{"id":5001,"title":"Nomination Form","purpose":"service","insurer":{"slug":"star-health-and-allied-insurance","name":"Star Health & Allied Insurance Co.Ltd."},"source_pdf":"https://d28c6jni2fmamz.cloudfront.net/Annexure_for_Proposal_form_712b95056b.pdf","sha256":"d4e7b9c8e5bc225d9659f3f438e66abf10ac808e77e804fe3689868503498859","pages":1,"collected":"2026-10-20","instructions":{"about":"This form is used by the proposer (policyholder) to nominate a person who will receive the policy benefits in case of the proposer's death.","notes":[],"title":"Nomination Form","submit":{"to":"","how":"","address":""},"purpose":"service","sections":[{"title":"Nominee Details","fields":[{"help":"","type":"text","label":"Name of the Proposer as per the Proposal form","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nominee Name","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth in DD/MM/YYYY format and age in years","type":"date","label":"Date of Birth and Age","options":[],"required":null,"pdf_field":""},{"help":"Age in years","type":"number","label":"Age","options":[],"required":null,"pdf_field":""},{"help":"Specify the relationship of the nominee to the proposer","type":"text","label":"Relationship to Proposer","options":[],"required":null,"pdf_field":""},{"help":"Current address of the nominee","type":"text","label":"Nominee Present Address","options":[],"required":null,"pdf_field":""},{"help":"Permanent address of the nominee","type":"text","label":"Nominee Permanent Address","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number of the nominee","type":"phone","label":"Nominee Mobile number","options":[],"required":null,"pdf_field":""},{"help":"Email address of the nominee (optional)","type":"email","label":"Nominee Email id","options":[],"required":false,"pdf_field":""},{"help":"Bank account number of the nominee","type":"text","label":"Nominee’s Bank Account number","options":[],"required":null,"pdf_field":""},{"help":"Type of bank account (e.g. Savings, Current)","type":"text","label":"Type of Account","options":[],"required":null,"pdf_field":""},{"help":"Name of the bank where nominee holds account","type":"text","label":"Name of the Bank","options":[],"required":null,"pdf_field":""},{"help":"Branch name of the bank","type":"text","label":"Name of the Branch","options":[],"required":null,"pdf_field":""},{"help":"IFSC code of the bank branch","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Appointee Details (if Nominee is a minor)","fields":[{"help":"Name of the person appointed to receive benefits on behalf of minor nominee","type":"text","label":"Name of the Appointee (if Nominee is a minor)","options":[],"required":null,"pdf_field":""},{"help":"Relationship of the appointee to the nominee","type":"text","label":"Relationship to Nominee","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth in DD/MM/YYYY format and age in years","type":"date","label":"Date of Birth and Age of the Appointee","options":[],"required":null,"pdf_field":""},{"help":"Age in years","type":"number","label":"Age","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Signature","fields":[{"help":"Sign or put thumb impression here","type":"signature","label":"Signature/ Thumb Impression of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"Place where the form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter the proposal form number","type":"text","label":"Proposal Form No.","options":[],"required":null,"pdf_field":""},{"help":"Name of the proposer","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Date of signing the form","type":"date","label":"Date","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"","attachments":[],"declarations":[],"dropped_labels":0},"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/5001-nomination-form"}