{"id":4988,"title":"Star Micro Rural And Farmers Care Proposal Form","purpose":"proposal","insurer":{"slug":"star-health-and-allied-insurance","name":"Star Health & Allied Insurance Co.Ltd."},"source_pdf":"https://d28c6jni2fmamz.cloudfront.net/3_Proposal_Form_Star_Micro_Rural_And_Farmers_Care_V_12_Web_06b97ba74a.pdf","sha256":"5fb3e8174f621c12361f2052d5932cf3cb70416595cab676f9cd4f171c82289e","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by individuals (proposers) to apply for the Star Micro Rural And Farmers Care insurance policy by providing personal, health, and payment details.","notes":["Fill the form in block letters.","Use original and valid documents for ID and address proof.","Attach all required photographs and nomination form.","Cash payments are not eligible for 80D tax benefits.","If PAN number is not available, submit Form 60.","No third-party payments are allowed; source of funds must be legal.","Beware of fraudulent calls and do not share sensitive information like OTP or passwords.","The proposal form must be filled honestly and completely to avoid policy invalidation."],"title":"Star Micro Rural And Farmers Care Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Ref. No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Business Type","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Do you come under below mentioned Social Sector Classification*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Are you a ASHA worker","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Are you a MGNREGA worker","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick applicable categories if Yes to Social Sector Classification","type":"checkbox","label":"If Yes (please tick)","options":["Unorganized Sector","Economically Vulnerable or Backward Classes","Other Categories of Persons","Informal Sector"],"required":null,"pdf_field":""},{"help":"Enter first name in block letters","type":"text","label":"First Name","options":[],"required":true,"pdf_field":""},{"help":"Enter middle name if any","type":"text","label":"Middle Name","options":[],"required":false,"pdf_field":""},{"help":"Enter last name in block letters","type":"text","label":"Last Name","options":[],"required":true,"pdf_field":""},{"help":"Enter father's or spouse's name","type":"text","label":"Father / Spouse Name","options":[],"required":true,"pdf_field":""},{"help":"Enter mother's name","type":"text","label":"Mother Name","options":[],"required":false,"pdf_field":""},{"help":"Sign or provide thumb impression","type":"signature","label":"Signature / Thumb impression of the proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Fill amount, cheque/DD number, date and bank name","type":"text","label":"Payment of Rs._______________________________ by cash/vide cheque/DD no.________________________dated ______________________________ drawn on ____________________","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Are you (Proposer) or any of the insured person is a PEP (Politically Exposed Person) or related to PEP","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter current address line 1","type":"text","label":"Current Address - Address line 1","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile Number","options":[],"required":true,"pdf_field":""},{"help":"Enter permanent address line 1","type":"text","label":"Permanent Address (should be same as address Proof) - Address line 1","options":[],"required":true,"pdf_field":""},{"help":"Enter alternate mobile number if any","type":"phone","label":"Alternate Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Attach one valid ID and address proof document","type":"choice","label":"Please attach any one proof in support of ID and Address","options":["Voter ID","Driving License","Aadhar Card","Passport","NREGA Job Card"],"required":true,"pdf_field":""},{"help":"Enter full name of nominee","type":"text","label":"Nominee’s Name","options":[],"required":true,"pdf_field":""},{"help":"Enter relationship of nominee to proposer","type":"text","label":"Relationship to Nominee","options":[],"required":true,"pdf_field":""},{"help":"Enter relationship of nominee to proposer","type":"text","label":"Relationship to Proposer","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Do you wish to receive the physical copy of the policy document","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter name of appointee if nominee is minor","type":"text","label":"Name of the Appointee (if nominee is a minor)","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"I would like to receive my insurance policy and all the information related to the proposed insurance policy through insurance repository","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter existing eIA number if any","type":"text","label":"If you already have an e-Insurance Account (eIA) number, please provide","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Do you want to pay the premium in Instalments","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select instalment frequency if paying in instalments","type":"choice","label":"If yes (Please choose Instalment option)","options":["Quarterly","Halfyearly"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Proposer and Agent Details","fields":[{"help":"Enter PAN number of Point of Sale Person","type":"text","label":"POSP PAN NUMBER","options":[],"required":null,"pdf_field":""},{"help":"Enter GST number of Point of Sale Person","type":"text","label":"POSP GST NUMBER","options":[],"required":null,"pdf_field":""},{"help":"Enter Sales Manager code","type":"text","label":"SM CODE","options":[],"required":null,"pdf_field":""},{"help":"Enter Sales Manager name","type":"text","label":"SM NAME","options":[],"required":null,"pdf_field":""},{"help":"Enter agent or broker code","type":"text","label":"AGENT / CORPORATE AGENT / BROKER / IMF / POSP / MICRO AGENT CODE","options":[],"required":null,"pdf_field":""},{"help":"Enter agent or broker name","type":"text","label":"AGENT / CORPORATE AGENT / BROKER / IMF / POSP / MICRO AGENT NAME","options":[],"required":null,"pdf_field":""}],"filled_by":"agent / intermediary"},{"title":"Details of the person proposed for insurance","fields":[{"help":"Enter date of birth for each insured person","type":"table","label":"Date of Birth (DD/MM/YYYY)","options":[],"required":true,"pdf_field":""},{"help":"Enter height in centimeters","type":"table","label":"Height (cms)","options":[],"required":false,"pdf_field":""},{"help":"Enter weight in kilograms","type":"table","label":"Weight (kgs)","options":[],"required":false,"pdf_field":""},{"help":"Specify relationship of each insured person to proposer","type":"table","label":"Relationship with proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter occupation of each insured person","type":"table","label":"Occupation","options":[],"required":true,"pdf_field":""},{"help":"Enter annual income in rupees","type":"table","label":"Annual Income (Rs.)","options":[],"required":false,"pdf_field":""},{"help":"Enter ABHA number if available","type":"table","label":"Ayushman Bharat Health Account (ABHA) No.","options":[],"required":false,"pdf_field":""},{"help":"Provide insurance company name, period, sum insured, and policy number for each existing policy","type":"table","label":"Existing Insurance Coverage with us and/or any other company give details","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Have you ever been declined health insurance coverage due to a diagnosis of a health condition?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide detailed health history; a dash is not sufficient","type":"text","label":"Health History: Please provide detailed, response-specific diagnosis and treatment.","options":[],"required":true,"pdf_field":""},{"help":"Provide health status details","type":"text","label":"Is the person proposed for insurance in good health free from physical and mental disease or infirmity. If not give details","options":[],"required":true,"pdf_field":""},{"help":"Enter family physician's name","type":"text","label":"Family Physician's Name","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details of the Proposer","fields":[{"help":"Enter bank name","type":"text","label":"Name of the Bank","options":[],"required":true,"pdf_field":""},{"help":"Enter branch name","type":"text","label":"Name of the Branch","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Account Number","options":[],"required":true,"pdf_field":""},{"help":"Select account type","type":"choice","label":"Type of Account","options":["Current Account","Savings Account","Others"],"required":true,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Attach cancelled cheque copy","type":"attachment","label":"Please attach a photo copy of cancelled cheque leaf","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Enter premium amount in rupees","type":"amount","label":"Premium Amount Rs.","options":[],"required":true,"pdf_field":""},{"help":"Select mode of payment","type":"choice","label":"Mode of Payment","options":["Cheque","DD","Debit Card","Credit Card","NEFT","ECS","Cash"],"required":true,"pdf_field":""},{"help":"Enter branch name for cheque/DD","type":"text","label":"Branch","options":[],"required":false,"pdf_field":""},{"help":"Enter cheque or DD number","type":"text","label":"Cheque / DD No.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Agent / Intermediary Declaration","fields":[{"help":"Enter date of declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter agent code","type":"text","label":"Code","options":[],"required":true,"pdf_field":""}],"filled_by":"agent / intermediary"}],"deadlines":["Contact our office in case policy is not received within 15 days from the date of payment of premium"],"applies_to":"Star Micro Rural And Farmers Care policy proposals","attachments":["Passport size photograph of the Proposer","Stamp size photograph of each Insured Person","Annexure to Proposal Form (Nomination Form)","Photo copy of cancelled cheque leaf"],"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 the premium and acceptance of the proposal.","The proposer will notify any change in occupation or health before risk acceptance.","The company may seek medical and insurance information for underwriting and claim settlement.","The proposer consents to sharing information with government and regulatory authorities and service providers.","Concealment or misrepresentation will render the policy void and claims will be denied.","The company reserves the right to not renew the policy in case of fraud or non-disclosure.","The proposer consents to premium deduction from the given bank account.","The proposer authorizes the company to contact them for service-related purposes overriding NCPR.","The proposer agrees to receive policy documents electronically to support a greener environment.","The proposer acknowledges the company’s privacy policy and agrees to professional conduct in communications."],"dropped_labels":30},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"044-69006900","label":"24 hours help-line","level":null,"hours":"24 hours","applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"xv) For assistance call 24 hours help-line 044-69006900 or Toll Free No. 1800 425 2255, Senior Citizens may call at 044-40020888 For the comprehensive list of documents to be","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800 425 2255","label":"Toll Free No.","level":null,"hours":"24 hours","applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"xv) For assistance call 24 hours help-line 044-69006900 or Toll Free No. 1800 425 2255, Senior Citizens may call at 044-40020888 For the comprehensive list of documents to be submitted while filing a reimbu","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"4th Floor, Balaji Complex, No.15, Whites Lane, Whites Road, Royapettah, Chennai-600014","label":"Grievance Redressal Officer postal address","level":1,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"tarhealth.in, grievances@starhealth.in\nPh. No. | : 044-69006900\nSenior Citizens may call at 044-69007500 Courier/Post : 4th Floor, Balaji Complex, No.15, Whites Lane, Whites Road, Royapettah, Chennai-600014 lnsured person may also approach the grievance cell at any of the Company’s branches with the details of grievance. If","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"gro@starhealth.in","label":"Grievance Redressal Officer","level":1,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"e: In case of any grievance the Insured Person may contact the Company through\nWebsite | : www.starhealth.in\nE-mail | : gro@starhealth.in, grievances@starhealth.in\nPh. No. | : 044-69006900\nSenior Citizens may call at 044-69007500 Courier/Post : 4th Floor, B","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"grievances@starhealth.in","label":"Grievance Redressal Officer","level":1,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"rievance the Insured Person may contact the Company through\nWebsite | : www.starhealth.in\nE-mail | : gro@starhealth.in, grievances@starhealth.in\nPh. No. | : 044-69006900\nSenior Citizens may call at 044-69007500 Courier/Post : 4th Floor, Balaji Complex, No.15, Whit","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"044-69006900","label":"Grievance Redressal Officer","level":1,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"xv) For assistance call 24 hours help-line 044-69006900 or Toll Free No. 1800 425 2255, Senior Citizens may call at 044-40020888 For the comprehensive list of documents to be","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"044-43664600","label":"Grievance Officer","level":2,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Prospectus_Super_Star_V_1_without_Premium_Chart_Single_Page_25b70db850.pdf","quote":"d with the redressal of grievance through one of the above methods, Insured Person may contact the grievance officer at 044-43664600.","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"https://www.starhealth.in/grievance-redressal","label":"Updated details of grievance officer","level":null,"hours":null,"applies_to":"all","source_url":"https://d28c6jni2fmamz.cloudfront.net/Policy_Star_Health_Assure_Insurance_Policy_V_9_c53663e68a.pdf","quote":"rson may contact the grievance officer at 044-43664600. For updated details of grievance officer, kindly refer the link https://www.starhealth.in/grievance-redressal If Insured Person is not satisfied with the redressal of grievance through above methods, the Insured Person may also a","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/star-health-and-allied-insurance/4988-star-micro-rural-and-farmers-care-proposal-form"}