":"ress: Shriram General Insurance Co. Ltd. E-8, EPIP, RIICO Industrial Area, Sitapura, Jaipur – 302022 Grievance Cell No: 1800-103-3009, 1800-300-30000 E-mail ID: md@shriramgi.com Fax No.: 91-141-2770693 You can also reach us by email or register their co","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-300-30000","label":"Grievance Cell No","level":null,"hours":null,"applies_to":"all","source_url":"https://cdn.shriramgi.com/webassets/download/policy-wordings/bd1c8925-acbd-4587-b36f-32bf85af43a5_Marine%20Cargo%20Insurance_%20Policy%20Wording.pdf","quote":"eneral Insurance Co. Ltd. E-8, EPIP, RIICO Industrial Area, Sitapura, Jaipur – 302022 Grievance Cell No: 1800-103-3009, 1800-300-30000 E-mail ID: md@shriramgi.com Fax No.: 91-141-2770693 You can also reach us by email or register their complaints on the","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/shriram-general-insurance/1902-portability-form"}