{"id":2678,"title":"ANNEXURE-II (CO-PROPOSER DETAILS) - CARE","purpose":"proposal","insurer":{"slug":"care-health-insurance","name":"Care Health Insurance Ltd"},"source_pdf":"https://cms.careinsurance.com/cms/public/uploads/download_center/care-(health-insurance-product)---proposal-form-(annexure-ii).pdf","sha256":"344f525acc75c2f02272029532f266ba0d3a8b477c76ee6de70d6d5ddcd7f0a0","pages":1,"collected":"2026-10-20","instructions":{"about":"This form is for providing details of the co-proposer who will share the premium payment with the proposer in the Care Health Insurance product. It is filled by the co-proposer.","notes":["If paying premium by cash, do so only at nearest Care Health Insurance branch or authorized bank branch and obtain computerized receipt","Claims without computerized receipt against cash payment will not be admitted","Cheque / Demand Draft should be drawn in favour of 'Care Health Insurance Limited'","If ECS is selected, submit standing instruction form available at branches"],"title":"ANNEXURE-II (CO-PROPOSER DETAILS) - CARE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Co-Proposer Personal Details","fields":[{"help":"Enter full name with title","type":"text","label":"Name : (Mr./Ms./Mrs.) (First Name) (Middle Name) (Last Name)","options":[],"required":null,"pdf_field":""},{"help":"Enter full correspondence address","type":"text","label":"Correspondence Address : Locality : City : Pin Code : State : Landmark :","options":[],"required":null,"pdf_field":""},{"help":"Tick if permanent address is same as correspondence address","type":"checkbox","label":"Permanent Address : If same as above, please tick here","options":["tick if same as correspondence address"],"required":null,"pdf_field":""},{"help":"Enter telephone number with STD code","type":"phone","label":"Telephone :","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile :","options":[],"required":null,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email :","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth in DD/MM/YYYY format","type":"date","label":"Date of Birth :","options":[],"required":null,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender : Male Female Others","options":["Male","Female","Others"],"required":null,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"PAN Number :","options":[],"required":null,"pdf_field":""},{"help":"Select Yes if submitting Form 60 instead of PAN","type":"choice","label":"Form 60 (only in case the customer does not have PAN no.) : Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter Aadhaar number","type":"text","label":"Aadhaar Number :","options":[],"required":null,"pdf_field":""}],"filled_by":"co-proposer"},{"title":"Premium Payment Details","fields":[{"help":"Tick the applicable premium payment mode","type":"choice","label":"Premium payment mode: Single Monthly Quarterly Half-yearly (þ Tick whichever is applicable)","options":["Single","Monthly","Quarterly","Half-yearly"],"required":null,"pdf_field":""},{"help":"Select payment mode and strike out others","type":"choice","label":"Payment By : Cash / Cheque / Demand Draft / Card /ECS (NACH) (Strike out whichever is not applicable)","options":["Cash","Cheque","Demand Draft","Card","ECS (NACH)"],"required":null,"pdf_field":""},{"help":"Enter cheque or demand draft number or authorization ID","type":"text","label":"Cheque / Demand Draft No. / Authorization ID :","options":[],"required":null,"pdf_field":""},{"help":"Enter date of payment in DD/MM/YYYY format","type":"date","label":"Date :","options":[],"required":null,"pdf_field":""},{"help":"Enter payment amount in rupees","type":"amount","label":"Payment Amount (`) :","options":[],"required":null,"pdf_field":""},{"help":"Enter name of bank","type":"text","label":"Bank Name :","options":[],"required":null,"pdf_field":""}],"filled_by":"co-proposer"}],"deadlines":[],"applies_to":"Care Health Insurance Product","attachments":[],"declarations":["By signing the Proposal form I give my consent for using my Aadhaar No. for Authentication of my Aadhaar Details","Co-proposer shares premium payment but has no rights other than that"],"dropped_labels":1},"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/2678-annexure-ii-co-proposer-details-care"}