{"id":2735,"title":"HEALTH ABSOLUTE 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-absolute/proposal-forms/health-absolute-proposal-form.pdf","sha256":"0d3c4e0673e00b334020954a5f2e901ae20303437faf78414035e90e3ed08856","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) to apply for the Health Absolute insurance policy with Generali Central Insurance Company Limited. The proposer fills it to provide personal, health, nominee, and payment details for policy issuance.","notes":["Fill all mandatory fields marked with an asterisk [*].","Complete all sections in capital letters and tick boxes where applicable.","Use original and valid age proof documents as specified.","Provide ABHA number or create one at https://healthid.ndhm.gov.in/register.","E-mandate/E-NACH activation is required for instalment payments; link sent to registered mobile.","Policy documents will be sent digitally unless physical copy is requested.","Use block letters and provide accurate contact details.","Attach portability/migration form if applying for portability.","Request for authorisation form is mandatory for claim/refund payments if premium exceeds ₹10,000.","The proposer must sign or provide thumb impression on the declaration.","Intermediary must declare product explanation and suitability to proposer.","Authorized representative must provide authorization details and signatures if applicable."],"title":"HEALTH ABSOLUTE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter full name in capitals and tick appropriate title","type":"text","label":"Proposer Name*","options":["Mr.","Mrs.","Ms."],"required":true,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"","type":"number","label":"Age (in years)","options":[],"required":null,"pdf_field":""},{"help":"Tick one option","type":"choice","label":"Marital Status*","options":["Married","Single","Widow / Widower","Divorcee","In Live-in relation"],"required":true,"pdf_field":""},{"help":"Tick one and specify if Others","type":"choice","label":"Nationality*","options":["Indian","NRI","Others (please specify)"],"required":true,"pdf_field":""},{"help":"Tick one","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":"Tick one and specify if Others","type":"choice","label":"Occupation","options":["Self Employed","Salaried","Housewife","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":"","type":"text","label":"Landmark","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City / Town","options":[],"required":null,"pdf_field":""},{"help":"","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":"Include STD code if applicable","type":"phone","label":"Telephone No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter 10-digit mobile number","type":"phone","label":"Mobile No.*","options":[],"required":true,"pdf_field":""},{"help":"Tick if same as permanent address, else fill present address","type":"text","label":"Present Address*(If same as above, please tick here)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Landmark","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City / Town","options":[],"required":null,"pdf_field":""},{"help":"","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":"Include STD code if applicable","type":"phone","label":"Telephone No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter 10-digit mobile number","type":"phone","label":"Mobile No.*","options":[],"required":true,"pdf_field":""},{"help":"Tick one","type":"yes-no","label":"Are you an existing Generali Central Customer?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick one if applicable","type":"yes-no","label":"If Yes, please provide, GCICL policyholder? *","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide if existing customer","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":"Specify type if differently abled","type":"text","label":"Type of Impairment","options":[],"required":null,"pdf_field":""},{"help":"Enter percentage if differently abled","type":"number","label":"Percentage of Impairment","options":[],"required":null,"pdf_field":""},{"help":"Unique Disability ID if applicable","type":"text","label":"UDID Number","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Plan Details","fields":[{"help":"Tick one","type":"choice","label":"Policy Period *","options":["1 Year","2 Year","3 Year"],"required":true,"pdf_field":""},{"help":"Enter start date DD/MM/YYYY","type":"date","label":"Proposed Policy Period* From","options":[],"required":true,"pdf_field":""},{"help":"Tick one","type":"choice","label":"Cover Type*","options":["Individual","Family Floater"],"required":true,"pdf_field":""},{"help":"Tick one plan","type":"choice","label":"Plan","options":["Classic","Platinum","Signature"],"required":null,"pdf_field":""},{"help":"Tick one sum insured amount","type":"choice","label":"Sum Insured","options":["₹ 3,00,000","₹ 5,00,000","₹ 10,00,000","₹ 15,00,000","₹ 20,00,000","₹ 25,00,000","₹ 30,00,000","₹ 35,00,000","₹ 50,00,000","₹ 75,00,000","₹ 1,00,00,000"],"required":null,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Do you want to opt for voluntary deductible?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick one deductible option matching your plan","type":"choice","label":"If yes, please tick on any one deductible as per the plan opted","options":["Classic: ₹ 10,000 (8%), ₹ 25,000 (15%), ₹ 50,000 (20%)","Platinum: ₹ 50,000 (15%), ₹ 75,000 (20%), ₹ 1,00,000 (25%)","Signature: ₹ 1,00,000 (15%), ₹ 2,50,000 (20%), ₹ 5,00,000 (25%)"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposed Insured Details","fields":[{"help":"Acceptable proofs: Passport, PAN Card, Driving License, School/College leaving certificate, Letter from recognized public authority","type":"attachment","label":"Please attach age proof document for each insured","options":[],"required":true,"pdf_field":""},{"help":"Provide ABHA number for all proposed insured persons or create one at https://healthid.ndhm.gov.in/register","type":"text","label":"ABHA number (Ayushman Bharat Health Account number)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Concurrent/Previous Insurance Policy Details","fields":[{"help":"Tick one","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":"Tick one if opting for instalment payment","type":"choice","label":"Instalment Frequency","options":["Monthly","Quarterly","Half Yearly","Annually"],"required":null,"pdf_field":""},{"help":"Tick to activate E-mandate/E-NACH; link will be sent to registered mobile","type":"checkbox","label":"E-mandate/E-NACH","options":[],"required":null,"pdf_field":""},{"help":"Tick one and specify if Others","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":null,"pdf_field":""},{"help":"Name on payment instrument","type":"text","label":"Account Holder Name","options":[],"required":null,"pdf_field":""},{"help":"Cheque/DD/Pay Order number","type":"text","label":"Instrument Number","options":[],"required":null,"pdf_field":""},{"help":"Date of payment instrument","type":"date","label":"Instrument Date","options":[],"required":null,"pdf_field":""},{"help":"Provide transaction ID if paid online","type":"text","label":"Transaction ID (for online payments)","options":[],"required":null,"pdf_field":""},{"help":"Bank name for claim/refund payments","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details of Proposer","fields":[{"help":"Tick one","type":"yes-no","label":"Do you have an EIA","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick one","type":"yes-no","label":"If No, do you wish to apply for EIA","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide EIA number if available","type":"text","label":"If Yes, please quote the EIA number","options":[],"required":null,"pdf_field":""},{"help":"Mention preferred repository if applied","type":"text","label":"Preferred Insurance Repository","options":[],"required":null,"pdf_field":""},{"help":"Provide registered email","type":"email","label":"Email Id (Registered with Insurance Repository)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Proposer","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Print name","type":"text","label":"Proposer Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Intermediary Declaration","fields":[{"help":"","type":"text","label":"Intermediary Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"POSP PAN","options":[],"required":null,"pdf_field":""}],"filled_by":"intermediary"}],"deadlines":[],"applies_to":"Health Absolute insurance policy proposals","attachments":["Age proof document 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 directly into bank account (mandatory if premium > ₹10,000)"],"declarations":["The proposer declares all information is true and complete to the best of their knowledge.","The policy will be effective only after acceptance and full premium payment.","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 information electronically and telecom modes.","The premium is paid from legally declared income and not from proceeds of crime.","The proposer confirms who paid the premium and requests refunds to proposer’s bank account.","The proposer declares applicable statuses (HNI, NRI, Politically Exposed Person, etc.) if any.","The proposer agrees information will be processed as per insurer’s privacy policy.","If ABHA number is shared, consent is given to use it for medical history verification confidentially.","The proposer consents to CKYC record verification and receiving related communications.","Consent to use Bima-ASBA facility for premium payment blocking if opted.","Optional consent to use personal information for quality and data analysis by third parties."],"dropped_labels":15},"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/2735-health-absolute-proposal-form"}