{"id":2055,"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_Add_on_bfb619a2a6.pdf","sha256":"b5d35e414fb1dd0bfbb14b00eb1d19019a05006ae8c38aee70e2540125313768","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for a proposer to apply for Acko International Travel Insurance and select add-on covers. The proposer fills this form.","notes":["Complete the form in CAPITAL LETTERS.","Submit the original form only; copies will not be accepted.","The company is not obliged to accept any proposal until premium is received in full.","Information must be true, accurate, and complete to avoid claim rejection."],"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":true,"pdf_field":""},{"help":"Enter full name in CAPITAL LETTERS","type":"text","label":"Name of the Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile number with country code if applicable","type":"phone","label":"Insured Mobile No.","options":[],"required":true,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Insured Email","options":[],"required":false,"pdf_field":""},{"help":"Enter in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Specify the travel destination or region","type":"text","label":"Geography of the risk to be covered","options":[],"required":true,"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 as per passport document","type":"text","label":"Passport Number","options":[],"required":true,"pdf_field":""},{"help":"Enter start date of insurance coverage","type":"date","label":"Period of Insurance (DD/MM/YYYY): Cover Start Date","options":[],"required":true,"pdf_field":""},{"help":"Provide details if any relevant medical history exists","type":"text","label":"Please mention past history with the duration of any disease, accident or hospitalization with details","options":[],"required":false,"pdf_field":""},{"help":"Select Yes if you are an existing customer, else No","type":"choice","label":"Existing Customer (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Covers","fields":[{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Accidental Medical Expense Reimbursement","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Illness Medical Expense Reimbursement","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if opting for illness cover","type":"text","label":"Details of Pre- Existing Disease","options":[],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"OPD Treatment","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Adventure Sports Injury","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Hospital Daily Allowance","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Physiotherapy","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Compassionate Visit","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Return of Minor Child","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Emergency Stay and Extension","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Evacuation (Medical and Catastrophe)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Accidental Death","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Permanent Total Disability","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Permanent Partial Disability","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Repatriation of Mortal Remains","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Flight Delay","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Delayed Arrival","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Delayed Departure","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Missed Flight","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Missed Connection","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Delay of Checked-in Baggage","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Delay of Sports Equipment","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Total Loss of Checked-in Baggage","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Partial Loss of Checked-in Baggage","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Kidnap / Hijack Cover","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Trip Cancellation","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Electronic Equipment Cover","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Trip Rescheduling","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Personal Liability & Bail Bond","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Pet Cover","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Fire and Allied Perils (Home Building and Contents)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Home Insurance Cover","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Pre-Existing Disease Cover","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Personal Accident (Common Carrier)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Trip Cancellation due to Covid-19","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Loss of Passport","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Financial Emergency Cover","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes to opt for this cover","type":"yes-no","label":"Bounced Booking","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Insured","fields":[{"help":"Enter date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Acko International Travel Insurance policies with optional add-on covers","attachments":["Original completed proposal form (copies not accepted)"],"declarations":["The statements made in this Proposal Form are true and form the basis of the contract.","Any additions or alterations in the risk after submission must be conveyed immediately.","No person shall offer or accept any rebate of commission or premium except as allowed by insurer's published prospectus.","Non-compliance with rebate provisions may lead to penalty up to ten lakh rupees."],"dropped_labels":22},"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/2055-acko-international-travel-insurance-proposal-form"}