{"id":4996,"title":"Super Star Proposal Form (Floater)","purpose":"proposal","insurer":{"slug":"star-health-and-allied-insurance","name":"Star Health & Allied Insurance Co.Ltd."},"source_pdf":"https://d28c6jni2fmamz.cloudfront.net/Super_Star_Proposal_Form_1_Floater_V1_02_12_24_63d81b2ef3.pdf","sha256":"d5a278d091986a4d42cf7d860ee8961082ac678db9e07f44838c3b4319c432fe","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is used by individuals (proposers) to apply for a floater health insurance policy covering multiple insured persons under Star Health and Allied Insurance Company Limited.","notes":["Fill the form in block letters.","Attach original or valid documents as proof.","Cash payments are not eligible for 80D tax benefits.","If nominee is minor, provide appointee details.","Use separate sheet if additional space is needed for medical details.","Beware of fraudulent calls and do not share sensitive information like OTP or passwords.","Multiple policies exceeding maximum sum insured may be cancelled ab-initio.","Refer to Annexure to Proposal Form for additional covers."],"title":"Super Star Proposal Form (Floater)","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Acknowledgement and Proposer Details","fields":[{"help":"Fill in the policy name, proposer name, payment amount, payment mode, cheque/DD number, date and bank name.","type":"text","label":"Received the proposal for ___________________________________________________________________________________________ policy from Mr/ Mrs/ Ms.__________________________________________________________________ along with payment of Rs._________________/- by Cash / vide Cheque/ DD No. ___________________________dt._________________________ drawn on _____________________________.","options":[],"required":null,"pdf_field":""},{"help":"Date of proposal submission.","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of proposal submission.","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Name and code of the person authorized to receive the proposal.","type":"text","label":"Name & Code of the authorised person","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":"Select the gender of the proposer.","type":"choice","label":"Gender","options":["Male","Female","Transgender"],"required":true,"pdf_field":""},{"help":"Select the source of income.","type":"choice","label":"Source of Income","options":["Salaried","Business","IT Returns","3mths Payslip"],"required":true,"pdf_field":""},{"help":"Enter annual income in rupees.","type":"number","label":"Annual Income (in Rs.)","options":[],"required":true,"pdf_field":""},{"help":"Enter PAN number or submit Form 60 if PAN is 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":"Select residential status.","type":"choice","label":"Residential Status","options":["Indian Resident","NRI","PIO","Foreign National"],"required":true,"pdf_field":""},{"help":"Indicate if you have a CKYC number.","type":"choice","label":"CKYC Number","options":["No","Yes"],"required":false,"pdf_field":""},{"help":"Answer if proposer or insured persons are politically exposed persons or related.","type":"yes-no","label":"Are you (Proposer) or any of the insured person is a PEP (Politically Exposed Person) or related to PEP","options":[],"required":true,"pdf_field":""},{"help":"Enter email address.","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Fill in full current address including city, district, state, country and pincode.","type":"text","label":"Current Address","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile phone number.","type":"phone","label":"Mobile Number","options":[],"required":true,"pdf_field":""},{"help":"Fill in permanent address matching address proof.","type":"text","label":"Permanent Address (should be same as address Proof)","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 government 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","Any Other Govt. Notified Document"],"required":true,"pdf_field":""},{"help":"Enter nominee's full name.","type":"text","label":"Nominee’s Name","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship to nominee.","type":"text","label":"Relationship to Nominee","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship of nominee to proposer.","type":"text","label":"Relationship to Proposer","options":[],"required":true,"pdf_field":""},{"help":"Select yes or no to receive physical policy document.","type":"yes-no","label":"Do you wish to receive the physical copy of the policy document","options":[],"required":true,"pdf_field":""},{"help":"Select one insurance repository if you do not have an e-Insurance Account number.","type":"choice","label":"If you don’t have an (elA) number, please choose any one Insurance Repository","options":["Karvy Insurance Repository Limited","CDSL Insurance Repository Limited","CAMS Insurance Repository Services Limited","NSDL National Insurance Repository (NIR)"],"required":false,"pdf_field":""},{"help":"Select yes or no to update CKYC with provided KYC details.","type":"yes-no","label":"Do you wish to update CKYC with the KYC details provided here","options":[],"required":false,"pdf_field":""},{"help":"Enter business type if applicable.","type":"text","label":"Business Type","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no if you belong to social sector classification.","type":"yes-no","label":"Do you come under below mentioned Social Sector Classification*","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no if you are an ASHA worker.","type":"yes-no","label":"Are you a ASHA worker","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no if you are a MGNREGA worker.","type":"yes-no","label":"Are you a MGNREGA worker","options":[],"required":false,"pdf_field":""},{"help":"Select the policy term in years.","type":"choice","label":"Please choose the Policy Term","options":["1yr","2yr","3yr","4yr","5yr"],"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":"Enter your existing e-Insurance Account number.","type":"text","label":"If you already have an e-Insurance Account (eIA) number, please provide","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no to pay premium in installments.","type":"yes-no","label":"Do you want to pay the premium in Instalments","options":[],"required":false,"pdf_field":""},{"help":"Select installment frequency if paying in installments.","type":"choice","label":"If yes (Please choose Instalment option)","options":["Quarterly","Halfyearly"],"required":false,"pdf_field":""},{"help":"Enter sales manager code.","type":"text","label":"SM CODE","options":[],"required":false,"pdf_field":""},{"help":"Enter sales manager name.","type":"text","label":"SM NAME","options":[],"required":false,"pdf_field":""},{"help":"Enter agent or broker code.","type":"text","label":"AGENT / CORPORATE AGENT / BROKER / IMF / POSP / CODE","options":[],"required":false,"pdf_field":""},{"help":"Enter agent or broker name.","type":"text","label":"AGENT / CORPORATE AGENT / BROKER / IMF / POSP / NAME","options":[],"required":false,"pdf_field":""},{"help":"Enter first name of proposer.","type":"text","label":"First Name","options":[],"required":true,"pdf_field":""},{"help":"Enter middle name of proposer if any.","type":"text","label":"Middle Name","options":[],"required":false,"pdf_field":""},{"help":"Enter last name of proposer.","type":"text","label":"Last Name","options":[],"required":true,"pdf_field":""},{"help":"Enter father or spouse name of proposer.","type":"text","label":"Father / Spouse Name","options":[],"required":true,"pdf_field":""},{"help":"Enter mother name of proposer.","type":"text","label":"Mother Name","options":[],"required":false,"pdf_field":""},{"help":"Sign or provide thumb impression here.","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.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details of the Proposer and Payment Details","fields":[{"help":"Enter bank name.","type":"text","label":"Name of the Bank","options":[],"required":true,"pdf_field":""},{"help":"Enter bank branch name.","type":"text","label":"Name of the Branch","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code of bank branch.","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Date of payment.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter bank account number.","type":"text","label":"Account Number","options":[],"required":true,"pdf_field":""},{"help":"Enter premium amount paid.","type":"amount","label":"Premium Amount Rs.","options":[],"required":true,"pdf_field":""},{"help":"Select type of bank account.","type":"choice","label":"Type of Account","options":["Current Account","Savings Account"],"required":true,"pdf_field":""},{"help":"Attach cancelled cheque leaf copy.","type":"attachment","label":"Payment Details (Please attach a photo copy of cancelled cheque leaf)","options":[],"required":true,"pdf_field":""},{"help":"Enter branch name again if needed.","type":"text","label":"Branch","options":[],"required":false,"pdf_field":""},{"help":"Enter cheque or demand draft number if applicable.","type":"text","label":"Cheque / DD No.","options":[],"required":false,"pdf_field":""},{"help":"Select mode of payment.","type":"choice","label":"Mode of Payment","options":["Cheque","DD","Debit Card","Credit Card","NEFT","ECS","Cash","CC Mandate","Others"],"required":true,"pdf_field":""},{"help":"Select sum insured amount on floater basis.","type":"choice","label":"Sum Insured on Floater Basis (Rs)","options":["5,00,000","7,50,000","10,00,000","15,00,000","20,00,000","50,00,000","100,00,000","Unlimited Sum Insured"],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":["Contact the office if policy is not received within 15 days from the date of payment of premium."],"applies_to":"Floater health insurance policies","attachments":["Photo of insured persons (stamp size)","Photo of proposer (passport size)","Proof of ID and Address (one government document)","Cancelled cheque leaf copy","Medical documents if any health conditions are disclosed","Insurance Agent’s Confidential Report (if any)"],"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 proposal by the insurer.","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 data with government and regulatory authorities for underwriting and claims.","Payment is made from proposer’s own bank account and source of funds is legal; no third-party payments allowed.","The proposer consents to receive communications from the insurer and acknowledges privacy policy.","Concealment, misdeclaration or non-disclosure will render the policy void and claims will be denied.","The insurer reserves the right to not renew the policy in case of fraud or misrepresentation.","The proposer agrees to professional conduct and understands consequences of unprofessional behavior.","The proposer authorizes premium deduction from the given bank account."],"dropped_labels":18},"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/4996-super-star-proposal-form-floater"}