{"id":5004,"title":"Star Domestic Travel Insurance Policy","purpose":"proposal","insurer":{"slug":"star-health-and-allied-insurance","name":"Star Health & Allied Insurance Co.Ltd."},"source_pdf":"https://d28c6jni2fmamz.cloudfront.net/Proposal_Form_Star_Domestic_Travel_Insurance_Policy_V_2_Web_1e43e85441.pdf","sha256":"58d7a388a84da0d02f1712c1c3dd17db2a89bba686f38c26fbcca58602f144ef","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is a proposal form to apply for the Star Domestic Travel Insurance Policy. It is filled by the proposer who wishes to insure themselves and/or other persons for domestic travel insurance coverage.","notes":["Fill the form in block letters.","Attach original or valid proofs as specified.","Cash payments are not eligible for 80D tax benefits.","If nominee is minor, provide appointee name.","If any health question is answered Yes, provide detailed information and attach separate sheet if needed.","Use the specified formats for dates (DD/MM/YYYY).","Attach photographs as specified.","Provide PAN number or submit Form 60 if PAN is not available.","Beware of fraudulent calls or emails asking for personal information.","Multiple policies exceeding maximum sum insured may be cancelled by the company."],"title":"Star Domestic Travel Insurance Policy","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Proposal Form No.:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Star Domestic Travel Insurance Policy - Unique Reference No.: SHAI/PR0076","options":[],"required":null,"pdf_field":""},{"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":"Select 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":["No","Yes"],"required":null,"pdf_field":""},{"help":"Fill address line 1, city/town/village, district, state, country and pincode","type":"text","label":"Current Address","options":[],"required":true,"pdf_field":""},{"help":"Enter valid mobile number","type":"phone","label":"Mobile Number","options":[],"required":true,"pdf_field":""},{"help":"Optional alternate mobile number","type":"phone","label":"Alternate Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Attach one valid ID and address proof from the listed options","type":"choice","label":"Please attach any one proof in support of ID and Address","options":["Voter ID","Driving License (with Expiry Date)","Aadhar Card","Passport (with Expiry Date)","NREGA Job Card"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you wish to receive the physical copy of the policy document","options":["Yes","No"],"required":null,"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","type":"yes-no","label":"Do you wish to update CKYC with the KYC details provided here","options":["No","Yes"],"required":null,"pdf_field":""},{"help":"Fill your business type","type":"text","label":"Business Type","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you come under below mentioned Social Sector Classification*","options":["No","Yes"],"required":null,"pdf_field":""},{"help":"Tick all applicable categories","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":"Fill 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":"Provide your existing eIA number","type":"text","label":"If you already have an e-Insurance Account (eIA) number, please provide","options":[],"required":false,"pdf_field":""},{"help":"Fill father's or spouse's name","type":"text","label":"Father/Spouse Name","options":[],"required":true,"pdf_field":""},{"help":"Fill mother's name","type":"text","label":"Mother Name","options":[],"required":false,"pdf_field":""},{"help":"Fill additional address details","type":"text","label":"Address line 2","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":"Fill place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Fill date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details of the Proposer","fields":[{"help":"Fill bank name","type":"text","label":"Name of the Bank","options":[],"required":true,"pdf_field":""},{"help":"Fill branch name","type":"text","label":"Name of the Branch","options":[],"required":true,"pdf_field":""},{"help":"Fill IFSC code of bank branch","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Fill 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":"Specify if account type is Others","type":"text","label":"Others Please Specify","options":[],"required":false,"pdf_field":""},{"help":"Fill date in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Attach cancelled cheque leaf photocopy","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":"Fill premium amount in rupees","type":"amount","label":"Premium Amount Rs.","options":[],"required":true,"pdf_field":""},{"help":"Select mode of payment (Cash payments are not eligible for 80D tax benefits)","type":"choice","label":"Mode of Payment","options":["Cheque","DD","Debit Card","Credit Card","NEFT","ECS","Cash"],"required":true,"pdf_field":""},{"help":"Fill branch name for cheque/DD","type":"text","label":"Branch","options":[],"required":false,"pdf_field":""},{"help":"Fill cheque or DD number","type":"text","label":"Cheque / DD No.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of the Person Proposed for Insurance","fields":[{"help":"Fill sum insured amount opted","type":"amount","label":"Sum Insured Opted (Please check brochure for Sum Insured)","options":[],"required":true,"pdf_field":""},{"help":"Provide details of existing insurance coverage if any","type":"text","label":"Existing Insurance Coverage with us and/or any other company - give details: 1. Name of the Insurance Company and Policy No., 2. Period of Insurance, 3. Sum Insured (Rs)","options":[],"required":false,"pdf_field":""},{"help":"Provide claim details if any","type":"text","label":"Details of Claims: 1. Ailment for which Claim was made, Year, 2. Claim Amount Paid / Rejected","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Have you ever been declined health insurance coverage due to a diagnosis of a health condition?","options":["No","Yes"],"required":null,"pdf_field":""},{"help":"Select one plan option","type":"choice","label":"Plan Options","options":["Silver Plan","Gold Plan","Platinum Plan"],"required":true,"pdf_field":""},{"help":"Select mode of transport","type":"choice","label":"Mode of Transport","options":["Air","Rail","Road (Common Carrier)","Multi Mode (available only for Multi Trip)"],"required":true,"pdf_field":""},{"help":"Fill journey details if applicable","type":"text","label":"Journey details (applicable only for Single and Round Trip): Place of Departure, Place of Arrival, Departure Date, Arrival Date","options":[],"required":false,"pdf_field":""},{"help":"Select applicable trip and duration for Air transport","type":"choice","label":"Selection of Trip and Duration – Mode of Transport - Air","options":["Single Trip","Round Trip","Multi Trip","1 day","2 days","1-7 days","8-15 days","16-30 days","Upto 30 days per trip","Upto 45 days per trip","Upto 60 days per trip"],"required":false,"pdf_field":""},{"help":"Select applicable trip and duration for Rail transport","type":"choice","label":"Selection of Trip and Duration – Mode of Transport - Rail","options":["Single Trip","Round Trip","Multi Trip","1 day","2-3 days","4-7 days","1-7 days","8-15 days","16-30 days","Upto 30 days per trip","Upto 45 days per trip","Upto 60 days per trip"],"required":false,"pdf_field":""},{"help":"Select applicable trip and duration for Road transport","type":"choice","label":"Selection of Trip and Duration – Mode of Transport – Road (Common Carrier)","options":["Single Trip","Round Trip","Multi Trip","1 day","2-3 days","4-7 days","1-7 days","8-15 days","16-30 days","Upto 30 days per trip","Upto 45 days per trip","Upto 60 days per trip"],"required":false,"pdf_field":""},{"help":"Select applicable trip duration for Multi Mode transport","type":"choice","label":"Selection of Trip and Duration – Mode of Transport – Multi Mode","options":["Upto 30 days per trip","Upto 45 days per trip","Upto 60 days per trip"],"required":false,"pdf_field":""},{"help":"Answer health history questions 1 to 8 in detail; attach separate sheet if needed","type":"text","label":"Health History: Please provide detailed, response-specific diagnosis and treatment. A mere dash is not sufficient","options":[],"required":true,"pdf_field":""},{"help":"Fill family physician's name","type":"text","label":"Family Physician's Name","options":[],"required":false,"pdf_field":""},{"help":"Fill family physician's phone number","type":"phone","label":"Phone","options":[],"required":false,"pdf_field":""},{"help":"Fill family physician's registration number","type":"text","label":"Regn No","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Signature","fields":[{"help":"Agent/intermediary confirms product suitability and truthfulness of information","type":"text","label":"Declaration of the Agent / Intermediary","options":[],"required":true,"pdf_field":""},{"help":"Date of agent's declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Agent code","type":"text","label":"Code","options":[],"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":"Star Domestic Travel Insurance Policy","attachments":["One proof in support of ID and Address (Voter ID, Driving License, Aadhar Card, Passport, NREGA Job Card)","Annexure to Proposal Form (Nomination Form)","Photograph of the Proposer","Photograph of each Insured Person (stamp size)","Photo copy of cancelled cheque leaf"],"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 by the insurer.","The proposer will notify any change in occupation or health before risk acceptance.","The insurer is authorized to seek medical and insurance information for underwriting and claim settlement.","The proposer consents to sharing of information with government and regulatory authorities and service providers.","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 consents to premium deduction from the given bank account and confirms source of funds is legal.","The proposer agrees to receive communications electronically and consents to the company’s privacy policy.","The proposer agrees to professional conduct and understands consequences of unprofessional behavior."],"dropped_labels":8},"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/5004-star-domestic-travel-insurance-policy"}