{"id":2734,"title":"Health PowHER Proposal Form","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/health-insurance/health-powher/proposal-forms/health-powher-proposal-form.pdf.pdf","sha256":"3816da7607049a9e007977ef24b8ea3e779077803a7104c68092c05e6b7db2bf","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) to apply for the Health PowHER insurance policy by Generali Central Insurance Company Limited. The proposer fills it to provide personal, health, nominee, and payment details for insurance coverage.","notes":["Complete all sections in capital letters and tick appropriate boxes.","Fields marked with an asterisk [*] are mandatory.","Attach age proof documents for each insured person.","Use original and recognized documents for age proof.","If number of persons to be insured exceeds 6, fill the attached Annexure.","For premium payment via E-mandate/E-NACH, activation link will be sent to registered mobile number.","Policy document will be sent digitally by default; tick box if physical copy is desired.","Read and understand the prospectus and product features before signing.","Prohibition of rebates as per Section 41 of the Insurance Act, 1938 applies."],"title":"Health PowHER Proposal Form","submit":{"to":"Generali Central Insurance Company Limited","how":"","address":"Registered Office: Unit No. 801 & 802, 8th Floor, Tower C, Embassy 247 Park, LBS Marg, Vikhroli (West), Mumbai – 400083\nEmail ID: gcicare@generalicentral.com\nToll-free Phone: 1800 220 233 / 1860 500 3333 / 022 6783 7800"},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Select appropriate title and enter full name in capital letters","type":"text","label":"Proposer Name *","options":["Mr.","Mrs.","Ms.","Mx."],"required":true,"pdf_field":""},{"help":"Enter date of birth in DD/MM/YYYY format","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"Enter age in years","type":"number","label":"Age (in years)","options":[],"required":null,"pdf_field":""},{"help":"Select one marital status","type":"choice","label":"Marital Status*","options":["Married","Single","Widow / Widower","Divorcee","Live-in relation"],"required":true,"pdf_field":""},{"help":"Select nationality or specify if others","type":"choice","label":"Nationality*","options":["Indian","NRI","Others (please specify)"],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender*","options":["Male","Female","Third Gender"],"required":true,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"E-mail Id*","options":[],"required":true,"pdf_field":""},{"help":"Select occupation or specify if others","type":"choice","label":"Occupation","options":["Self Employed","Salaried","Homemaker","Retired","Others (please specify)"],"required":null,"pdf_field":""},{"help":"Mandatory if premium exceeds Rs. 50,000 in cash or Rs. 1,00,000 in any mode","type":"text","label":"PAN Number","options":[],"required":null,"pdf_field":""},{"help":"Enter full permanent address","type":"text","label":"Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter nearby landmark","type":"text","label":"Landmark","options":[],"required":null,"pdf_field":""},{"help":"Enter city or town","type":"text","label":"City / Town","options":[],"required":null,"pdf_field":""},{"help":"Enter district","type":"text","label":"District","options":[],"required":null,"pdf_field":""},{"help":"Enter 6-digit postal code","type":"number","label":"Pin Code*","options":[],"required":true,"pdf_field":""},{"help":"Enter telephone number with STD code","type":"phone","label":"Telephone No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile No.*","options":[],"required":true,"pdf_field":""},{"help":"Tick if present address is same as permanent address","type":"checkbox","label":"Present Address: (If same as above, please tick here)","options":[],"required":null,"pdf_field":""},{"help":"Enter nearby landmark for present address","type":"text","label":"Landmark","options":[],"required":null,"pdf_field":""},{"help":"Enter city or town for present address","type":"text","label":"City / Town","options":[],"required":null,"pdf_field":""},{"help":"Enter district for present address","type":"text","label":"District","options":[],"required":null,"pdf_field":""},{"help":"Enter 6-digit postal code for present address","type":"number","label":"Pin Code*","options":[],"required":true,"pdf_field":""},{"help":"Enter telephone number with STD code for present address","type":"phone","label":"Telephone No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile number for present address","type":"phone","label":"Mobile No.*","options":[],"required":true,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Are you an existing Generali Central Customer? *","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter existing policy number if applicable","type":"text","label":"If yes, existing policy no.","options":[],"required":null,"pdf_field":""},{"help":"Enter customer ID number if applicable","type":"text","label":"Customer ID No.","options":[],"required":null,"pdf_field":""},{"help":"Tick if applicable","type":"checkbox","label":"If you are Differently Abled, please tick mark on the checkbox to provide confirmation.","options":[],"required":null,"pdf_field":""},{"help":"Provide details if differently abled","type":"section","label":"If yes, kindly provide the below details","fields":[{"help":"Describe type of impairment","type":"text","label":"Type of Impairment","options":[],"required":null,"pdf_field":""},{"help":"Enter percentage impairment","type":"number","label":"Percentage of Impairment","options":[],"required":null,"pdf_field":""},{"help":"Enter Unique Disability ID number","type":"text","label":"UDID Number","options":[],"required":null,"pdf_field":""}],"options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Plan Details","fields":[{"help":"Select policy period","type":"choice","label":"Policy Period *","options":["1 Year","2 Year","3 Year"],"required":true,"pdf_field":""},{"help":"Enter start date of policy in DD/MM/YYYY","type":"date","label":"Proposed Policy Period* From","options":[],"required":true,"pdf_field":""},{"help":"Enter end date of policy in DD/MM/YYYY","type":"date","label":"To","options":[],"required":true,"pdf_field":""},{"help":"Select cover type","type":"choice","label":"Cover Type*","options":["Individual","Family Floater"],"required":true,"pdf_field":""},{"help":"Select plan","type":"choice","label":"Plans","options":["Essential","Advance","Supreme"],"required":null,"pdf_field":""},{"help":"Select sum insured amount","type":"choice","label":"Base Cover Sum Insured","options":["₹ 5,00,000","₹ 10,00,000","₹ 15,00,000","₹ 20,00,000","₹ 25,00,000","₹ 50,00,000","₹ 75,00,000","₹ 10,000,000"],"required":null,"pdf_field":""},{"help":"Select voluntary co-payment percentage if applicable","type":"choice","label":"Do you want to opt for Voluntary Co-payment? If yes, please tick on any one co-payment:","options":["10%","20%","30%"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposed Insured Details","fields":[{"help":"Attach Passport, PAN Card, Driving License, School/College leaving certificate, or Letter from recognized public authority","type":"attachment","label":"Attach age proof document for each insured","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Medical and Health Information","fields":[{"help":"Answer for each insured","type":"yes-no","label":"Are you in good health and free from physical and mental disease or infirmity or medical complaints or deformity? Yes/No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"For each female insured, indicate pregnancy and expected delivery date (DD/MM/YY)","type":"choice","label":"Is any of the female insured pregnant? If yes, please mention the expected date of delivery","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Concurrent/Previous Insurance Policy Details","fields":[{"help":"Tick yes or no; if yes, attach portability/migration form","type":"yes-no","label":"Are you applying for portability / migration?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Payment and Bank Details","fields":[{"help":"Select premium payment frequency","type":"choice","label":"Instalment Frequency","options":["Monthly","Quarterly","Half Yearly","Annually"],"required":null,"pdf_field":""},{"help":"Tick to activate E-mandate/E-NACH; provide Bank Name","type":"checkbox","label":"E-mandate/E-NACH","options":[],"required":null,"pdf_field":""},{"help":"Select payment mode","type":"choice","label":"Payment Option","options":["Cheque","Demand Draft","Fund Transfer","Pay Order","Debit Card","Credit Card","Others (please specify)"],"required":null,"pdf_field":""},{"help":"Enter premium amount in rupees","type":"amount","label":"Premium Amount","options":[],"required":true,"pdf_field":""},{"help":"Write premium amount in words","type":"text","label":"Amount in Words","options":[],"required":true,"pdf_field":""},{"help":"Enter name of account holder for payment","type":"text","label":"Account Holder Name","options":[],"required":null,"pdf_field":""},{"help":"Enter cheque/DD/instrument number if applicable","type":"text","label":"Instrument Number","options":[],"required":null,"pdf_field":""},{"help":"Enter instrument date in DD/MM/YYYY","type":"date","label":"Instrument Date","options":[],"required":null,"pdf_field":""},{"help":"Enter transaction ID for online payment","type":"text","label":"Transaction ID (for online payments)","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name for payment","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details of Proposer","fields":[{"help":"Select yes or no","type":"yes-no","label":"Do you have an EIA","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"If no, do you wish to apply for EIA","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter EIA number if applicable","type":"text","label":"If yes, please quote the EIA number","options":[],"required":null,"pdf_field":""},{"help":"Enter preferred insurance repository","type":"text","label":"If applied, please mention your preferred Insurance Repository","options":[],"required":null,"pdf_field":""},{"help":"Enter registered email ID","type":"email","label":"Email Id (Registered with Insurance Repository)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Health PowHER insurance policy proposals","attachments":["Age proof documents for each insured (Passport, PAN Card, Driving License, School/College leaving certificate, Letter from recognized public authority)","Portability / migration form (if applying for portability)","Request for authorisation form to receive claim/refund payments via NEFT (mandatory if premium > ₹10,000)"],"declarations":["The proposer declares all information is true and complete to the best of their knowledge.","The policy will come into force only after full payment of premium.","The proposer will notify any change in occupation or health before risk acceptance.","The company may seek medical and insurance information for underwriting and claims.","The company may share proposal and medical information with government/regulatory authorities.","Non-disclosure or untrue information may void the policy and forfeit premium.","The proposer consents to receive service-related information electronically.","The data provided will be stored and used for insurance and servicing purposes.","Premium is paid from legally declared income and not from proceeds of crime.","The premium payer has insurable interest; refunds will be processed to proposer’s bank account.","The proposer confirms if they belong to any special categories (HNI, NRI, Politically Exposed Person, etc.).","Information will be processed as per the insurer’s privacy policy.","If ABHA number is shared, consent is given to use it for medical record verification and claims facilitation.","Consent is given to verify KYC records from Central KYC Records Registry.","Consent is given to use Bima-ASBA facility to block premium amount in bank account upon proposal acceptance."],"dropped_labels":19},"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/2734-health-powher-proposal-form"}