{"id":2687,"title":"Proposal Form - ‘GRAMEEN CARE’ - Micro Insurance Product","purpose":"proposal","insurer":{"slug":"care-health-insurance","name":"Care Health Insurance Ltd"},"source_pdf":"https://cms.careinsurance.com/cms/public/uploads/download_center/grameen-care-(micro-insurance-product)---proposal-form.pdf","sha256":"b3e3978d9331c417781033a542a91a5e2021238995081a4618af68647be3a4a4","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is used by the proposer (the person applying for insurance) to apply for the Grameen Care micro insurance product from Care Health Insurance Limited.","notes":["Fill the form in CAPITAL LETTERS only.","Attach all required KYC documents as per Appendix 1.","Use additional sheets if space is insufficient.","Cheque/Demand Draft should be drawn in favour of 'Care Health Insurance Limited'.","This form is a proposal and does not guarantee policy issuance.","Keep the acknowledgement receipt for records; it is not proof of policy acceptance.","Original bills and documents may be required later for claims.","Refer to www.careinsurance.com for detailed exclusions and policy terms."],"title":"Proposal Form - ‘GRAMEEN CARE’ - Micro Insurance Product","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 your first name in CAPITAL LETTERS.","type":"text","label":"First Name","options":[],"required":true,"pdf_field":""},{"help":"Enter your last name in CAPITAL LETTERS.","type":"text","label":"Last Name","options":[],"required":true,"pdf_field":""},{"help":"Enter your email address.","type":"email","label":"E-mail ID","options":[],"required":false,"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 your locality.","type":"text","label":"Locality","options":[],"required":true,"pdf_field":""},{"help":"Enter your city.","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Enter your state.","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter your postal pin code.","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter a nearby landmark if any.","type":"text","label":"Landmark","options":[],"required":false,"pdf_field":""},{"help":"Enter your landline number with STD code.","type":"phone","label":"Landline","options":[],"required":false,"pdf_field":""},{"help":"Enter your mobile phone number.","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Enter your PAN number as it is mandatory.","type":"text","label":"PAN  ( Mandatory )","options":[],"required":true,"pdf_field":""},{"help":"Provide any one valid identification number or bank account number or Aadhaar number.","type":"text","label":"Identification No. / Bank Account No. / Aadhaar Card No./any other","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Details","fields":[{"help":"Enter policy start date in DD/MM/YYYY format.","type":"date","label":"Policy Period : Start Date","options":[],"required":true,"pdf_field":""},{"help":"Enter policy end date in DD/MM/YYYY format.","type":"date","label":"Midnight of End Date","options":[],"required":true,"pdf_field":""},{"help":"Select the number of members to be covered.","type":"choice","label":"Family Combination Opted","options":["1 Member","2 Members","3 Members","4 Members","5 Members"],"required":true,"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":"Declaration","fields":[{"help":"Enter the date of signing in DD/MM/YYYY format.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form to declare all information is true and consent to terms.","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Payment Information","fields":[{"help":"Enter the date of payment in DD/MM/YYYY format.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter the amount paid in rupees.","type":"amount","label":"Payment Amount (`)","options":[],"required":true,"pdf_field":""},{"help":"Enter cheque or demand draft number or authorization ID.","type":"text","label":"Cheque / Demand Draft No. / Authorization ID","options":[],"required":true,"pdf_field":""},{"help":"Select the mode of payment and strike out others.","type":"choice","label":"Payment by","options":["Cheque","Demand Draft","Card","Authorization ID"],"required":true,"pdf_field":""},{"help":"Enter the name of the bank if applicable.","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Appendix 1 - KYC Documents Required","fields":[{"help":"Attach required KYC documents depending on entity type (individual, partnership, trust, company) as listed.","type":"attachment","label":"KYC Documents as per Appendix 1","options":[],"required":true,"pdf_field":""},{"help":"Provide ABHA number if available.","type":"text","label":"Do you have ABHA No. ? If Yes, please mention","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Grameen Care Micro Insurance Product","attachments":["KYC documents as per Appendix 1","Additional sheets if space is insufficient","Annexure - I details of persons to be insured"],"declarations":["The information provided is true and complete to the best of the proposer's knowledge.","The policy will come into force only after full payment of the premium.","The proposer consents to the company seeking medical and insurance information for underwriting and claims settlement.","The proposer will notify any change in occupation or health after submission of the proposal.","The proposer consents to receiving information from Central CKYC Registry via SMS/Email."],"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/2687-proposal-form-grameen-care-micro-insurance-product"}