Policy Processing

Health Insurance Proposal

Star Health / National Insurance · Please complete all relevant sections. Fields marked * are required.

Proposer details

The person paying the premium and primary policy holder.

Full name (as per PAN) *

Date of birth

Gender

Marital status

Occupation

Annual income (INR)

PAN number

Aadhaar (last 4 digits)

Contact & address

Phone *

Alternate phone

Address line 1

Address line 2

City

State

Pincode

Plan details

Insurer

Plan type *

Sum insured (INR)

Policy term (years)

Nominee

Nominee name

Relation

Nominee DOB

Medical history

Please answer truthfully — non-disclosure can void claims.

Existing insurance

Do you currently hold any health policy?

Yes

Has any insurer ever declined / postponed your proposal?

Yes

Bank details

Required for premium auto-debit and claim settlement.

Bank name *

IFSC code *

Account number *

Notes for our policy desk

Declaration

I declare that the information provided is true and complete to the best of my knowledge. I understand that any misrepresentation may lead to rejection of claims or cancellation of the policy.

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