{"id":2659,"title":"Proposal Form- ‘Explore Protect Plus’","purpose":"proposal","insurer":{"slug":"care-health-insurance","name":"Care Health Insurance Ltd"},"source_pdf":"https://cms.careinsurance.com/cms/public/uploads/download_center/explore-protect-plus---proposal-form.pdf","sha256":"630ed6b4b642c4822b47392f19b5ccf43be291d3709c569ee3a15cb91acc4476","pages":4,"collected":"2026-10-20","instructions":{"about":"This form is used by individuals or groups proposing to purchase the Explore Protect Plus insurance policy from Care Health Insurance Limited. The proposer fills it to provide personal, travel, and payment details for underwriting and policy issuance.","notes":["Fill all questions fully and correctly; write 'Not Applicable' or 'NA' if a question does not apply.","Fill in CAPITAL letters only.","If insufficient space, provide details on a separate sheet.","All attached documents form part of the proposal.","Ask for computerized receipt against cash payment; claims without it will not be admitted.","Cheque/Demand Draft should be drawn in favor of 'Care Health Insurance Limited'.","Payment by cash is advised only at nearest Care Health Insurance branch or authorized bank branch.","This form is only a proposal; policy issuance is subject to underwriting and premium receipt.","Use original documents for KYC as per Appendix 1.","The acknowledgement receipt does not amount to acceptance of risk or policy commencement."],"title":"Proposal Form- ‘Explore Protect Plus’","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Policyholder Information and Risk Information","fields":[{"help":"Enter the proposal number if available","type":"text","label":"Proposal No.:","options":[],"required":null,"pdf_field":""},{"help":"Unique Reference Number if applicable","type":"text","label":"URN :","options":[],"required":null,"pdf_field":""},{"help":"Enter start date of add-on policy period (DD/MM/YYYY)","type":"date","label":"Add-on Policy Period Start Date :","options":[],"required":null,"pdf_field":""},{"help":"Enter end date of add-on policy period (DD/MM/YYYY)","type":"date","label":"Add-on Policy Period End Date :","options":[],"required":null,"pdf_field":""},{"help":"Select the cover type","type":"choice","label":"Cover Type :","options":["Individual"],"required":true,"pdf_field":""},{"help":"Select the trip type","type":"choice","label":"Trip Type :","options":["Single Trip","Multi-trip"],"required":true,"pdf_field":""},{"help":"Select purpose of travel; if Others, provide description","type":"choice","label":"Purpose of travel :","options":["Business","Seminar","Leisure","Adventure Sports","Educational","Pilgrimage","Others"],"required":true,"pdf_field":""},{"help":"Select multi-trip duration if applicable","type":"choice","label":"If opted for Multi Trip :","options":["30day","60 days","90 days","180 days"],"required":false,"pdf_field":""},{"help":"Select maximum trip duration","type":"choice","label":"Maximum trip duration:","options":["7 Days","14 Days","30 Days","60 Days"],"required":false,"pdf_field":""},{"help":"Provide details for single trip","type":"text","label":"If opted for Single Trip :","options":[],"required":false,"pdf_field":""},{"help":"Specify geographical scope for travel","type":"text","label":"Geographical Scope","options":[],"required":false,"pdf_field":""},{"help":"Enter number of days for the trip","type":"number","label":"Number of days required","options":[],"required":false,"pdf_field":""},{"help":"Enter maximum trip duration required","type":"number","label":"Maximum Trip Duration Required","options":[],"required":false,"pdf_field":""},{"help":"Enter age band of the insured","type":"text","label":"Age Band","options":[],"required":false,"pdf_field":""},{"help":"Indicate if Form 60 is submitted","type":"yes-no","label":"Form 60 (only in case the customer does not have PAN no.) :","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter last 4 digits of Aadhaar number","type":"number","label":"Aadhaar Number(last 4 digits):","options":[],"required":false,"pdf_field":""},{"help":"Enter nationality","type":"text","label":"Nationality  :","options":[],"required":false,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"PAN Number( Mandatory ) :","options":[],"required":true,"pdf_field":""},{"help":"Enter correspondence address","type":"text","label":"Correspondence Address :","options":[],"required":true,"pdf_field":""},{"help":"Enter locality of correspondence address","type":"text","label":"Locality :","options":[],"required":false,"pdf_field":""},{"help":"Enter city of correspondence address","type":"text","label":"City :","options":[],"required":false,"pdf_field":""},{"help":"Enter pin code of correspondence address","type":"number","label":"Pin Code :","options":[],"required":false,"pdf_field":""},{"help":"Enter state of correspondence address","type":"text","label":"State :","options":[],"required":false,"pdf_field":""},{"help":"Enter key person's name with title","type":"text","label":"Key Person Name : (Mr./Ms./Mrs.)","options":[],"required":false,"pdf_field":""},{"help":"Enter permanent address or tick if same as correspondence","type":"text","label":"Permanent Address :","options":[],"required":false,"pdf_field":""},{"help":"Tick if permanent address is same as correspondence address","type":"checkbox","label":"If same as above, please tick here","options":[],"required":false,"pdf_field":""},{"help":"Enter telephone number","type":"phone","label":"Telephone :","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile :","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email :","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Intermediary and Branch Details","fields":[{"help":"Enter intermediary code","type":"text","label":"Intermediary Code :","options":[],"required":false,"pdf_field":""},{"help":"Enter intermediary name","type":"text","label":"Intermediary Name :","options":[],"required":false,"pdf_field":""},{"help":"Enter intermediary RM code","type":"text","label":"Intermediary RM Code :","options":[],"required":false,"pdf_field":""},{"help":"Enter branch code","type":"text","label":"Branch Code :","options":[],"required":false,"pdf_field":""},{"help":"Enter Care Health Insurance RM name","type":"text","label":"CHIL RM Name :","options":[],"required":false,"pdf_field":""},{"help":"Enter client ID","type":"text","label":"Client ID :","options":[],"required":false,"pdf_field":""},{"help":"Enter receipt ID","type":"text","label":"Receipt ID :","options":[],"required":false,"pdf_field":""}],"filled_by":"intermediary or proposer"},{"title":"Premium Payment Information","fields":[{"help":"Select mode of payment; strike out non-applicable","type":"choice","label":"Mode of payment :","options":["Cash","Cheque","Demand Draft","NEFT","Any other mode"],"required":true,"pdf_field":""},{"help":"Enter payment date (DD/MM/YYYY)","type":"date","label":"Date :","options":[],"required":true,"pdf_field":""},{"help":"Enter bank name if applicable","type":"text","label":"Bank Name :","options":[],"required":false,"pdf_field":""},{"help":"Enter payment amount in INR","type":"amount","label":"Payment Amount (`) :","options":[],"required":true,"pdf_field":""},{"help":"Enter premium amount in INR","type":"amount","label":"Premium Amount (`) :","options":[],"required":true,"pdf_field":""},{"help":"Select source of funds; if Others, specify","type":"choice","label":"Sources of Funds :","options":["Salary","Business","Others"],"required":false,"pdf_field":""},{"help":"Enter cheque/DD number or authorization ID","type":"text","label":"Cheque / Demand Draft No. / Authorization ID :","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Material Disclosures","fields":[{"help":"Provide any additional relevant information; use extra sheets if needed","type":"text","label":"Any additional information relevant to the policy applied for","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposer’s Declaration","fields":[{"help":"Sign to declare all information is true and consent given","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Date of signing (DD/MM/YYYY)","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Opted for Benefits (Annexure – I)","fields":[{"help":"Enter coverage amount opted for trip cancellation and interruption","type":"amount","label":"Base Benefit 1 : Trip Cancellation & Interruption Indemnity Coverage Opted","options":[],"required":false,"pdf_field":""},{"help":"Select multi trip option per year","type":"choice","label":"Base Benefit 4: Multi trip options","options":["30 days","60 days","90 days","180 days"],"required":false,"pdf_field":""},{"help":"Coverage up to base policy coverage amount","type":"text","label":"Base Benefit 6: Home to Home cover","options":[],"required":false,"pdf_field":""},{"help":"Indicate if pre-existing disease cover is opted","type":"text","label":"Pre-Existing Disease Cover In Life Threatening Medical Condition and/or Medical Condition","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Addendum – Vernacular Declaration","fields":[{"help":"Enter place of declaration","type":"text","label":"Place :","options":[],"required":true,"pdf_field":""},{"help":"Enter date of declaration","type":"date","label":"Date : (DD/MM/YYYY)","options":[],"required":true,"pdf_field":""},{"help":"Enter name of declarant","type":"text","label":"Name of the Declarant :","options":[],"required":true,"pdf_field":""}],"filled_by":"declarant"}],"deadlines":[],"applies_to":"Explore Protect Plus travel insurance proposal","attachments":["KYC documents as per Appendix 1","Medical reports (wherever applicable)","Additional sheets if space is insufficient"],"declarations":["The information provided forms the basis of the insurance policy and must be true and complete.","The policy will come into force only after full payment of the premium.","The proposer consents to the company seeking medical information from doctors or hospitals for underwriting and claims.","The proposer consents to sharing proposal and medical information with government and regulatory authorities.","The proposer will notify any change in occupation or health after submission but before acceptance.","The proposer consents to receiving information from Central CKYC Registry via SMS/Email.","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 penalty up to ten lakh rupees."],"dropped_labels":6},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"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/care-health-insurance/2659-proposal-form-explore-protect-plus"}