Health Insurance Proposal Form

THE RIGHT COVER TODAY, PEACE OF MIND ALWAYS

Congratulations! You've taken an important step towards strengthening your overall financial well-being. Health insurance is one of the core pillars of a solid financial plan, and completing this form brings you closer to ensuring long-term protection for your family.

This form captures the key details needed for your health insurance proposal. Please provide accurate information for seamless processing. Also, ensure that any pre-existing medical conditions are clearly disclosed to avoid potential claim issues in the future.

Quick instructions
Proposer — the person buying / paying for this policy (their details and documents are mandatory).
Nominee — the person who will receive policy reimbursements/benefits if something happens to the proposer. Nominee details & documents are mandatory.
Insured persons — people to be covered under the policy (may include proposer and nominee). For any additional insured person (other than proposer & nominee), Aadhaar front & back are mandatory.

Please keep these documents ready before you start:
Proposer — PAN, Aadhaar (front & back), cancelled cheque / Bank Passbook Front Page or recent Bank Statement, passport-size photo.
Nominee — Aadhaar (front & back) and cancelled cheque / Bank Passbook Front Page or Bank Statement.
Other insured persons — Aadhaar (front & back). Both Aadhaar front & back copies are required;
If you have a PDF copy of Aadhaar, upload the same under any ONE of the sections.

Proposer Name *

Proposer Date of Birth (DD-MM-YYYY) *

Format: DD-MM-YYYY

Proposer Age (completed years)

Email ID *

Mobile No. *

Address (As per Aadhaar) *

Highest Educational Qualification *

Occupation *

Annual Income *

Number of people to be covered *

Proposer is also to be covered? *

Nominee is also to be covered? *

Nominee Details *

Nominee Name *

Relationship with Proposer *

Nominee Email ID *

Nominee Mobile No. *

Nominee Date of Birth (DD-MM-YYYY) *

Format: DD-MM-YYYY

Nominee Age (years)

Upload Proposer's Documents

Allowed: jpg, jpeg, png, pdf. Max size per file: 1 MB. These documents are required whether or not proposer is selected to be covered.

Upload Nominee's Documents

Allowed: jpg, jpeg, png, pdf. Max size per file: 1 MB. These documents are required whether or not nominee is selected to be covered.

Upload Insured Documents (Aadhaar - Front & Back)

For each additional insured person (excluding proposer & nominee). Allowed: jpg, jpeg, png, pdf. Max size per file: 1 MB. Aadhaar front & back are mandatory for these additional insured persons.

I agree that my details will be shared with the insurance company to submit the proposal for insurance. *