{"id":2766,"title":"Jet Set Secure: Proposal Form","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/travel-insurance/jet-set-secure/proposal-forms/jet-set-secure-proposal-form.pdf.pdf","sha256":"31b99b012134d961be3c14c878b9a2d08f2a24a564a84f315ef0662e7b936774","pages":12,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer to apply for the Jet Set Secure travel insurance policy. The proposer fills it to provide personal, travel, plan, nominee, medical, and payment details.","notes":["Complete all sections in capital letters and tick appropriate boxes.","Fields marked with an asterisk [*] are mandatory.","Failure to disclose material facts may lead to rejection or cancellation of policy.","Only one insurance cover will be admitted for each unique insurance period per age band.","Use original documents and provide accurate details.","ABHA numbers can be created at https://healthid.ndhm.gov.in/register if not available.","Policy documents will be sent digitally unless physical copy is requested.","Premium payment via E-mandate requires activation via link sent to registered mobile.","Request for authorisation form must be attached if premium exceeds ₹10,000 for direct claim payments.","Prohibition of rebates as per Section 41 of Insurance Act, 1938 applies."],"title":"Jet Set Secure: Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Select your title","type":"choice","label":"Proposer Name*","options":["Mr.","Mrs.","Ms.","Mx."],"required":true,"pdf_field":""},{"help":"Enter your birth date in DD/MM/YYYY format","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"Enter your age in years","type":"number","label":"Age (in years)","options":[],"required":null,"pdf_field":""},{"help":"Select your marital status","type":"choice","label":"Marital Status*","options":["Married","Single","Widow / Widower","Divorcee"],"required":true,"pdf_field":""},{"help":"Select your nationality or specify if others","type":"choice","label":"Nationality*","options":["Indian","NRI","Others (please specify)"],"required":true,"pdf_field":""},{"help":"Select your gender","type":"choice","label":"Gender*","options":["Male","Female","Third Gender"],"required":true,"pdf_field":""},{"help":"Enter your email address","type":"email","label":"E-mail ID*","options":[],"required":true,"pdf_field":""},{"help":"Select your occupation or specify if others","type":"choice","label":"Occupation","options":["Self Employed","Salaried","Homemaker","Retired","Student","Others (please specify)"],"required":null,"pdf_field":""},{"help":"Mandatory if premium exceeds Rs. 50,000 in cash or Rs. 1 lakh in any mode","type":"text","label":"PAN Number","options":[],"required":null,"pdf_field":""},{"help":"Enter your permanent address","type":"text","label":"Permanent Address","options":[],"required":null,"pdf_field":""},{"help":"Enter landmark near your 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 pin code of permanent address","type":"number","label":"Pin Code","options":[],"required":null,"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":"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 landmark near your 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 pin code of present address","type":"number","label":"Pin Code","options":[],"required":null,"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":"choice","label":"Are you an existing Generali Central customer? *","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide existing policy number if applicable","type":"text","label":"If yes, existing policy no.","options":[],"required":null,"pdf_field":""},{"help":"Provide customer ID number if applicable","type":"text","label":"Customer ID No.","options":[],"required":null,"pdf_field":""},{"help":"Enter policy start date","type":"date","label":"Proposed Policy Period: FROM","options":[],"required":null,"pdf_field":""},{"help":"Enter policy end date","type":"date","label":"TO","options":[],"required":null,"pdf_field":""},{"help":"Select purpose of travel or specify if others","type":"choice","label":"Purpose of Travel","options":["Business","Employment/ Work","Study","Visiting Family/Friends","Leisure","Pilgrimage","Others <<Specify Details>>"],"required":null,"pdf_field":""},{"help":"Select mode of travel","type":"choice","label":"Mode of Travel","options":["Air","Water","Land"],"required":null,"pdf_field":""},{"help":"Tick if you are differently abled","type":"checkbox","label":"If you are Differently Abled, please tick mark on the checkbox to provide confirmation?","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Plan Details","fields":[{"help":"Select trip type","type":"choice","label":"Trip Type","options":["Overseas – Single Trip","Overseas – Annual Multi Trip","Student"],"required":null,"pdf_field":""},{"help":"Select plan variant applicable","type":"choice","label":"Variant under each Plan Type","options":["Standard","Silver","Gold","Platinum","Senior Citizen","Gold Plus","Platinum Plus","Senior Citizen Plus"],"required":null,"pdf_field":""},{"help":"Specify max trip duration limit","type":"text","label":"Max Trip Duration Limit","options":[],"required":null,"pdf_field":""},{"help":"Select max days per trip","type":"choice","label":"Per Trip","options":["30 Days","45 Days","60 Days","90 Days"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Details","fields":[{"help":"If differently abled, specify type of impairment","type":"text","label":"Type of Impairment","options":[],"required":null,"pdf_field":""},{"help":"Specify percentage of 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":"Insured Persons Details","fields":[{"help":"Provide details for up to 6 insured persons including name, relationship, DOB, height, weight, gender, nationality, email, Aadhaar, ABHA, passport details, profession, duty, trip dates, travel days, residence city, area of cover, overseas address, visa type, visa validity, and overseas contact numbers","type":"table","label":"Details of Insured Persons","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Medical and Health Information","fields":[{"help":"Applicable if student cover opted","type":"text","label":"Is any of the female insured pregnant? If yes, please mention the expected date of delivery","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Payment and Bank Details","fields":[{"help":"Tick to activate E-mandate/E-NACH for premium payment","type":"checkbox","label":"E-Aadhar mandate","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 mode","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 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":"Name of account holder for payment","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 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 claims/refunds","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details of Proposer","fields":[{"help":"Select if you have an Electronic Insurance Account","type":"choice","label":"Do you have an EIA","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select if you want to apply for EIA","type":"choice","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":"Provide preferred insurance repository","type":"text","label":"If applied, please mention your preferred Insurance Repository","options":[],"required":null,"pdf_field":""},{"help":"Provide registered email ID","type":"email","label":"Email Id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration","fields":[{"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":""},{"help":"Sign or provide thumb impression","type":"signature","label":"Signature / Thumb Impression of Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Authorized Representative or Person with Disability","fields":[{"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":"authorized representative or proposer"},{"title":"Intermediary Declaration","fields":[{"help":"Intermediary signature","type":"signature","label":"Signature of Agent / Intermediary","options":[],"required":true,"pdf_field":""}],"filled_by":"insurance agent or 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 signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"witness"}],"deadlines":[],"applies_to":"Jet Set Secure travel insurance policies","attachments":["Request for authorisation form to receive Claim / Refund Payments directly into bank account"],"declarations":["The proposer declares that all information provided 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 after submission but before acceptance.","The proposer consents to the insurer seeking medical and other information for underwriting and claims.","The proposer authorizes sharing of proposal and medical information with government and regulatory authorities.","The proposer agrees that non-disclosure or untrue information may void the policy and forfeit premium.","The proposer agrees to receive service-related information electronically and consents to data storage and use.","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 be processed to the proposer’s bank account.","The proposer declares applicable statuses such as HNI, NRI, Politically Exposed Person, etc.","The proposer agrees that information will be processed as per the insurer’s privacy policy.","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.","The proposer consents to Bima-ASBA facility for premium payment blocking and debiting.","The proposer optionally consents to use of personal information for quality and data analysis by third parties."],"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/2766-jet-set-secure-proposal-form"}