{"id":4995,"title":"Star Women Care Insurance Policy - SHAI/PR0069","purpose":"proposal","insurer":{"slug":"star-health-and-allied-insurance","name":"Star Health & Allied Insurance Co.Ltd."},"source_pdf":"https://d28c6jni2fmamz.cloudfront.net/Proposal_Form_aeff10b821.pdf","sha256":"10d59c5e7a6b08c963da9942f59415ae9cb72614a3069807a74b49e9d785d683","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is a proposal form to apply for the Star Women Care Insurance Policy and related health insurance products. It is filled by the proposer (applicant) and includes details of the insured persons, health history, and payment information.","notes":["Fill the form in block letters.","Attach original or valid documents as proof where required.","Use the prescribed format for dates (DD/MM/YYYY).","Attach all required photographs and documents.","Original bills and documents may be required for claims (not applicable here but general note).","Beware of fraudulent calls and do not share sensitive information like OTP, passwords, CVV.","If proposer is illiterate or signs in a different language, details must be explained and signed by a witness.","Nomination form annexure is mandatory.","PAN card copy or Form 60 is mandatory unless CKYC number is provided.","Cash payments are not eligible for 80D tax benefits.","Policy will not be on risk until proposal is accepted and premium is fully paid."],"title":"Star Women Care Insurance Policy - SHAI/PR0069","submit":{"to":"Star Health and Allied Insurance Company Limited office or as directed by the company","how":"post / in person / as per company instructions","address":"Registered Office: No.1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai-600034"},"purpose":"proposal","sections":[{"title":"Acknowledgement and Declaration","fields":[{"help":"Enter the name of the proposer","type":"text","label":"Received the proposal for policy from Mr/ Mrs/ Ms.","options":[],"required":null,"pdf_field":""},{"help":"Enter the amount paid","type":"amount","label":"payment of Rs.","options":[],"required":null,"pdf_field":""},{"help":"Specify payment mode and cheque/DD number if applicable","type":"text","label":"by Cash / vide Cheque/ DD No.","options":[],"required":null,"pdf_field":""},{"help":"Date of cheque/DD","type":"date","label":"dt.","options":[],"required":null,"pdf_field":""},{"help":"Bank name on which cheque/DD is drawn","type":"text","label":"drawn on","options":[],"required":null,"pdf_field":""},{"help":"Date of acknowledgement","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of acknowledgement","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Name and code of company official acknowledging receipt","type":"text","label":"Name & Code of the authorised person","options":[],"required":null,"pdf_field":""},{"help":"Signature of company official","type":"signature","label":"Signature of the authorised person","options":[],"required":null,"pdf_field":""},{"help":"Proposal form number if any","type":"text","label":"Proposal Form No.","options":[],"required":null,"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":"proposer"},{"title":"Proposer Details","fields":[{"help":"Enter first name","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","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":"Enter date of birth in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female","Transgender"],"required":true,"pdf_field":""},{"help":"Select residential status","type":"choice","label":"Residential Status","options":["Indian Resident","NRI","PIO","Foreign National"],"required":true,"pdf_field":""},{"help":"Enter occupation","type":"text","label":"Occupation","options":[],"required":true,"pdf_field":""},{"help":"Enter annual income","type":"amount","label":"Annual Income (in Rs.)","options":[],"required":false,"pdf_field":""},{"help":"Specify source of income","type":"text","label":"Source of Income","options":[],"required":false,"pdf_field":""},{"help":"Enter PAN number or submit Form 60 if not available","type":"text","label":"PAN Number","options":[],"required":true,"pdf_field":""},{"help":"Enter GST number if applicable","type":"text","label":"GST Number","options":[],"required":false,"pdf_field":""},{"help":"Enter CKYC number if available","type":"text","label":"CKYC Number","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile Number","options":[],"required":true,"pdf_field":""},{"help":"Enter alternate mobile number if any","type":"phone","label":"Alternate Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter current address line 1","type":"text","label":"Current Address - Address line 1","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":"Attach one valid ID and address proof","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","Any Other Govt. Notified Document"],"required":true,"pdf_field":""},{"help":"Enter nominee's name","type":"text","label":"Nominee’s Name","options":[],"required":true,"pdf_field":""},{"help":"Enter relationship to nominee","type":"text","label":"Relationship to Nominee","options":[],"required":true,"pdf_field":""},{"help":"Enter relationship to proposer","type":"text","label":"Relationship to Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter appointee's name if nominee is minor","type":"text","label":"Name of the Appointee (if nominee is a minor)","options":[],"required":false,"pdf_field":""},{"help":"Select if you want physical copy of policy","type":"choice","label":"Do you wish to receive the physical copy of the policy document","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter eIA number if available","type":"text","label":"If you already have an e-Insurance Account (eIA) number, please provide","options":[],"required":false,"pdf_field":""},{"help":"Select if you want to update CKYC","type":"choice","label":"Do you wish to update CKYC with the KYC details provided here","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if premium payment in instalments is desired","type":"choice","label":"Do you want to pay the premium in Instalments","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select instalment frequency","type":"choice","label":"If yes (Please choose Instalment option)","options":["Quarterly","Halfyearly"],"required":false,"pdf_field":""},{"help":"Select policy term","type":"choice","label":"Policy Term Opted","options":["1 yr","2 yrs","3 yrs"],"required":true,"pdf_field":""},{"help":"Select business type","type":"choice","label":"Business Type","options":["Salaried","Business","Others"],"required":false,"pdf_field":""},{"help":"Select if you belong to social sector classification","type":"choice","label":"Do you come under below mentioned Social Sector Classification*","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Tick applicable social sector categories","type":"checkbox","label":"If Yes (please tick)","options":["Unorganized Sector","Economically Vulnerable or Backward Classes","Other Categories of Persons","Informal Sector"],"required":false,"pdf_field":""},{"help":"Select if ASHA worker","type":"choice","label":"Are you a ASHA worker","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if MGNREGA worker","type":"choice","label":"Are you a MGNREGA worker","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy and Payment Details","fields":[{"help":"Select policy type","type":"choice","label":"Policy Type (Please )","options":["Individual","Floater"],"required":true,"pdf_field":""},{"help":"Enter sum insured amount in lakhs for floater","type":"number","label":"Sum Insured on Floater Basis in Lakhs","options":[],"required":false,"pdf_field":""},{"help":"Enter bank branch name","type":"text","label":"Name of the Branch","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 IFSC code","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Enter premium amount","type":"amount","label":"Premium Amount Rs.","options":[],"required":true,"pdf_field":""},{"help":"Enter branch where payment was made","type":"text","label":"Payment Details - Branch","options":[],"required":false,"pdf_field":""},{"help":"Enter cheque or DD number if applicable","type":"text","label":"Cheque / DD No.","options":[],"required":false,"pdf_field":""},{"help":"Attach cancelled cheque copy","type":"attachment","label":"Please attach a photo copy of cancelled cheque leaf","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 family size composition","type":"text","label":"Family Size (A=Adult, C=Child)","options":[],"required":true,"pdf_field":""},{"help":"Enter number of parents or parents-in-law included","type":"number","label":"Number of Parents / Parents-in-law (as part of the same floater sum insured)","options":[],"required":false,"pdf_field":""},{"help":"Select if deductible option is desired","type":"choice","label":"Do you wish to choose Deductible option","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select deductible amount","type":"choice","label":"If yes, choose Deductible Option","options":["Rs.25,000/-","Rs.50,000/-","Rs.1,00,000/-"],"required":false,"pdf_field":""},{"help":"Select if optional cover is desired","type":"choice","label":"Do you want to opt for Optional Cover","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select optional cover type","type":"choice","label":"If yes, choose anyone option","options":["Reduction of Co-pay","Waiver of Co-pay"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of the Person(s) Proposed for Insurance","fields":[{"help":"Enter name of each insured person","type":"table","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Select gender for each insured person","type":"table","label":"Gender","options":["M","F","Transgender"],"required":true,"pdf_field":""},{"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":"Enter relationship to proposer","type":"table","label":"Relationship with proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter occupation","type":"table","label":"Occupation","options":[],"required":false,"pdf_field":""},{"help":"Enter annual income","type":"table","label":"Annual Income (Rs.)","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured for individual policy","type":"table","label":"Sum Insured Opted (For Individual Policy) (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":"Select if optional cover is desired for female insured persons","type":"table","label":"Applicable for Star Women Care Insurance Policy - Do you want optional Cover (Applicable only for Females)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter sum insured for optional cover","type":"table","label":"If yes, Please mention Sum Insured Opted (Rs.) for Optional Cover","options":[],"required":false,"pdf_field":""},{"help":"Select deductible option for each insured person","type":"table","label":"Applicable for Star Health Assure Insurance Policy (Individual Policy) - Do you wish to choose Deductible option","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select deductible amount for each insured person","type":"table","label":"If yes, choose deductible (Rs.)","options":["Rs.50,000/-","Rs.1,00,000/-"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Existing Insurance Coverage and Claims Details","fields":[{"help":"Enter name of insurance company for existing policies","type":"table","label":"Name of the Insurance Company","options":[],"required":false,"pdf_field":""},{"help":"Enter insurance period","type":"table","label":"Period of Insurance","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount","type":"table","label":"Sum Insured (Rs)","options":[],"required":false,"pdf_field":""},{"help":"Enter policy number","type":"table","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Enter ailment details for claims made","type":"table","label":"Ailment for which Claim was made","options":[],"required":false,"pdf_field":""},{"help":"Enter claim amount paid or rejected","type":"table","label":"Claim Amount Paid / Rejected","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Health History","fields":[{"help":"Answer yes or no and provide details if no","type":"yes-no","label":"Is the person proposed for insurance in good health free from physical and mental disease or infirmity. If not give details","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer yes or no and provide details if yes","type":"yes-no","label":"Has the person proposed for insurance consulted / diagnosed / taken treatment / been admitted for any illness / injury. If yes, give details","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer yes or no and attach documents if yes","type":"yes-no","label":"Does the person proposed for insurance have any complications during / following birth. If yes, please submit all necessary documents.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer yes or no and provide scan reports if yes","type":"yes-no","label":"Whether the insured person is pregnant if yes, kindly provide duration of pregnancy and scan reports.","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Answer yes or no and provide detailed diagnosis and treatment if yes","type":"yes-no","label":"Has the person proposed for insurance ever suffered or suffering from any of the following (Diabetes Mellitus, High BP/Cholesterol, Thyroid disorders, Heart and vascular disease, Stroke, epilepsy, respiratory diseases, bone/joint diseases, arthritis, gynecological disorders, sub-fertility, stomach/kidney/prostate/eye diseases, cancer, blood disorders, autoimmune diseases, other health problems)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer yes or no and provide details if yes","type":"yes-no","label":"Does the person proposed for insurance have any of the mentioned habits (Chew Tobacco, Smoke, Consume Alcohol). If yes, since when and details of any related disease/complications","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer yes or no and provide medical details if yes","type":"yes-no","label":"Is the person proposed for insurance positive for HIV, Hepatitis B/C. If yes, mention duration/date of diagnosis, medication details, CD4 count and Viral load (attach proof)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"List medical documents submitted","type":"text","label":"Type and the total number of medical documents provided","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Specific Questions for Female Insured Persons (Star Women Care Insurance Policy)","fields":[{"help":"Answer yes or no and attach scan reports if yes","type":"yes-no","label":"Is the person proposed for insurance presently pregnant? (If Yes, please submit the scan reports taken during 12th and 20th week of Pregnancy period and mention the expected date of delivery)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Any complaint of Diabetes, Hypertension or any complication during current or earlier pregnancy?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Has the person proposed for insurance ever undergone hysterectomy or had any disease of uterus, cervix or ovaries?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"History of Oocyte donation, if any","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"History of Surrogacy, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration of the Agent / Intermediary","fields":[{"help":"Date of declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Agent or intermediary code","type":"text","label":"Code","options":[],"required":true,"pdf_field":""}],"filled_by":"agent"}],"deadlines":["Contact the office if policy is not received within 15 days from the date of payment of premium"],"applies_to":"Star Women Care Insurance Policy and related health insurance policies including Star Health Assure and Star Health Premier Insurance Policies","attachments":["Stamp size photographs of insured persons","Passport size photograph of proposer","Photo copy of cancelled cheque leaf","Proof of ID and Address (Voter ID, Driving License, Aadhar Card, Passport, NREGA Job Card, or other government notified document)","Scan reports for pregnancy (if applicable)","Medical documents related to health history"],"declarations":["The proposer declares that all information given is true and complete to the best of their knowledge.","The policy will come into force only after full payment of 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 other information for underwriting and claims.","The proposer consents to sharing information with government and regulatory authorities as required.","Concealment or misrepresentation will render the policy void and claims will not be payable.","The company reserves the right to not renew the policy in case of fraud or non-disclosure.","The proposer consents to electronic communication and overrides any NCPR registration.","The proposer confirms payment source is legal and no third-party payments are allowed.","The proposer agrees to professional conduct standards in communications with the company.","The proposer authorizes premium deduction from the given bank account."],"dropped_labels":29},"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/4995-star-women-care-insurance-policy-shai-pr0069"}