{"id":2747,"title":"HEALTH XTRA 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-xtra/proposal-forms/health-xtra-proposal-form.pdf.pdf","sha256":"f1ed480d162dbdbc1f0e3113cf416143ed2ea6e134006af9f68fb61f94cd3c27","pages":13,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or groups proposing to purchase the Health Xtra insurance policy from Generali Central Insurance Company Limited. The proposer fills this form to provide personal, health, nominee, and payment details for policy issuance.","notes":["Complete all sections in capital letters and check applicable boxes.","Fields marked with * are mandatory.","Use original age proof documents as specified.","Policy issuance is subject to acceptance and premium receipt.","Policy document will be sent digitally unless physical copy is requested.","For more details, visit https://generalicentralinsurance.com","If more than 6 persons to be insured, fill the attached Annexure.","Fill portability/migration form if applying for portability.","E-mandate/E-NACH activation is required for instalment payments.","Use block letters and provide accurate contact details."],"title":"HEALTH XTRA 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"},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Select title and enter full name in capital letters","type":"text","label":"Proposer Name*","options":["Mr.","Mrs.","Ms.","M/s"],"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","type":"choice","label":"Marital Status*","options":["Married","Single","Widow / Widower","Divorcee","In Live-in relation"],"required":true,"pdf_field":""},{"help":"Select one and specify if Others","type":"choice","label":"Nationality*","options":["Indian","NRI","Others (please specify)"],"required":true,"pdf_field":""},{"help":"Select 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":"Select one and specify if Others","type":"choice","label":"Occupation*","options":["Self Employed","Salaried","Homemaker","Retired","Others (please specify)"],"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":"Enter full permanent address","type":"text","label":"Permanent Address","options":[],"required":null,"pdf_field":""},{"help":"Enter landmark near permanent address","type":"text","label":"Landmark","options":[],"required":null,"pdf_field":""},{"help":"Enter city or town of permanent address","type":"text","label":"City / Town","options":[],"required":null,"pdf_field":""},{"help":"Enter district of permanent address","type":"text","label":"District","options":[],"required":null,"pdf_field":""},{"help":"Enter 6-digit pin code","type":"number","label":"Pin Code*","options":[],"required":true,"pdf_field":""},{"help":"Enter telephone number","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":"Enter present address or tick if same as permanent","type":"text","label":"Present Address (If same as above, please tick here)","options":[],"required":null,"pdf_field":""},{"help":"Enter landmark near present address","type":"text","label":"Landmark","options":[],"required":null,"pdf_field":""},{"help":"Enter city or town of present address","type":"text","label":"City / Town","options":[],"required":null,"pdf_field":""},{"help":"Enter district of present address","type":"text","label":"District","options":[],"required":null,"pdf_field":""},{"help":"Enter 6-digit pin code","type":"number","label":"Pin Code*","options":[],"required":true,"pdf_field":""},{"help":"Enter telephone number","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":"Select Yes or No","type":"yes-no","label":"Are you Insured under any existing GCICL Group Health Insurance Policy? *","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If Yes above, provide policy number","type":"text","label":"Group Health Insurance Policy Number","options":[],"required":null,"pdf_field":""},{"help":"If Yes above, provide member ID","type":"text","label":"Member ID","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":"If differently abled, specify impairment type","type":"text","label":"Type of Impairment","options":[],"required":null,"pdf_field":""},{"help":"Specify percentage impairment","type":"number","label":"Percentage of Impairment","options":[],"required":null,"pdf_field":""},{"help":"Provide UDID number if applicable","type":"text","label":"UDID Number","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy and Cover Details","fields":[{"help":"Select policy period","type":"choice","label":"Policy Period *","options":["1 Year","2 Years","3 Years"],"required":true,"pdf_field":""},{"help":"Enter start date DD/MM/YYYY","type":"date","label":"Proposed Policy Period* From","options":[],"required":true,"pdf_field":""},{"help":"Select cover type","type":"choice","label":"Cover Type*","options":["Individual","Family Floater"],"required":true,"pdf_field":""},{"help":"Select sum insured option","type":"checkbox","label":"Sum Insured","options":["₹ 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":"Select pre-hospitalization coverage days","type":"choice","label":"Pre-Hospitalization Medical Expenses","options":["60 days","90 days"],"required":null,"pdf_field":""},{"help":"Select post-hospitalization coverage days","type":"choice","label":"Post-Hospitalization Medical Expenses","options":["90 days","120 days","150 days","180 days"],"required":null,"pdf_field":""},{"help":"Select deductible amount","type":"checkbox","label":"Optional Covers - Voluntary Deductible","options":["₹10,000","₹25,000","₹50,000","₹75,000","₹100,000","₹250,000","₹500,000"],"required":null,"pdf_field":""},{"help":"Select if opting for bonus booster","type":"choice","label":"Cumulative Bonus Booster","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select bonus percentage","type":"choice","label":"If yes, please select percentage value","options":["500%","1000%"],"required":null,"pdf_field":""},{"help":"Select if opting for this cover","type":"choice","label":"Consumables / Non-Medical Expenses Cover","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select if opting for critical illness booster","type":"choice","label":"Critical Illness Booster","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select if opting for co-pay waiver","type":"choice","label":"Mandatory Co-Pay Waiver (For Insured member aged 61 years and above)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposed Insured Details","fields":[{"help":"Enter full name of each insured person","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female","Third Gender"],"required":true,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of Birth (DD/MM/YYYY)","options":[],"required":true,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"Marital Status","options":["Married","Single","Widow / Widower","Divorcee","In Live-in relation"],"required":null,"pdf_field":""},{"help":"Provide Ayushman Bharat Health Account number or create one at https://healthid.ndhm.gov.in/register","type":"text","label":"ABHA No^^","options":[],"required":null,"pdf_field":""},{"help":"Specify relationship to proposer","type":"text","label":"Relationship with Proposer","options":[],"required":null,"pdf_field":""},{"help":"Enter height in centimeters","type":"number","label":"Height (Cm)","options":[],"required":null,"pdf_field":""},{"help":"Enter weight in kilograms","type":"number","label":"Weight (Kg)","options":[],"required":null,"pdf_field":""},{"help":"Enter occupation","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"Enter sum insured for each insured","type":"text","label":"Sum Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter pre-hospitalization coverage days","type":"text","label":"Pre-Hospitalization Medical Expenses","options":[],"required":null,"pdf_field":""},{"help":"Enter post-hospitalization coverage days","type":"text","label":"Post-Hospitalization Medical Expenses","options":[],"required":null,"pdf_field":""},{"help":"Enter deductible amount if opted","type":"text","label":"Optional Covers: Voluntary Deductible","options":[],"required":null,"pdf_field":""},{"help":"Enter accident care sum insured if opted","type":"text","label":"Accident Care (For members aged between 3 to 65 years only)","options":[],"required":null,"pdf_field":""},{"help":"Select applicable illnesses","type":"checkbox","label":"PED Coverage for ABCD Illness (Asthma, High Blood Pressure, High Cholesterol and Diabetes)","options":["Asthma","High Blood Pressure","High Cholesterol","Diabetes"],"required":null,"pdf_field":""},{"help":"Select bonus percentage","type":"choice","label":"Cumulative Bonus Booster","options":["500%","1000%"],"required":null,"pdf_field":""},{"help":"Select if opted","type":"choice","label":"Consumables / Non-Medical Expenses Cover","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select if opted","type":"choice","label":"Critical Illness Booster","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select if opted","type":"choice","label":"Mandatory Co-Pay Waiver (For Insured member aged 61 years and above)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Enter nominee name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee date of birth","type":"date","label":"Age (DOB)","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Enter nominee email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Enter nominee present address","type":"text","label":"Present Address","options":[],"required":null,"pdf_field":""},{"help":"Enter nominee permanent address or tick if same","type":"text","label":"Permanent Address (If same as above, please tick here)","options":[],"required":null,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship with the Proposer","options":[],"required":null,"pdf_field":""},{"help":"Total must not exceed 100%","type":"number","label":"Specify the Percentage (%) of Claim amount payable to each nominee","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of the Bank","options":[],"required":null,"pdf_field":""},{"help":"Enter account holder name","type":"text","label":"Account Holder Name","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Appointee Details (if nominee is minor)","fields":[{"help":"Enter appointee name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Enter appointee date of birth","type":"date","label":"Age (DOB)","options":[],"required":true,"pdf_field":""},{"help":"Enter appointee mobile number","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"Enter appointee email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Enter appointee present address","type":"text","label":"Present Address","options":[],"required":null,"pdf_field":""},{"help":"Enter appointee permanent address or tick if same","type":"text","label":"Permanent Address (If same as above, please tick here)","options":[],"required":null,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship with Appointee","options":[],"required":null,"pdf_field":""},{"help":"Total must not exceed 100%","type":"number","label":"Specify the Percentage (%) of Claim amount payable to each nominee","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of the Bank","options":[],"required":null,"pdf_field":""},{"help":"Enter account holder name","type":"text","label":"Account Holder Name","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Medical and Health Information","fields":[{"help":"Select Yes or No for each insured","type":"yes-no","label":"Do you consume tobacco in any form?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify type if tobacco consumed","type":"text","label":"Type- Cigarette/ Beedi/ Cigar/ Gutkha/ Others","options":[],"required":null,"pdf_field":""},{"help":"Enter month and year if stopped","type":"date","label":"If you have stopped smoking – Since when (MM/YYYY)","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No for each insured","type":"yes-no","label":"Do you consume alcohol in any form?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify type if alcohol consumed","type":"text","label":"Type – Beer/ Hard liquor/ Wine/ Others","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are you in good health and free from physical and mental disease or infirmity or medical complaints or deformity?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select applicable conditions for each insured","type":"checkbox","label":"Has any person proposed to be insured been suffering from/suffered in the past/taking treatment for any illness/disease or injury for following medical conditions, presently? (Select for each condition)","options":["Psychiatric/ Mental/ Sleep Disorder","Stroke/ Epilepsy/ Paralysis or other brain / nervous system disorders","Disease related to Ear/ Nose/ Throat","Tuberculosis/Asthma or any lung / respiratory disorder","Hypertension/ Chest pain/ Heart Disease","Liver Disease/ Ulcers (stomach/ duodenum)/ Gall stones/ Hepatitis/ other digestive Disorders","Kidney Failure/ Dialysis/ Kidney Stones/ Prostate/ other kidney disorders","HIV/ AIDS/ Sexually Transmitted Disease","Diabetes/ Thyroid or any other endocrine disorders","Arthritis, Spondylitis, Joint Pain, Slip Disc, Spinal Disorder or any other disorder of muscle/ bone/ joint","Cancer/Tumour- Benign or Malignant","Anaemia or any other blood disorder","Females Specific – Fibroid / Cyst/ Fibroadenoma/ Breast disorder or any other Gynaecological Disorder","Any accidental injury that has caused disability / hospitalization","Treatment for Infertility or has been advised for?","Others (Please Specify with diagnosis)"],"required":null,"pdf_field":""},{"help":"Select Yes or No and provide expected delivery date if Yes","type":"date","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":"Additional Information","fields":[{"help":"Enter name of insured with illness","type":"text","label":"Name of the proposed insured person","options":[],"required":null,"pdf_field":""},{"help":"Specify illness or surgery","type":"text","label":"Name of Illness/ Surgery","options":[],"required":null,"pdf_field":""},{"help":"Provide medication details","type":"text","label":"Medication Details","options":[],"required":null,"pdf_field":""},{"help":"Select if fully cured","type":"yes-no","label":"Is the person fully cured? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Concurrent/Previous Insurance Policy Details","fields":[{"help":"Enter insured name under previous policy","type":"text","label":"Insured Name","options":[],"required":null,"pdf_field":""},{"help":"Enter policy number","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Enter insurer name","type":"text","label":"Insurer Name","options":[],"required":null,"pdf_field":""},{"help":"Enter policy start date","type":"date","label":"Policy Period From","options":[],"required":null,"pdf_field":""},{"help":"Enter sum insured","type":"amount","label":"Sum Insured","options":[],"required":null,"pdf_field":""},{"help":"Provide claim details if any","type":"text","label":"Claim Lodged (if Yes, give details)","options":[],"required":null,"pdf_field":""},{"help":"Enter product name","type":"text","label":"Product Name","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","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 instalment frequency","type":"choice","label":"Instalment Frequency","options":["Monthly","Quarterly","Half Yearly","Annually"],"required":null,"pdf_field":""},{"help":"Tick to opt for E-mandate/E-NACH","type":"checkbox","label":"E-mandate/E-NACH","options":[],"required":null,"pdf_field":""},{"help":"Provide bank name for E-mandate","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Select payment option","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 account holder name","type":"text","label":"Account Holder Name","options":[],"required":null,"pdf_field":""},{"help":"Enter cheque/DD number","type":"text","label":"Instrument Number","options":[],"required":null,"pdf_field":""},{"help":"Enter instrument date","type":"date","label":"Instrument Date","options":[],"required":null,"pdf_field":""},{"help":"Enter transaction ID","type":"text","label":"Transaction ID (for online payments)","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name for premium payment","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of the bank","options":[],"required":true,"pdf_field":""},{"help":"Enter bank branch","type":"text","label":"Branch","options":[],"required":true,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Account no.","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"Bank IFSC code","options":[],"required":true,"pdf_field":""},{"help":"Enter MICR code","type":"text","label":"MICR","options":[],"required":null,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Account Type","options":["Savings","Current","Others (please specify)"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details of Proposer","fields":[{"help":"Select if you have an electronic insurance account","type":"yes-no","label":"Do you have an eIA","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select if you want to apply for eIA","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 available","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":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration","fields":[{"help":"Sign or provide thumb impression","type":"signature","label":"Signature / Thumb Impression of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter proposer name","type":"text","label":"Proposer Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Intermediary Declaration","fields":[{"help":"Enter intermediary name","type":"text","label":"Name of Agent","options":[],"required":true,"pdf_field":""},{"help":"Enter intermediary code","type":"text","label":"Code","options":[],"required":true,"pdf_field":""},{"help":"Enter POSP PAN if applicable","type":"text","label":"POSP PAN","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Agent /POSP/Intermediary","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary"},{"title":"Vernacular Declaration","fields":[{"help":"Enter witness name","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"Date of declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of declaration","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary"},{"title":"Declaration by Authorized Representative or Person with Disability","fields":[{"help":"Proposer signature","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter authorized representative name","type":"text","label":"Name of Authorized Representative","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship with the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter address of authorized representative","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Enter contact number","type":"phone","label":"Contact No.","options":[],"required":true,"pdf_field":""},{"help":"Authorized representative signature","type":"signature","label":"Signature of the Authorized Representative","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter witness name","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"Date of witness signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer or authorized representative"}],"deadlines":[],"applies_to":"Health Xtra insurance policy proposal","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"],"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 and 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 proposer confirms premium is paid from legally declared income sources.","The proposer confirms who paid the premium and requests refund to specified bank account.","The proposer declares if they belong to any special categories like HNI, NRI, Politically Exposed Person, etc.","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.","The proposer consents to Bima-ASBA facility for premium payment blocking if opted.","Optional consent to allow insurer to collect and use personal information for servicing and claims."],"dropped_labels":6},"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/2747-health-xtra-proposal-form"}