{"id":2460,"title":"My Health Care Super Top-Up Plan (Plan 8) Proposal Form","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/my-health-care-plan-8-(super-top-up)-collaterals/My-Health-Care-Plan-8-(Super-Top-Up)-PF-Digital.pdf","sha256":"f9d501ca6bec8909d1523795331251c2642c09685876e65e400828aa1378953c","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) to apply for the My Health Care Super Top-Up Plan insurance policy from Bajaj General Insurance. The proposer fills it to provide personal, health, and insurance details for underwriting.","notes":["Please answer all questions in BLOCK letters.","The liability of the company does not commence until the proposal is accepted and premium paid.","Use original documents and provide all relevant information fully and accurately.","Nominee for primary insured must be one of the specified relations.","Income commensuration is mandatory in event of claim for loss of income.","If the proposal form is filled in vernacular language or by a representative, signatures of witness and authorized representative are required.","No rebate of commission or premium is allowed as per Insurance Act 1938 Section 41.","Keep policy contact and bank details updated for faster service.","Politically Exposed Persons (PEPs) must disclose their status.","Consent is required for KYC verification through CERSAI or NSDL portals.","Premium must be paid from legally acquired sources."],"title":"My Health Care Super Top-Up Plan (Plan 8) Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter your full name in block letters","type":"text","label":"Full Name : Title First Name Middle Name Surname","options":[],"required":true,"pdf_field":"TEX 1"},{"help":"Select Yes or No","type":"choice","label":"Are you an existing Bajaj General Customer: Yes No, if Yes please share below details","options":["Yes","No"],"required":true,"pdf_field":"G1"},{"help":"Provide if existing customer","type":"text","label":"the Policy No.","options":[],"required":false,"pdf_field":"Policy NoRow1"},{"help":"Provide if existing customer","type":"text","label":"Existing Customer (PID) No.","options":[],"required":false,"pdf_field":"Existing Customer PID No"},{"help":"","type":"choice","label":"Gender: Male Female Other","options":["Male","Female","Other"],"required":true,"pdf_field":"G2"},{"help":"DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":"4 Date of Birth"},{"help":"","type":"text","label":"Pan No.","options":[],"required":false,"pdf_field":"TEXT 3"},{"help":"Enter only last 4 digits","type":"text","label":"Aadhaar No. Enter last 4 digits only","options":[],"required":false,"pdf_field":"Enter last 4 digits only"},{"help":"","type":"text","label":"Bajaj Employee Code, if Proposer is General/Life Employee","options":[],"required":false,"pdf_field":"EmpLG CodeRow1"},{"help":"","type":"choice","label":"Marital Status: Married Single Divorced Widowed","options":["Married","Single","Divorced","Widowed"],"required":true,"pdf_field":"G3"},{"help":"Enter number of sons and daughters","type":"number","label":"No. of children: Sons Daughters","options":[],"required":false,"pdf_field":"G5"},{"help":"If Other, specify","type":"choice","label":"Occupation Business Salaried Professional Student House wife Retired Other","options":["Business","Salaried","Professional","Student","House wife","Retired","Other"],"required":true,"pdf_field":"G4"},{"help":"If Yes, provide ABHA number in section 4","type":"choice","label":"Are you or any of your family members registered under the Ayushmaan Bharat Yojana? Yes No","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Address Details","fields":[{"help":"Fill all communication address fields in block letters","type":"text","label":"Communication Address (all communications will be sent to below): House No. House Name Landmark/Locality Road/Area Name City/District State Pin Code Telephone Mobile Email","options":[],"required":true,"pdf_field":"House No_2 House Name_2 LandmarkLocality_2 RoadArea Name_3 CityDistrict_3 State_3 Pin Code_2 tel2 Mobile1 Email_2"}],"filled_by":"proposer"},{"title":"Other Details","fields":[{"help":"Select highest qualification","type":"choice","label":"Educational Qualification","options":["Matriculate","Under Graduate","Graduate","Post Graduate","Professionally Qualified"],"required":true,"pdf_field":"G8"},{"help":"Enter monthly income in INR","type":"amount","label":"Proposer Monthly Income: 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