{"id":2674,"title":"Proposal Form - ‘Group Global Care’","purpose":"proposal","insurer":{"slug":"care-health-insurance","name":"Care Health Insurance Ltd"},"source_pdf":"https://cms.careinsurance.com/cms/public/uploads/download_center/group-global-care---proposal-form.pdf","sha256":"be5c4356f603f08686b328787465f78ebad5aa50db8f7e1a174f16a7be469378","pages":7,"collected":"2026-10-20","instructions":{"about":"This form is used by a proposer (policyholder entity) to apply for the Group Global Care health insurance policy from Care Health Insurance Limited. The proposer fills in details about the group, past policies, proposed insured members, and medical declarations.","notes":["Fill the form in CAPITAL LETTERS only.","Use additional sheets if space is insufficient.","Incomplete or discrepant proposals may be rejected and premium refunded after deducting medical test costs.","Attach original KYC documents as per Appendix 1.","Cheque/Demand Draft should be drawn in favour of 'Care Health Insurance Ltd.'","This form is not valid against cash payments.","Keep the counterfoil receipt for records; it does not amount to acceptance of risk or policy commencement.","Acceptance of proposal is subject to underwriting decision and receipt of all documents and premium."],"title":"Proposal Form - ‘Group Global Care’","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter the proposal number if available","type":"text","label":"Proposal No.:","options":[],"required":null,"pdf_field":""},{"help":"Enter the full legal name of the proposer entity","type":"text","label":"Full name of the Proposer/Entity :","options":[],"required":true,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Incorporation/Date of Birth :","options":[],"required":true,"pdf_field":""},{"help":"Enter full address including locality, city, state, pin code","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Enter nearby landmark for address clarity","type":"text","label":"Landmark :","options":[],"required":false,"pdf_field":""},{"help":"Enter 6-digit postal code","type":"number","label":"Pin Code :","options":[],"required":true,"pdf_field":""},{"help":"Enter state name","type":"text","label":"State :","options":[],"required":true,"pdf_field":""},{"help":"Enter residential landline number with STD code","type":"phone","label":"Contact Details: Land line (R) :","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile No :","options":[],"required":true,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E-mail ID :","options":[],"required":false,"pdf_field":""},{"help":"Enter PAN number as per KYC documents","type":"text","label":"PAN ( Mandatory ) :","options":[],"required":true,"pdf_field":""},{"help":"Attach KYC documents listed in Appendix 1","type":"attachment","label":"Please share the required KYC documents as per Appendix 1 (mandatory)","options":[],"required":true,"pdf_field":""},{"help":"Enter locality for correspondence address","type":"text","label":"Locality :","options":[],"required":false,"pdf_field":""},{"help":"Enter city for correspondence address","type":"text","label":"City :","options":[],"required":false,"pdf_field":""},{"help":"Enter pin code for correspondence address","type":"number","label":"Pin Code :","options":[],"required":false,"pdf_field":""},{"help":"Enter state for correspondence address","type":"text","label":"State :","options":[],"required":false,"pdf_field":""},{"help":"Enter any identification or bank account number","type":"text","label":"Identification No. / Bank Account No. / any other :","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do all the members proposed to be insured form part of one Group or Association or Corporate body?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter name of key contact person","type":"text","label":"Key contact person name :","options":[],"required":true,"pdf_field":""},{"help":"Enter phone number of key contact person","type":"phone","label":"Contact details of Key Contact person :","options":[],"required":false,"pdf_field":""},{"help":"Select if scheme is contributory","type":"yes-no","label":"Is the scheme contributory","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of the Proposed to be Insured","fields":[{"help":"Attach Annexure 1 with details of all proposed insured members","type":"attachment","label":"Please provide complete details of Proposed to be Insured as per Annexure 1","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Details","fields":[{"help":"Select coverage type","type":"choice","label":"Coverage Type","options":["Individual","Family"],"required":true,"pdf_field":""},{"help":"Select coverage basis for optional benefits if family coverage chosen","type":"choice","label":"If Family coverage type is opted, then Coverage for Optional Benefit 1 (Hospitalization Expenses), Optional Benefit 2 (Out-Patient Care) and its Optional Coverage Type is on","options":["Individual basis","Floater basis"],"required":false,"pdf_field":""},{"help":"Specify member combination if family coverage","type":"text","label":"If Family coverage type is opted, then the Member Combination chosen: Members","options":[],"required":false,"pdf_field":""},{"help":"Select geographical coverage scope","type":"choice","label":"Geographical Scope","options":["Worldwide","Worldwide excluding US","Asia","Indian subcontinental + SE Asia (excluding Singapore)","India"],"required":true,"pdf_field":""},{"help":"Attach Annexure II with optional benefits and extensions chosen","type":"attachment","label":"Details of Optional Benefit(s) and Optional Extension(s) as per Final quote and/or Annexure – II","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Medical Declaration - Section A Part A","fields":[{"help":"For each disease, mark Yes or No and specify since when","type":"table","label":"Have you or any of the persons proposed for insurance suffered from any of the following disease and/or have undergone treatment in a hospital for these disease / for any","options":["Y","N"],"required":true,"pdf_field":""}],"filled_by":"proposed insured members"},{"title":"Medical Declaration - Section A Part B","fields":[{"help":"Sign on behalf of all persons to be insured","type":"signature","label":"Signature of the Primary Insured Member","options":[],"required":true,"pdf_field":""}],"filled_by":"proposed insured members"},{"title":"Corporate Declaration - Section B","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"Is any person to be insured currently hospitalized or advised for inpatient stay or surgery?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"During the last 6 months, has any person to be insured been advised to take repeat medication or injections for at least 3 times a week for minimum 3 weeks?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Has anyone been diagnosed/hospitalized or under any treatment for any illness/injury in the past?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Is anyone of the Insured’s family member (1st blood relationship) suffering from any genetic disorders?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Sign on behalf of all persons to be insured","type":"signature","label":"Signature of the Primary Insured Member","options":[],"required":true,"pdf_field":""}],"filled_by":"applicant’s authorized personnel"},{"title":"Coverage Opted - Optional Benefit / Optional Extension (Annexure II)","fields":[{"help":"Mark coverage opted and provide details for each optional benefit or extension","type":"table","label":"Coverage opted (ü), Co-payment, Deductible, Coverage Amount, Special Terms & Conditions for each Optional Benefit or Optional Cover","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Payment Information","fields":[{"help":"Enter payment date","type":"date","label":"Date :","options":[],"required":true,"pdf_field":""},{"help":"Enter payment amount in INR","type":"amount","label":"Payment Amount (INR) :","options":[],"required":true,"pdf_field":""},{"help":"Specify payment mode and instrument number","type":"text","label":"Payment By : Cheque / Demand Draft No. / Any other Mode (Strike out whichever is not applicable)","options":[],"required":true,"pdf_field":""},{"help":"Enter cheque or draft number or authorization ID","type":"text","label":"Cheque / Demand Draft No. / Authorization ID :","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name if applicable","type":"text","label":"Bank Name :","options":[],"required":false,"pdf_field":""},{"help":"Enter premium amount","type":"amount","label":"Premium Amount :","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Group Global Care health insurance policy proposals","attachments":["Additional Information section if space insufficient","Annexure 1 - Enrollment Data with details of proposed insured members","Annexure II - Coverage Opted for Optional Benefit / Optional Extension","Appendix 1 - KYC documents as per entity type"],"declarations":["The proposer declares that all statements and particulars are true and complete to the best of their knowledge and they are authorized to propose on behalf of others.","The information provided forms the basis of the insurance policy and the policy is effective only after full premium payment.","The proposer will notify in writing any change in occupation or health after submission but before risk acceptance.","The proposer consents to the company seeking medical information from doctors or hospitals who attended the insured or proposer.","The proposer authorizes sharing of proposal information including medical records for underwriting and claims settlement with government or regulatory authorities.","The proposer consents to receiving information from Central CKYC Registry via SMS/Email.","Prohibition of rebates as per Section 41 of Insurance Act 1938 is acknowledged."],"dropped_labels":10},"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/2674-proposal-form-group-global-care"}