{"id":2769,"title":"Travel Suraksha | Proposal Form","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/travel-insurance/travel-suraksha/proposal-forms/travel-suraksha-proposal-form.pdf.pdf","sha256":"5802388fb4e94a304e4e4991a9cff6d515fefd9f219795383f4be3357ee633cc","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals proposing to purchase the Travel Suraksha insurance policy from Generali Central Insurance Company Limited. The proposer fills it to provide personal, travel, health, and nominee details for underwriting and policy issuance.","notes":["Information for fields marked with asterisk [*] is mandatory.","Use original documents and accurate information to avoid rejection or cancellation.","PAN is mandatory if premium exceeds Rs. 50,000 in cash or Rs. 1 lakh in any mode.","ABHA number is required for all insured persons or create one at https://healthid.ndhm.gov.in/register.","Total percentage of claim amount payable to nominees must not exceed 100%.","Fill bank details carefully for direct claim/refund payments; mandatory if premium > ₹10,000.","Policy document will be sent digitally unless physical copy is requested.","E-mandate/E-NACH activation is required for auto-debit of premium installments.","Intermediary must explain product features and proposal form contents to proposer.","Use block letters and provide complete contact details.","Attach request for authorization form for claim/refund payments if applicable."],"title":"Travel Suraksha | Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Select title and enter full name","type":"text","label":"Name of the Proposer (in full) * Mr. Mrs. Ms.","options":["Mr.","Mrs.","Ms."],"required":true,"pdf_field":""},{"help":"Enter full permanent address","type":"text","label":"Permanent Address","options":[],"required":true,"pdf_field":""},{"help":"Enter state of permanent address","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter postal pin code","type":"number","label":"Pin code","options":[],"required":true,"pdf_field":""},{"help":"Tick if present address is same as permanent","type":"checkbox","label":"Present Address: (If same as above, please tick here) ☐ *","options":[],"required":true,"pdf_field":""},{"help":"Enter state of present address","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter postal pin code of present address","type":"number","label":"Pin code","options":[],"required":true,"pdf_field":""},{"help":"Enter telephone number","type":"phone","label":"Tel No*","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile no*","options":[],"required":true,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email id *","options":[],"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":false,"pdf_field":""},{"help":"If not available, download form from website and submit with proposal","type":"text","label":"e-IA Number (e-Insurance Account Number)","options":[],"required":false,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender*","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"Marital Status*","options":["Married","Single","Divorced","Widowed"],"required":true,"pdf_field":""},{"help":"Enter nationality","type":"text","label":"Nationality*","options":[],"required":true,"pdf_field":""},{"help":"Select visa type","type":"choice","label":"Visa Type*","options":["Immigrant","Resident","Student","Travel"],"required":true,"pdf_field":""},{"help":"Select purpose or specify if Others","type":"choice","label":"Purpose of Travel","options":["Business","Employment/ Work","Leisure","Study","Others"],"required":false,"pdf_field":""},{"help":"Select plan and coverage amount","type":"choice","label":"Plan Details* (Please tick on relevant box)","options":["Standard","Silver","Gold","Platinum","Overseas Travel","Worldwide","Ex – USA / Canada","Asia Travel","Individual","Family","Multi Trip","Worldwide 30","Worldwide 45","Superior Care (Senior Citizen)"],"required":true,"pdf_field":""},{"help":"Tick if applicable and provide details below","type":"checkbox","label":"If you are Differently Abled, please tick mark on the checkbox to provide confirmation. ☐","options":[],"required":false,"pdf_field":""},{"help":"Describe impairment type","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Enter UDID number","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Travel and Insured Persons Details","fields":[{"help":"Enter departure date","type":"date","label":"Proposed Date of Departure from Republic of India*","options":[],"required":true,"pdf_field":""},{"help":"Enter number of days for insurance coverage","type":"number","label":"No of Days to be insured","options":[],"required":false,"pdf_field":""},{"help":"List all countries to be visited","type":"text","label":"Please mention the list of Countries that you intend to visit","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee and Appointee Details","fields":[{"help":"Fill details for each appointee; total percentage must not exceed 100%","type":"table","label":"Appointee Details (Required only if the nominee is a minor) (Name, Age, Mobile No., Email ID, Present Address, Permanent Address (tick if same), Relationship with Appointee, Percentage of Claim amount payable, Bank details including Account No., IFSC/MICR Code, Bank Name, Account Holder Name)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Health Information","fields":[{"help":"Tick yes or no; if yes, provide details below","type":"yes-no","label":"Does any person to be insured suffer or has suffered from any of the following? Yes No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide family doctor's contact details","type":"text","label":"Details of Family Doctor: Name, Address & Contact No.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Payment and Bank Details","fields":[{"help":"Select payment mode or specify if others","type":"choice","label":"Payment Option: Cheque, Demand Draft, Fund Transfer, Pay Order, Debit Card, Credit Card, Others (please specify)","options":["Cheque","Demand Draft","Fund Transfer","Pay Order","Debit Card","Credit Card","Others"],"required":false,"pdf_field":""},{"help":"Enter premium amount in rupees","type":"amount","label":"Premium Amount","options":[],"required":false,"pdf_field":""},{"help":"Write premium amount in words","type":"text","label":"Amount in Words","options":[],"required":false,"pdf_field":""},{"help":"Name of bank account holder","type":"text","label":"Account Holder Name","options":[],"required":false,"pdf_field":""},{"help":"Cheque/DD/Instrument number","type":"text","label":"Instrument Number","options":[],"required":false,"pdf_field":""},{"help":"Date of instrument","type":"date","label":"Instrument Date","options":[],"required":false,"pdf_field":""},{"help":"Enter transaction ID for online payment","type":"text","label":"Transaction ID (for online payments)","options":[],"required":false,"pdf_field":""},{"help":"Name of bank for payment","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Authorizations","fields":[{"help":"Enter full name of proposer","type":"text","label":"Proposer’s Name","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":"Sign or provide thumb impression","type":"signature","label":"Proposer’s Signature/ Thumb Impression","options":[],"required":true,"pdf_field":""},{"help":"Fill if proposer authorizes a representative or is a person with disability","type":"signature","label":"Declaration By Authorized Representative Or Person With Disability (Name, Authorization details, Signature, Witness details)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Travel insurance proposals for various plans under Travel Suraksha","attachments":["Request for authorisation form to receive Claim / Refund Payments if premium is more than ₹ 10,000/-","Prospectus/Product details from website https://generalicentralinsurance.com"],"declarations":["The proposer and insured must disclose all material facts truthfully and completely.","Policy comes into force only after full payment of premium.","Notify insurer in writing of any change in occupation or health after proposal submission and before risk acceptance.","Consent to insurer seeking medical and insurance information for underwriting and claims.","Consent to sharing proposal and medical information with government and regulatory authorities.","No undisclosed material information; false information voids policy and forfeits premium.","Consent to receive service information electronically including WhatsApp.","Information provided will be stored and used for insurance and servicing purposes.","Premium paid from legally declared income, not from proceeds of crime; insurer may verify source of funds.","Consent to process personal data as per insurer's privacy policy.","Consent to share ABHA number for medical history verification if provided.","Consent to insurer verifying KYC records from Central KYC Registry.","Consent to Bima-ASBA facility for blocking premium amount in bank account if opted."],"dropped_labels":9},"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/2769-travel-suraksha-proposal-form"}