{"id":5009,"title":"Common Proposal Form For Overseas Travel Insurance","purpose":"proposal","insurer":{"slug":"star-health-and-allied-insurance","name":"Star Health & Allied Insurance Co.Ltd."},"source_pdf":"https://d28c6jni2fmamz.cloudfront.net/Common_Proposal_Form_for_Overseas_Travel_Insurance_V_9_Web_4ceccf4fd0.pdf","sha256":"d2cc635a700714697de479f7f9b394d0f53daf83e5cb2f2672e728a619c5a601","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is used by individuals (proposers) applying for overseas travel insurance with Star Health and Allied Insurance Company Limited. The proposer fills it to provide personal, health, travel, and payment details for insurance coverage.","notes":["Fill the form in block letters.","Attach original or valid proofs as specified.","Use the annexure for nomination details if multiple nominees.","Cash payments are not eligible for 80D tax benefits.","Beware of fraudulent calls and never share sensitive information like OTP or passwords.","The proposal form must be filled honestly and completely to avoid policy invalidation.","Photographs required: passport size for proposer, stamp size for insured persons.","Medical history must be detailed; a dash is not sufficient.","Medical fitness certificate mandatory for persons above 65 years or with heart ailments.","Attach all required documents including proof of income, ID, and address.","The receipt of payment does not mean acceptance of risk until policy is issued."],"title":"Common Proposal Form For Overseas Travel Insurance","submit":{"to":"Star Health and Allied Insurance Company Limited","how":"","address":"Registered Office: No. 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai - 600 034"},"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":"Select Yes if applicable","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":"Full overseas address","type":"text","label":"Overseas Address - Address line 1","options":[],"required":true,"pdf_field":""},{"help":"Mobile number while overseas","type":"phone","label":"Overseas Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"Permanent address in India","type":"text","label":"Permanent Address (should be same as address Proof) - Address line 1","options":[],"required":true,"pdf_field":""},{"help":"Mobile number in India","type":"phone","label":"Mobile No. while in India","options":[],"required":false,"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"],"required":true,"pdf_field":""},{"help":"Name of nominee","type":"text","label":"Nominee’s Name","options":[],"required":true,"pdf_field":""},{"help":"Relationship of nominee to proposer","type":"text","label":"Relationship to Nominee","options":[],"required":true,"pdf_field":""},{"help":"Relationship of nominee to proposer","type":"text","label":"Relationship to Proposer","options":[],"required":true,"pdf_field":""},{"help":"Select Yes to receive physical copy","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 Yes to update CKYC","type":"yes-no","label":"Do you wish to update CKYC with the KYC details provided here","options":["No","Yes"],"required":null,"pdf_field":""},{"help":"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":"Consent to receive policy via insurance repository","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":null,"pdf_field":""},{"help":"Provide 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":"Proposer's first name","type":"text","label":"First Name","options":[],"required":true,"pdf_field":""},{"help":"Proposer's middle name","type":"text","label":"Middle Name","options":[],"required":false,"pdf_field":""},{"help":"Proposer's last name","type":"text","label":"Last Name","options":[],"required":true,"pdf_field":""},{"help":"Name of father or spouse","type":"text","label":"Father / Spouse Name","options":[],"required":true,"pdf_field":""},{"help":"Name of mother","type":"text","label":"Mother Name","options":[],"required":false,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female","Transgender"],"required":true,"pdf_field":""},{"help":"Proposer's occupation","type":"text","label":"Occupation","options":[],"required":true,"pdf_field":""},{"help":"Select source of income","type":"choice","label":"Source of Income","options":["Salaried","Business"],"required":true,"pdf_field":""},{"help":"Attach if applicable","type":"text","label":"IT Returns","options":[],"required":false,"pdf_field":""},{"help":"Attach if applicable","type":"text","label":"3mths Payslip","options":[],"required":false,"pdf_field":""},{"help":"Enter annual income in rupees","type":"amount","label":"Annual Income (in Rs.)","options":[],"required":true,"pdf_field":""},{"help":"Mandatory; if not available submit Form 60","type":"text","label":"PAN Number","options":[],"required":true,"pdf_field":""},{"help":"Provide 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":"Provide if available","type":"text","label":"CKYC Number","options":[],"required":false,"pdf_field":""},{"help":"Provide email address","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Specify other proof if any","type":"text","label":"Other Proof, please specify","options":[],"required":false,"pdf_field":""},{"help":"Attach proof of income","type":"text","label":"Proof of Income to be submitted","options":[],"required":false,"pdf_field":""},{"help":"Specify other details if any","type":"text","label":"Others, please specify","options":[],"required":false,"pdf_field":""},{"help":"Specify business type","type":"text","label":"Business Type","options":[],"required":false,"pdf_field":""},{"help":"Select Yes if applicable","type":"yes-no","label":"Do you come under below mentioned Social Sector Classification*","options":["No","Yes"],"required":null,"pdf_field":""},{"help":"Select Yes if applicable","type":"yes-no","label":"Are you a ASHA worker","options":["No","Yes"],"required":null,"pdf_field":""},{"help":"Select Yes if applicable","type":"yes-no","label":"Are you a MGNREGA worker","options":["No","Yes"],"required":null,"pdf_field":""},{"help":"Tick applicable social sector classification","type":"choice","label":"If Yes (please tick)","options":["Unorganized Sector","Economically Vulnerable or Backward Classes","Other Categories of Persons","Informal Sector"],"required":false,"pdf_field":""},{"help":"Name as per KYC/ID proof","type":"text","label":"Proposer Name (same as KYC/ID proof)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Plan Selection","fields":[{"help":"Select one plan type","type":"choice","label":"Plan Type (Tick your Option)","options":["PLAN A1 : USD5 0000 Including USA And Canada","PLAN A2 : USD5 0000 Including USA And Canada","PLAN A1 : USD5 0000 Excluding USA And Canada","PLAN A2 : USD5 0000 Excluding USA And Canada","PLAN B1 : USD1 00000","PLAN B2 : USD1 00000","PLAN C1 : USD2 50000","PLAN C2 : USD2 50000","PLAN D1 : USD 500000","PLAN D2 : USD 500000","CTP 1 : USD 100000","CTP 2 : USD 250000","CTP 3 : USD 500000","STP 1 : USD 50000","STP 2 : USD 100000","STP 3 : USD 250000","Gold","Silver","Standard"],"required":true,"pdf_field":""},{"help":"Select trip duration band","type":"choice","label":"Trip band","options":["30 days","45 days"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of the Person Proposed for Insurance","fields":[{"help":"Date of birth of insured person","type":"date","label":"Date of Birth (DD/MM/YYYY)","options":[],"required":true,"pdf_field":""},{"help":"Height in centimeters","type":"number","label":"Height (cms)","options":[],"required":false,"pdf_field":""},{"help":"Weight in kilograms","type":"number","label":"Weight (kgs)","options":[],"required":false,"pdf_field":""},{"help":"Relationship to proposer","type":"text","label":"Relationship with proposer","options":[],"required":true,"pdf_field":""},{"help":"Sum insured amount in rupees","type":"amount","label":"Sum Insured Opted (For Individual Policy) (Rs.)","options":[],"required":true,"pdf_field":""},{"help":"Passport number of insured person","type":"text","label":"Passport Number","options":[],"required":true,"pdf_field":""},{"help":"Passport expiry date","type":"date","label":"Passport Expiry Date (DD/MM/YYYY)","options":[],"required":true,"pdf_field":""},{"help":"Provide ABHA number if available","type":"text","label":"Ayushman Bharat Health Account (ABHA) No.","options":[],"required":false,"pdf_field":""},{"help":"Provide details if yes","type":"text","label":"Do you have any health Insurance policy with us? If Yes Provide details","options":[],"required":false,"pdf_field":""},{"help":"Provide detailed health history; dash is not sufficient","type":"text","label":"Health History: Please provide answer in detail, specific diagnosis and treatment details","options":[],"required":true,"pdf_field":""},{"help":"Name of family physician","type":"text","label":"Family Physician's Name","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No for each insured person","type":"yes-no","label":"Is the person proposed for insurance suffering or has ever suffered from any illness / disease up to the time of making this proposal?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify illness or disease","type":"text","label":"If Yes Please Specify","options":[],"required":false,"pdf_field":""},{"help":"Provide diagnosis, date, medication, and treatment details","type":"text","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, Osteoporosis, Disease of bones / joints, slipped disc, spinal disorder, injury to ligaments, Any other problem","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you have any physical defect or deformity?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide hospitalization details","type":"text","label":"Have you ever been hospitalized for treatment / observation? If so, please furnish details.","options":[],"required":false,"pdf_field":""},{"help":"Provide medication details","type":"text","label":"Are you currently or in the past on Medication? Please furnish details","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Have you suffered from any illness or had an Accident in the preceding 12 Months?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach health check-up report if Yes","type":"yes-no","label":"Have you recently (within 60 days) taken any health check-up - If yes please attach report","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"List countries to be visited","type":"text","label":"Countries to be visited","options":[],"required":true,"pdf_field":""},{"help":"Specify frequency","type":"text","label":"How Frequently do you travel overseas?","options":[],"required":false,"pdf_field":""},{"help":"Departure date in DD/MM/YYYY","type":"date","label":"Date of Departure from India","options":[],"required":true,"pdf_field":""},{"help":"Return date in DD/MM/YYYY","type":"date","label":"Proposed date of return to India","options":[],"required":true,"pdf_field":""},{"help":"Number of days of travel","type":"number","label":"No. of days","options":[],"required":true,"pdf_field":""},{"help":"Select purpose and specify if Others","type":"choice","label":"Purpose of Visit","options":["Business","Holiday","Study","Others (Please Specify)"],"required":true,"pdf_field":""},{"help":"Specify visa type","type":"text","label":"Nature of Visa","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Information for Star Student Travel Protect","fields":[{"help":"Full name of student","type":"text","label":"Name of the Student","options":[],"required":true,"pdf_field":""},{"help":"Date of birth in DD/MM/YYYY","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Name of educational institution","type":"text","label":"Name of the Institution where the student proposed to study","options":[],"required":true,"pdf_field":""},{"help":"Provide I-20 number or admission letter copy","type":"text","label":"I-20 Number / Attach copy of admission letter as applicable","options":[],"required":false,"pdf_field":""},{"help":"Provide full address and contact details","type":"text","label":"Detailed address of the Institution/Telephone No. & Name of the contact person at the institution","options":[],"required":true,"pdf_field":""},{"help":"Provide tuition fee details","type":"text","label":"Tuition fees per Semester: (Please give the detailed breakup)","options":[],"required":true,"pdf_field":""},{"help":"Specify internship period if any","type":"text","label":"Internship Period","options":[],"required":false,"pdf_field":""},{"help":"Attach medical report if Yes","type":"yes-no","label":"Have you undergone medical examination / fitness test? If yes attach report","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide sponsor name if applicable","type":"text","label":"If sponsored by persons / bodies other than above - Name of the Sponsor","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer (student)"},{"title":"Bank Details of the Proposer","fields":[{"help":"Bank account number","type":"text","label":"Account Number","options":[],"required":true,"pdf_field":""},{"help":"Bank name","type":"text","label":"Name of the Bank","options":[],"required":true,"pdf_field":""},{"help":"Branch name","type":"text","label":"Name of the Branch","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Premium amount in rupees","type":"amount","label":"Premium Amount Rs.","options":[],"required":true,"pdf_field":""},{"help":"Select payment mode","type":"choice","label":"Mode of Payment","options":["Cheque","DD","Debit Card","Credit Card","NEFT","ECS","Cash","Others"],"required":true,"pdf_field":""},{"help":"Bank branch for payment","type":"text","label":"Branch","options":[],"required":false,"pdf_field":""},{"help":"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 account type","type":"choice","label":"Type of Account","options":["Current Account","Savings Account"],"required":true,"pdf_field":""},{"help":"Specify other payment details if any","type":"text","label":"Others Please Specify","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Signature","fields":[{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Name of proposer","type":"text","label":"Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration for illiterate proposer or different language signer","fields":[{"help":"Date of explanation","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Name of explainer","type":"text","label":"Name of the person who explained","options":[],"required":true,"pdf_field":""},{"help":"Signature of explainer","type":"signature","label":"Signature of the person who explained","options":[],"required":true,"pdf_field":""}],"filled_by":"person who explained"},{"title":"Declaration of the Agent / Intermediary","fields":[{"help":"Date of declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Agent code","type":"text","label":"Code","options":[],"required":true,"pdf_field":""}],"filled_by":"agent"},{"title":"Medical History of the proposer to be completed by M.D. Cardiologist","fields":[{"help":"Provide past medical history","type":"text","label":"Past Medical History (diagnosis / treatment / surgery)","options":[],"required":true,"pdf_field":""},{"help":"Describe current health","type":"text","label":"Current health status","options":[],"required":true,"pdf_field":""},{"help":"Provide details of interventions","type":"text","label":"Details of active (hospitalisation / day care) surgical or medical intervention required to address the health status","options":[],"required":true,"pdf_field":""},{"help":"Doctor to confirm fitness","type":"yes-no","label":"From the Lab reports ECG, Fasting and Post Prandial Blood Sugar Report, Creatinine, Complete Urine Examination, liver function test, do you consider that the Proposer is fit to undertake travel abroad?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Doctor's signature with date and reg no.","type":"signature","label":"Signature of the Doctor with Date and Registration Number","options":[],"required":true,"pdf_field":""}],"filled_by":"doctor"}],"deadlines":["Contact the office if policy is not received within 15 days from the date of payment of premium"],"applies_to":"Overseas travel insurance policies","attachments":["One proof in support of ID and Address (e.g. Voter ID, Driving License, Aadhar Card, Passport, NREGA Job Card)","Annexure to Proposal Form (Nomination Form)","Passport size photograph of the Proposer","Stamp size photograph of each Insured Person","Photo copy of cancelled cheque leaf","Medical reports if health check-up done within 60 days","Admission letter or I-20 copy for students","Form 60 if PAN not available"],"declarations":["The proposer declares all information is true and complete to the best of their knowledge.","The policy will be effective 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 may seek medical and other information for underwriting and claim settlement.","The proposer consents to sharing information with government and regulatory authorities and service providers.","Concealment or misrepresentation will void the policy and claims.","The insurer reserves the right to not renew the policy in case of fraud or non-disclosure.","The proposer consents to electronic communication and overrides NCPR for service purposes.","The proposer confirms payment source is legal and no third-party payments are allowed.","The proposer agrees to professional conduct and understands consequences of unprofessional behavior.","The proposer authorizes premium deduction from the given bank account."],"dropped_labels":31},"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/5009-common-proposal-form-for-overseas-travel-insurance"}