NIVESQOO
WISDOM · WEALTH · PROSPERITY
HEALTH INSURANCE

Health Insurance Proposal Form

Protect your family's health. Provide complete and accurate details for all members to be covered.

📋 Purpose

This form collects proposer and family member information for a Health Insurance proposal. Your NIVESQOO advisor will use this to prepare a customised floater or individual health policy quote, matching your family's medical profile and income.

⚠️ Important Warnings

  • Disclose ALL pre-existing conditions honestly — non-disclosure leads to claim rejection.
  • All members to be covered must be listed in this form.
  • Health conditions like diabetes, BP, cancer history must be clearly mentioned.
  • Smoking and alcohol details affect premium — please answer truthfully.
  • This is a data collection form — not a policy binding document.

📖 Instructions

  1. Fill the Proposer (the person paying the premium) details first.
  2. Add all family members to be insured using the + Add Member button.
  3. Fill health details for each member carefully — even if healthy, select "No".
  4. Upload your photo and income proof.
  5. Click "Review & Generate PDF" to preview and download.
  6. Generate the PDF and share it directly with your NIVESQOO advisor. By sharing this form, you provide your explicit consent for your advisor to access and process sensitive personal data including PAN, Aadhaar, and health information solely for the purpose of insurance advisory.
1. Proposer Details (Premium Payer)
Required
Required
Required
Valid 10-digit required
Valid email required
Required
Required
2. Insured Members

Add all family members you want to include in the health policy. The proposer can also be an insured member.

3. Existing Policy & Nominee
Required
Required
4. Documents

Upload clear, readable copies. Aadhaar and PAN are required for KYC compliance as mandated by IRDAI.

📸
Click or drag
JPG, PNG · Max 5MB
Photo required
🪪
Click or drag
JPG, PNG, PDF · Max 5MB
Aadhaar front required
🪪
Click or drag
JPG, PNG, PDF · Max 5MB
Aadhaar back required
💳
Click or drag
JPG, PNG, PDF · Max 5MB
PAN card required
📄
Click or drag
PDF or image · Max 10MB
5. Data Consent & Declaration

By submitting this form, I confirm that all information provided is true and accurate to the best of my knowledge. I understand that this is a proposal form only and not a binding policy document. I hereby provide explicit consent under applicable data protection laws for NIVESQOO and my IRDAI-licensed advisor to collect, store, and process my personal data — including Aadhaar, PAN, and health information — strictly for the purpose of evaluating and recommending suitable insurance products.

AFTER DOWNLOAD — SHARE THE PDF WITH YOUR NIVESQOO ADVISOR

✅
Submitted!
Your Health Insurance proposal is recorded. Your NIVESQOO advisor will reach you shortly.