{"id":2765,"title":"PROPOSAL FORM SHUBH YATRA","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/travel-insurance/shubh-yatra/proposal-forms/shubh-yatra-proposal-form.pdf.pdf","sha256":"4164f39101910ac5ecd69095cf35f496ef6ef3905e78639e81714b9e265f81b7","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) to apply for the Shubh Yatra travel insurance policy offered by Generali Central Insurance Company Limited.","notes":["Fields marked with * are mandatory.","PAN is mandatory if premium exceeds Rs. 50,000 in cash or Rs. 1,00,000 in any mode.","Use block letters to fill the form.","Provide ABHA number for all insured persons or create one at https://healthid.ndhm.gov.in/register.","Digitally signed policy documents will be sent by email; physical copy available on request.","Attach the request for authorisation form for NEFT payments if premium is more than ₹10,000.","Age eligibility for plans is 18 to 70 years.","Annual Multi Trip plans limit each trip to a maximum of 30 days.","Nominee(s) should preferably be immediate relatives; proposer is default nominee for other insured persons unless advised otherwise."],"title":"PROPOSAL FORM SHUBH YATRA","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Period of Insurance Desired","fields":[{"help":"Specify the desired insurance coverage period","type":"text","label":"PERIOD OF INSURANCE DESIRED*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposer Details","fields":[{"help":"Enter full name with surname, first name, middle name","type":"text","label":"Name of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Full permanent address","type":"text","label":"Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6-digit postal code","type":"number","label":"Pin code*","options":[],"required":true,"pdf_field":""},{"help":"Landline number if any","type":"phone","label":"Contact Number Landline","options":[],"required":null,"pdf_field":""},{"help":"Valid email address","type":"email","label":"Email Id*","options":[],"required":true,"pdf_field":""},{"help":"Full present address","type":"text","label":"Present Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6-digit postal code","type":"number","label":"Pin code*","options":[],"required":true,"pdf_field":""},{"help":"Landline number if any","type":"phone","label":"Contact Number Landline","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender*","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"Mandatory if premium exceeds Rs. 50,000 in cash or Rs. 1,00,000 in any mode","type":"text","label":"PAN","options":[],"required":null,"pdf_field":""},{"help":"If not available, download form from website and submit","type":"text","label":"e-IA Number (e-Insurance Account Number)","options":[],"required":null,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"Marital Status*","options":["Married","Single","Widow/Widower","Divorced"],"required":true,"pdf_field":""},{"help":"Enter nationality","type":"text","label":"Nationality*","options":[],"required":true,"pdf_field":""},{"help":"Select purpose or specify others","type":"choice","label":"Purpose of Travel*","options":["Business/ Employment/ Work","Leisure/ Vacation","Others: _______________________"],"required":true,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Are you an existing Generali Central Insurance customer*?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If existing customer, provide policy number","type":"text","label":"Existing Policy No.","options":[],"required":null,"pdf_field":""},{"help":"If existing customer, provide customer ID","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 impairment type if applicable","type":"text","label":"Type of Impairment","options":[],"required":null,"pdf_field":""},{"help":"Specify percentage if applicable","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":"Travel Itinerary (In case of Single Trip Plans)","fields":[{"help":"Date of departure","type":"date","label":"Departure Date","options":[],"required":null,"pdf_field":""},{"help":"Date of arrival","type":"date","label":"Arrival Date","options":[],"required":null,"pdf_field":""},{"help":"Select mode of travel; specify if Others","type":"choice","label":"Mode of Travel","options":["Rail","Road","Air","Water","Others*"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Provide appointee details if nominee is minor","type":"table","label":"Appointee Details (Required only if the nominee is a minor) (Name, Age, Mobile No., Email ID, Present Address, Permanent Address, Relationship with Appointee, Percentage of Claim amount payable, Bank details including Account No., IFSC/MICR Code, Bank Name, Account Holder Name)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Family doctor details","fields":[{"help":"Name of family doctor","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Address and contact number of family doctor","type":"text","label":"Address & Contact No.","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"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 numbers","type":"amount","label":"Premium Amount","options":[],"required":null,"pdf_field":""},{"help":"Write premium amount in words","type":"text","label":"Amount in Words","options":[],"required":null,"pdf_field":""},{"help":"Name of account holder for 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":"Online transaction reference","type":"text","label":"Transaction ID (for online payments)","options":[],"required":null,"pdf_field":""},{"help":"Name of bank for payment","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Provide bank details for claim/refund payments","type":"text","label":"Bank Details (required for direct payment of claims/refunds in the account)","options":[],"required":null,"pdf_field":""},{"help":"Account holder name for claims/refunds","type":"text","label":"Name of the account holder","options":[],"required":null,"pdf_field":""},{"help":"Bank name for claims/refunds","type":"text","label":"Name of the bank","options":[],"required":null,"pdf_field":""},{"help":"Bank branch","type":"text","label":"Branch","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Account no.","options":[],"required":null,"pdf_field":""},{"help":"IFSC code of bank branch","type":"text","label":"Bank IFSC code","options":[],"required":null,"pdf_field":""},{"help":"MICR code of bank branch","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":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Shubh Yatra travel insurance plans including Daily Commuters Plan, Business Plan, and Vacations Plan","attachments":["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 commence only after full payment of premium.","The proposer will notify any change in occupation or health before risk acceptance.","The proposer consents to the insurer seeking medical and insurance information for underwriting and claims.","The proposer authorizes sharing of proposal and medical information with government and regulatory authorities.","The proposer confirms no undisclosed material information and consents to electronic communication from insurer.","The proposer agrees information will be processed as per insurer's privacy policy.","The premium is paid from legally declared sources and not from proceeds of crime.","The proposer confirms their status (HNI, NRI, Politically Exposed Person, etc.) as applicable.","The proposer consents to sharing ABHA number for medical record access and claims facilitation.","The proposer consents to CKYC record verification and receiving related communications."],"dropped_labels":8},"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/2765-proposal-form-shubh-yatra"}