{"id":2477,"title":"PORTABILITY FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Digital-Portability-Form.pdf","sha256":"adf95717bc73a57f2992ac045cd2d0a4ad6fe5b72ba60f06a1283d3a3a1a3bcf","pages":1,"collected":"2026-10-17","instructions":{"about":"This form is used by policyholders to apply for portability of their existing health insurance policy to a new policy with the insurer.","notes":[],"title":"PORTABILITY FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Part I: Policyholder and Existing Policy Details","fields":[{"help":"","type":"text","label":"Name of the Policyholder / insured (s)","options":[],"required":null,"pdf_field":"Name of the Policyholder  insured s"},{"help":"Enter date of birth or age","type":"date","label":"Date of Birth / Age","options":[],"required":null,"pdf_field":"Date of Birth  Age"},{"help":"","type":"text","label":"Address of policyholder /insured","options":[],"required":null,"pdf_field":"Address of policyholder insured"},{"help":"","type":"text","label":"Details of existing insurer - i. Name of the product","options":[],"required":null,"pdf_field":"i Name of the product"},{"help":"","type":"text","label":"Details of the proposed insurance - i. Name of the product proposed/intended to take","options":[],"required":null,"pdf_field":"i Name of the product proposedintended to take"},{"help":"Explain why you want to port your policy","type":"text","label":"Reason (s) of portability","options":[],"required":null,"pdf_field":"Reason s of portability"},{"help":"Number of family members to include","type":"number","label":"No of family member to be included in the policy to be ported","options":[],"required":null,"pdf_field":"No of family member to be included in the policy to be ported"}],"filled_by":"policyholder"},{"title":"Part II: PED Exclusion Declaration","fields":[{"help":"Indicate if waiting period for pre-existing diseases is longer than previous policy","type":"yes-no","label":"Whether the PED exclusions / time bound exclusion have longer exclusion period than existing policy (Please indicate Yes /No)","options":["Yes","No"],"required":null,"pdf_field":"Group2"},{"help":"Write your consent agreeing to observe additional waiting period","type":"text","label":"If yes, please give written consent to the declaration below","options":[],"required":null,"pdf_field":"Text1"}],"filled_by":"policyholder"},{"title":"Signatures","fields":[{"help":"","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Policyholder","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"health insurance portability","attachments":["Photocopy of the existing policy documents"],"declarations":["The proposer agrees to observe any additional waiting period for diseases or treatments if the new policy has longer exclusion periods than the previous policy."],"dropped_labels":7},"pdf_fields":[{"name":"Name of the Policyholder  insured s","page":1,"type":"text","label":"Name of the Policyholder / insured (s"},{"name":"Date of Birth  Age","page":1,"type":"text","label":"Date of Birth / Age"},{"name":"Address of policyholder insured","page":1,"type":"text","label":"Address of policyholder /insured"},{"name":"i Name of the product","page":1,"type":"text","label":"i. Name of the product"},{"name":"ii Sum Insured","page":1,"type":"text","label":"ii. Sum Insured"},{"name":"iii Cumulative Bonus","page":1,"type":"text","label":"iii. Cumulative Bonus"},{"name":"iv Add onsRiders taken","page":1,"type":"text","label":"iv. Add ons/Riders taken"},{"name":"v Policy Number","page":1,"type":"text","label":"v. Policy Number"},{"name":"i Name of the product proposedintended to take","page":1,"type":"text","label":"i. Name of the product proposed/intended to take"},{"name":"ii Sum insured proposed","page":1,"type":"text","label":"ii. Sum insured proposed"},{"name":"iii Whether Cumulative Bonus to be converted to an enhanced sum insured","page":1,"type":"text","label":"iii. Whether Cumulative Bonus to be converted to an enhanced sum insured"},{"name":"Reason s of portability","page":1,"type":"text","label":"Reason (s) of portability"},{"name":"No of family member to be included in the policy to be ported","page":1,"type":"text","label":"No of family member to be included in the policy to be ported"},{"name":"First Name of InsuredRow1","page":1,"type":"text","label":"First Name of Insured_Row_1"},{"name":"Details of Previous Health Insurance Policy  Policy NoRow1","page":1,"type":"text","label":"Details of Previous Health Insurance Policy / Policy No._Row_1"},{"name":"Health ID Card numberRow1","page":1,"type":"text","label":"Health ID Card number_Row_1"},{"name":"Sum InsuredRow1","page":1,"type":"text","label":"Sum Insured_Row_1"},{"name":"CBRow1","page":1,"type":"text","label":"CB_Row_1"},{"name":"From ddmmyyyyRow1","page":1,"type":"text","label":"From dd/mm/yyyy_Row_1"},{"name":"To ddmmyyyyRow1","page":1,"type":"text","label":"To dd/mm/yyyy_Row_1"},{"name":"First Policy inception dateRow1","page":1,"type":"text","label":"First Policy inception date_Row_1"},{"name":"First Name of InsuredRow2","page":1,"type":"text","label":"First Name of Insured_Row_2"},{"name":"Details of Previous Health Insurance Policy  Policy NoRow2","page":1,"type":"text","label":"Details of Previous Health Insurance Policy / Policy No._Row_2"},{"name":"Health ID Card numberRow2","page":1,"type":"text","label":"Health ID Card number_Row_2"},{"name":"Sum InsuredRow2","page":1,"type":"text","label":"Sum Insured_Row_2"},{"name":"CBRow2","page":1,"type":"text","label":"CB_Row_2"},{"name":"From ddmmyyyyRow2","page":1,"type":"text","label":"From dd/mm/yyyy_Row_2"},{"name":"To ddmmyyyyRow2","page":1,"type":"text","label":"To dd/mm/yyyy_Row_2"},{"name":"First Policy inception dateRow2","page":1,"type":"text","label":"First Policy inception date_Row_2"},{"name":"First Name of InsuredRow3","page":1,"type":"text","label":"First Name of Insured_Row_3"},{"name":"Details of Previous Health Insurance Policy  Policy NoRow3","page":1,"type":"text","label":"Details of Previous Health Insurance Policy / Policy No._Row_3"},{"name":"Health ID Card numberRow3","page":1,"type":"text","label":"Health ID Card number_Row_3"},{"name":"Sum InsuredRow3","page":1,"type":"text","label":"Sum Insured_Row_3"},{"name":"CBRow3","page":1,"type":"text","label":"CB_Row_3"},{"name":"From ddmmyyyyRow3","page":1,"type":"text","label":"From dd/mm/yyyy_Row_3"},{"name":"To ddmmyyyyRow3","page":1,"type":"text","label":"To dd/mm/yyyy_Row_3"},{"name":"First Policy inception dateRow3","page":1,"type":"text","label":"First Policy inception date_Row_3"},{"name":"First Name of InsuredRow4","page":1,"type":"text","label":"First Name of Insured_Row_4"},{"name":"Details of Previous Health Insurance Policy  Policy NoRow4","page":1,"type":"text","label":"Details of Previous Health Insurance Policy / Policy No._Row_4"},{"name":"Health ID Card numberRow4","page":1,"type":"text","label":"Health ID Card number_Row_4"},{"name":"Sum InsuredRow4","page":1,"type":"text","label":"Sum Insured_Row_4"},{"name":"CBRow4","page":1,"type":"text","label":"CB_Row_4"},{"name":"From ddmmyyyyRow4","page":1,"type":"text","label":"From dd/mm/yyyy_Row_4"},{"name":"To ddmmyyyyRow4","page":1,"type":"text","label":"To dd/mm/yyyy_Row_4"},{"name":"First Policy inception dateRow4","page":1,"type":"text","label":"First Policy inception date_Row_4"},{"name":"First Name of InsuredRow5","page":1,"type":"text","label":"First Name of Insured_Row_5"},{"name":"Details of Previous Health Insurance Policy  Policy NoRow5","page":1,"type":"text","label":"Details of Previous Health Insurance Policy / Policy No._Row_5"},{"name":"Health ID Card numberRow5","page":1,"type":"text","label":"Health ID Card number_Row_5"},{"name":"Sum InsuredRow5","page":1,"type":"text","label":"Sum Insured_Row_5"},{"name":"CBRow5","page":1,"type":"text","label":"CB_Row_5"},{"name":"From ddmmyyyyRow5","page":1,"type":"text","label":"From dd/mm/yyyy_Row_5"},{"name":"To ddmmyyyyRow5","page":1,"type":"text","label":"To dd/mm/yyyy_Row_5"},{"name":"First Policy inception dateRow5","page":1,"type":"text","label":"First Policy inception date_Row_5"},{"name":"First Name of InsuredRow6","page":1,"type":"text","label":"First Name of Insured_Row_6"},{"name":"Details of Previous Health Insurance Policy  Policy NoRow6","page":1,"type":"text","label":"Details of Previous Health Insurance Policy / Policy No._Row_6"},{"name":"Health ID Card numberRow6","page":1,"type":"text","label":"Health ID Card number_Row_6"},{"name":"Sum InsuredRow6","page":1,"type":"text","label":"Sum Insured_Row_6"},{"name":"CBRow6","page":1,"type":"text","label":"CB_Row_6"},{"name":"From ddmmyyyyRow6","page":1,"type":"text","label":"From dd/mm/yyyy_Row_6"},{"name":"To ddmmyyyyRow6","page":1,"type":"text","label":"To dd/mm/yyyy_Row_6"},{"name":"First Policy inception dateRow6","page":1,"type":"text","label":"First Policy inception date_Row_6"},{"name":"Text1","page":1,"type":"text"},{"name":"Group2","page":1,"type":"radiobutton"},{"name":"Group2","page":1,"type":"radiobutton"}],"fillable_pdf":true,"send_to":[{"purpose":"customer-care","channel":"email","value":"careforyou@bajajgeneral.com","label":"Customer Service Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"in a new tab\nBajaj General Insurance Limited\nTollfree: For sales :\n1800-209-0144\nFor service :\n1800-209-5858\nEmail id:\ncareforyou@bajajgeneral.com\nFor senior citizens:\nseniorcitizen@bajajgeneral.com\nFor senior citizens:\n1800-209-5858\nFax no:\n020-30512246\nRegistered","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-209-5858","label":"Service Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"Careers\nBecome\n                                An Agent\nAwards\nUpdate KYC\nMY ABHA\nBuy Policy:\n1800-209-0144\n| Service:\n1800-209-5858\nService Chat:\n+91 75074 25858\nInsure\nHealth Insurance\nIndividual Health Insurance\nFamily Health Insurance\nInternational","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-209-0144","label":"Sales Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"nsurance\nSupport\nAbout Us\nCareers\nBecome\n                                An Agent\nAwards\nUpdate KYC\nMY ABHA\nBuy Policy:\n1800-209-0144\n| Service:\n1800-209-5858\nService Chat:\n+91 75074 25858\nInsure\nHealth Insurance\nIndividual Health Insurance\nFamily Healt","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-209-5858","label":"Customer Service Toll Free Number","level":1,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"ted servicing team to help you meet your service needs.\nCustomer Service - We're Here to Help\nDial our Toll Free Number\n1800-209-5858\nEmail us on\ncareforyou@bajajgeneral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Cha","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"ggro@bajajgeneral.com","label":"Grievance Redressal Officer Email Mr. Jerome Vincent","level":2,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"fied with the response given to you by our team, you may write to our Grievance Redressal Officer Mr. Jerome Vincent at\nggro@bajajgeneral.com\nLevel 3\nHead Customer Service\nif you are still not satisfied with the solutions provided, or have some feedback for us,","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-209-7073","label":"Toll free No. Intermediary","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"Here to Help\nDial our Toll Free Number\n1800-209-5858\nEmail us on\ncareforyou@bajajgeneral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Chatbot\nConnect with us on WhatsApp +91 7507425858\nFor Support\nBajaj General App\nPle","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"whatsapp","value":"+91 7507425858","label":"BOING WhatsApp Chatbot","level":null,"hours":"24x7","applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"ral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Chatbot\nConnect with us on WhatsApp +91 7507425858\nFor Support\nBajaj General App\nPlease scan and download\nMissed Call Facility\nMissed Call - 80809 45060 Short code - SMS","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/bajaj-general-insurance/2477-portability-form"}