{"id":2053,"title":"Acko International Travel Insurance Proposal Form","purpose":"proposal","insurer":{"slug":"acko-life-insurance","name":"Acko Life Insurance Limited"},"source_pdf":"https://acko-cms.ackoassets.com/Proposal_form_Acko_International_Travel_Insurance_aa125c3172.pdf","sha256":"3694912734dfd07b6852cd02c07b0dccf1aa120f5e75df8803fc51e9a73b4776","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for a person proposing to buy Acko International Travel Insurance to provide details about themselves and the insurance coverage they want. The proposer fills this form.","notes":["Complete the form in CAPITAL LETTERS.","Submit the original form only; copies are not accepted.","The Company is not obliged to accept any proposal until premium is received in full."],"title":"Acko International Travel Insurance Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Details about Proposer and Insured","fields":[{"help":"Enter full name in CAPITAL LETTERS","type":"text","label":"Name of the Proposer:","options":[],"required":null,"pdf_field":""},{"help":"Enter full name in CAPITAL LETTERS","type":"text","label":"Name of the Insured:","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Insured Mobile No.:","options":[],"required":null,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Insured Email:","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"Specify the geographic area for insurance coverage","type":"text","label":"Geography of the risk to be covered:","options":[],"required":null,"pdf_field":""},{"help":"Enter nominee's name and relationship if applicable","type":"text","label":"Name and relationship of the Nominee (optional)","options":[],"required":false,"pdf_field":""},{"help":"Enter passport number","type":"text","label":"Passport Number:","options":[],"required":null,"pdf_field":""},{"help":"Enter start date of insurance coverage","type":"date","label":"Period of Insurance (DD/MM/YYYY): Cover Start Date:","options":[],"required":null,"pdf_field":""},{"help":"Enter end date of insurance coverage","type":"date","label":"Cover End Date:","options":[],"required":null,"pdf_field":""},{"help":"Provide details of any past medical history or disabilities","type":"text","label":"Please mention past history with the duration of any disease or any disability (with percentage), accident or hospitalization with details:","options":[],"required":null,"pdf_field":""},{"help":"Indicate if you are an existing customer","type":"yes-no","label":"Existing Customer: (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Covers","fields":[{"help":"Select Yes or No to opt for this cover","type":"yes-no","label":"Accidental Medical Expense Reimbursement","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No to opt for this cover","type":"yes-no","label":"Illness Medical Expense Reimbursement","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Details of Pre- Existing Disease","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"OPD Treatment","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Adventure Sports Injury","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Hospital Daily Allowance","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter daily sum insured amount in rupees","type":"amount","label":"Per day Sum Insured:","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Physiotherapy","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Compassionate Visit","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Return of Minor Child","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Emergency Stay and Extension","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Evacuation (Medical and Catastrophe)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Accidental Death","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Permanent Total Disability","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Permanent Partial Disability","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Repatriation of Mortal Remains","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Flight Delay","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Delayed Arrival","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Delayed Departure","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Missed Flight","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Missed Connection","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Delay of Checked-in Baggage","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Delay of Sports Equipment","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Total Loss of Checked-in Baggage","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Partial Loss of Checked-in Baggage","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Kidnap / Hijack Cover","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Trip Cancellation","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Electronic Equipment Cover","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Trip Rescheduling","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Personal Liability & Bail Bond","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Pet Cover","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Fire and Allied Perils (Home Building and Contents)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Home Insurance Cover","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Pre-Existing Disease Cover","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Personal Accident (Common Carrier)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Trip Cancellation due to Covid-19","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Loss of Passport","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Financial Emergency Cover","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Bounced Booking","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Insured","fields":[{"help":"Enter date of signing","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 the Proposer:","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Acko International Travel Insurance","attachments":[],"declarations":["The statements made in this Proposal Form are true and form the basis of the insurance contract.","Any changes in risk after submission must be immediately conveyed to the Company.","No person shall offer or accept any rebate as an inducement to take or renew insurance except as allowed by published prospectuses.","Non-compliance with rebate provisions may lead to a penalty up to ten lakh rupees."],"dropped_labels":10},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"1800-210-1992","label":"Customer Care Number","level":null,"hours":"Monday to Sunday: 9:00 AM – 8:00 PM","applies_to":"life","source_url":"https://www.acko.com/life/contact-us/","quote":"t us\nSupport\nRenewals\nNew to ACKO?\nRenew life insurance\nExisting ACKO Customer\nLogin and renew policy\nClaims\nCall us at\n1800-210-1992\nEmail us at\n[email protected]\nLogin\nACKO Life Home\n/\nLife Insurance\n/\nAcko Life Insurance Customer Care | Customer Care","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"+91 8069067215","label":"Customer Care Phone Number for PERSONS WITH DISABILITIES (PwD)","level":null,"hours":"Monday to Sunday: 9:00 AM – 8:00 PM","applies_to":"life","source_url":"https://www.acko.com/life/contact-us/","quote":"y to Sunday: 9:00 AM – 8:00 PM\nACKO Life Insurance Customer Care Phone Number for PERSONS WITH DISABILITIES (PwD)\nCall: +91 8069067215\nMonday to Sunday: 9:00 AM – 8:00 PM\nProducts\nLife insurance\nTerm insurance\n1 crore term insurance\nCompany\nAbout us\nCare","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-210-1992","label":"Grievance desk phone number","level":1,"hours":null,"applies_to":"life","source_url":"https://www.acko.com/life/customer-service/grievance-redressal/","quote":"t us\nSupport\nRenewals\nNew to ACKO?\nRenew life insurance\nExisting ACKO Customer\nLogin and renew policy\nClaims\nCall us at\n1800-210-1992\nEmail us at\n[email protected]\nLogin\nACKO Life Home\n/\nACKO Life Insurance Customer Service\n/\nACKO Life Insurance Grievan","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Ms. Komal Arawat (Grievance Redressal Officer) Acko Life Insurance Limited, 36/5 Hustlehub One East, Somasandrapalya, 27th Main Road, Sector 2, HSR Layout, Bangalore – 560102","label":"Grievance Redressal Officer postal address","level":2,"hours":null,"applies_to":"life","source_url":"https://www.acko.com/life/customer-service/grievance-redressal/","quote":null,"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/acko-life-insurance/2053-acko-international-travel-insurance-proposal-form"}