{"id":2027,"title":"E-Statement Registration Form","purpose":"service","insurer":{"slug":"star-union-dai-ichi-life-insurance","name":"Star Union Dai-Ichi Life Insurance Company Limited"},"source_pdf":"https://dxwkpt4djlxwl.cloudfront.net/E_Statement_Registration_Form_0d6546a09b_dc09bf720f.pdf","sha256":"7db538d7b22e473f2d9f4cf734220ac9eda22fde555443c58cd0c7f64d2362cf","pages":1,"collected":"2026-10-20","instructions":{"about":"This form is used by policyholders to register for receiving their policy communications electronically via email (E-Statements). The policyholder fills this form to enroll or update their email ID for electronic communication.","notes":["Email ID is mandatory for processing the request and must be the one already registered with the insurer.","New email ID provided will be updated for future communications.","Policyholder must update details with the insurer to receive uninterrupted service.","If difficulty in accessing electronic communications occurs, notify the insurer within 24 hours."],"title":"E-Statement Registration Form","submit":{"to":"","how":"","address":""},"purpose":"service","sections":[{"title":"Policyholder Details","fields":[{"help":"","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Enter your Client ID","type":"text","label":"Client ID*:","options":[],"required":true,"pdf_field":""},{"help":"Enter your Policy Number","type":"text","label":"or Policy No*:","options":[],"required":true,"pdf_field":""},{"help":"Enter your full name","type":"text","label":"Name of Policyholder:","options":[],"required":null,"pdf_field":""},{"help":"Enter your full address","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"Enter your contact number","type":"text","label":"Contact No.:","options":[],"required":null,"pdf_field":""},{"help":"Enter your mobile number","type":"phone","label":"Mobile*:","options":[],"required":true,"pdf_field":""},{"help":"Enter your residence phone number","type":"phone","label":"Residence:","options":[],"required":null,"pdf_field":""},{"help":"Enter the email ID already registered with the insurer","type":"email","label":"Email ID*:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"If you wish to add/change/correct the email ID, then Please provide the new email id below:","options":[],"required":false,"pdf_field":""},{"help":"Enter new email ID to update for future communications","type":"email","label":"New email ID**:","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration and Agreement","fields":[{"help":"Sign to agree to enroll for E-Statements","type":"yes-no","label":"I hereby declare that I would like to enrol for E-Statements and I request you to kindly register my E-mail ID in your records to send all the future communications through electronic medium.","options":["I agree"],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Policyholder","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"","attachments":[],"declarations":["The E-Statement is an optional facility to the policy holders.","By signing up, the policyholder agrees to receive policy communications electronically for all policies under the customer ID.","Policyholder understands that some communications may still be sent in hard copy.","Policyholder is responsible for providing and updating the correct email address with the insurer.","Policyholder must notify the insurer immediately if the email address is compromised or if there is difficulty accessing communications.","Policyholder accepts risks related to unsecured email transmission and exempts the insurer from liability for misuse or interception.","The insurer is not liable to verify authenticity of emails.","The insurer may discontinue or modify the E-Statement facility at its discretion.","The insurer does not assure continuous and uninterrupted service under this initiative."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"18002668833","label":"Toll Free No","level":null,"hours":null,"applies_to":"all","source_url":"https://irdai.gov.in/documents/37343/563751/Saral+Jeevan+Bima+PD+V_1_5+%28final%29_2020-21.pdf/dc4af66a-d7ca-94d8-62a4-432805c9f5ed?version=1.1&t=1667460523120&download=true","quote":"PAID.\nFor any assistance relating to your Policy or claim related query, you may get in touch with us via Toll Free No: 18002668833 or Land line No: 022 71966300 (charges apply) or email Us at: customercare@sudlife.in.\nThanking you once again for your","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"022 71966300","label":"Land line No","level":null,"hours":"charges apply","applies_to":"all","source_url":"https://irdai.gov.in/documents/37343/563751/Saral+Jeevan+Bima+PD+V_1_5+%28final%29_2020-21.pdf/dc4af66a-d7ca-94d8-62a4-432805c9f5ed?version=1.1&t=1667460523120&download=true","quote":"ting to your Policy or claim related query, you may get in touch with us via Toll Free No: 18002668833 or Land line No: 022 71966300 (charges apply) or email Us at: customercare@sudlife.in.\nThanking you once again for your patronage and looking forward","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"022 39546300","label":"Land line No","level":null,"hours":"charges apply","applies_to":"all","source_url":"https://irdai.gov.in/documents/37343/563751/142N056V01_2017-18.pdf/53e63035-8872-7f44-0263-63016740a6c8?version=1.1&t=1667469582333&download=true","quote":"ting to your Policy or claim related query, you may get in touch with us via Toll Free No: 18002668833 or Land line No: 022 39546300 (charges apply) or email Us at: customercare@sudlife.in.\nThanking you once again for your patronage and looking forward","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Grievance Redressal Officer, Star Union Dai-ichi Life Insurance Company Ltd., 11th Floor, Vishwaroop IT Park, Plot No. 34, 35 & 38, Sector 30A of IIP, Vashi, Navi Mumbai – 400 703","label":"Grievance Redressal Officer","level":1,"hours":null,"applies_to":"all","source_url":"https://irdai.gov.in/documents/37343/563751/GEBP+Master+Pol+doc_2020-21.pdf/a5b92dec-159b-de50-83f9-52e6f268a1fc?version=1.1&t=1667460674786&download=true","quote":"our website\nIf You are not satisfied with the response provided by any of the above touch points, You may write to the Grievance Redressal Officer at grievanceredressal@sudlife.in or send a communication at Grievance Redressal Officer, Star Union Dai-ichi Life Insurance Company Ltd., 11th Floor, Vishwaroop IT Park, Plot No. 34, 35 & 38, Sector 30A of IIP, Vashi, Navi Mumbai – 400 703.\nTo further escalate the matter","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"grievanceredressal@sudlife.in","label":"Grievance Redressal Officer","level":1,"hours":null,"applies_to":"all","source_url":"https://irdai.gov.in/documents/37343/563751/GEBP+Master+Pol+doc_2020-21.pdf/a5b92dec-159b-de50-83f9-52e6f268a1fc?version=1.1&t=1667460674786&download=true","quote":"isfied with the response provided by any of the above touch points, You may write to the Grievance Redressal Officer at grievanceredressal@sudlife.in or send a communication at Grievance Redressal Officer, Star Union Dai-ichi Life Insurance Company Ltd., 11th Floor, Vi","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/star-union-dai-ichi-life-insurance/2027-e-statement-registration-form"}