{"id":2724,"title":"Aarogya Bima Proposal Form","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/health-insurance/future-aarogya-bima/proposal-forms/aarogya-bima-proposal-form.pdf.pdf","sha256":"0f6dc5690127468670a3a029ebf8ac022debdbf0240c29538055db4dc2db9854","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or families proposing to purchase the Aarogya Bima health insurance policy from Generali Central Insurance. The proposer fills it to provide personal, health, and nominee details for underwriting and policy issuance.","notes":["Fields marked with * are mandatory.","Use block letters to fill the form.","Provide ABHA number for all insured persons or create one online.","Total percentage of claim amount payable to nominees must not exceed 100%.","Attach duly filled and signed ACH/ECS/E-Mandate form for instalment payment option.","Policy document will be sent digitally unless physical copy is requested.","PAN is mandatory if premium exceeds Rs. 50,000 in cash or Rs. 1 lakh in any mode.","Original documents may be required for verification.","For portability/migration, attach the relevant request form.","Authorized representative declarations require signatures and witness details."],"title":"Aarogya Bima Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter surname, first name, and middle name","type":"text","label":"Name of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Include state and pin code","type":"text","label":"Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"Provide mobile number; landline optional","type":"phone","label":"Contact Number* Landline: Mobile*","options":[],"required":true,"pdf_field":""},{"help":"Tick box if same as permanent address","type":"text","label":"Present Address* (if same as above, please click here ☐)","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"Email Id*","options":[],"required":true,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Gender*","options":["Male","Female","Third Gender"],"required":true,"pdf_field":""},{"help":"Mandatory if premium exceeds Rs. 50,000 in cash or Rs. 1 lakh in any mode","type":"text","label":"PAN","options":[],"required":null,"pdf_field":""},{"help":"If not available, download form from website and submit with proposal","type":"text","label":"e-IA Number (e-Insurance Account Number)","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status*","options":["Married","Single","Widow/Widower","Divorced","Live-in Relationship"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Nationality*","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Occupation*","options":["Service","Self Employed","Others: ______________________________"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Are you an existing Generali Central Insurance customer*? If yes, please provide Existing Policy No. and Customer ID No.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide Type of Impairment, Percentage of Impairment, UDID Number","type":"checkbox","label":"If you are Differently Abled, please tick mark on the checkbox to provide confirmation. ☐","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Family Doctor Details","fields":[{"help":"Enter surname, first name, middle name","type":"text","label":"Name of the Dr*","options":[],"required":true,"pdf_field":""},{"help":"Include state and pin code","type":"text","label":"Full Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Contact Number Landline: Mobile:","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email Id","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Term and Payment Options","fields":[{"help":"","type":"choice","label":"Policy term* (please tick the term opted): 1 Year / 2 Years / 3 Years","options":["1 Year","2 Years","3 Years"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Health Questions","fields":[{"help":"","type":"text","label":"Please confirm if any of the persons to be insured is pregnant (For females only)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"","type":"choice","label":"Payment Option","options":["Cheque","Demand Draft","Fund Transfer","Pay Order","Debit Card","Credit Card","Others (please specify)"],"required":true,"pdf_field":""},{"help":"Enter amount in figures and words","type":"amount","label":"Premium Amount","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Account Holder Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Instrument Number","options":[],"required":false,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Instrument Date","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Transaction ID (for online payments)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"Format DD/MM/YYYY","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Proposer’s Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Proposer’s Signature/ Thumb Impression","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Aarogya Bima health insurance policies","attachments":["Request for authorisation form to receive Claim / Refund Payments directly into bank account (if premium > ₹10,000)","Portability/Migration Request Form (if applicable)"],"declarations":["The proposer declares all information is true and complete to the best of their knowledge.","The policy will commence only after full payment of premium and acceptance by insurer.","The proposer will notify any change in occupation or health before risk acceptance.","The insurer may seek medical and other information for underwriting and claims.","The insurer may share proposal and medical information with regulatory authorities.","Non-disclosure or untrue information may void the policy and forfeit premium.","The proposer consents to electronic communication and data storage by insurer.","Premium is paid from legally declared income and not from proceeds of crime.","The proposer agrees to insurer's privacy policy and data processing terms.","If ABHA number is shared, consent is given to use it for claims and insurance services.","Consent is given to verify KYC records from Central KYC Registry.","Consent to use Bima-ASBA facility to block premium amount in bank account if opted."],"dropped_labels":11},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"grievance","channel":"email","value":"GCIcare@generalicentral.com","label":"HELPLINE Email","level":1,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"atrix given below.\nLEVEL 1\nYou Can Call On Our HELPLINE\n1800-220-233 / 1860-500-3333 / 022-67837800\nOR\nSEND US AN EMAIL\nGCIcare@generalicentral.com\nOur senior citizen policyholders can avail priority support by choosing the valid option from the helpline menu or writ","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-220-233 / 1860-500-3333 / 022-67837800","label":"HELPLINE","level":1,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"may have. You can escalate your concerns as per the\nescalation matrix given below.\nLEVEL 1\nYou Can Call On Our HELPLINE\n1800-220-233 / 1860-500-3333 / 022-67837800\nOR\nSEND US AN EMAIL\nGCIcare@generalicentral.com\nOur senior citizen policyholders can avail priority support by choosing","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Generali Central Insurance Company Ltd.\nUnit No. 301, 3rd Floor Part, Building No. 8,\nMindspace IT/ITES SEZ, MIDC Industrial Area,\nAiravali, Navi Mumbai,\nThane District – 400 708.","label":"Corporate Grievance Redressal Officer (GRO) Address","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mishra\nADDRESS\nGenerali Central Insurance Company Ltd.\nUnit No. 301, 3\nrd\nFloor Part, Building No. 8,\nMindspace IT/ITES SEZ, MIDC Industrial Area,\nAiravali, Navi Mumbai,\nThane District – 400 708.\nLEVEL 3\nIf you are still not satisfied with the solution provided, you can email\nour CEO’s office.\nEMAIL OUR CEO’s OFF","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"GCIGRO@generalicentral.com","label":"Corporate Grievance Redressal Officer (GRO) Email","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"solution provided to you does not meet your expectations,\nyou can write directly to our Corporate GRO.\nSEND US AN EMAIL\nGCIGRO@generalicentral.com\nOR\nCALL US ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mish","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"+91-79001 97777","label":"Corporate Grievance Redressal Officer (GRO) Phone","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"ur expectations,\nyou can write directly to our Corporate GRO.\nSEND US AN EMAIL\nGCIGRO@generalicentral.com\nOR\nCALL US ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mishra\nADDRESS\nGenerali Central In","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/generali-central-insurance/2724-aarogya-bima-proposal-form"}