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National Insurance Proposal Form

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PROPOSAL FORM CUM SCHEDULE FOR BARODA HEALTH

National Insurance Company Limited

Regd. Office 3, Middleton Street, Post Box 9229, Kolkata 700 071

1. Name of the Bank Branch Agency Code No

2. Name of the Customer

3. Type of Account (SB/CA/FDR/Anyother Pl. tick) and Account Number

4. PAN No. (if any)

5. Postal Address & Telephone No.

Pin Code

6. Name and Address of the Medical Practitioner & Family Doctor (if any)

7. Date Of Payment of Premium

Period of Insurance (one year from date of payment of premium) to

8. Sum insured per family:

Sum Insured (Rs.) Premium up to 65 Years including S.T at 12.36% Premium above 65 years & upto 80 years
50,000931/-1164/-
1,00,0001748/-2185/-
1,50,0002638/-3298/-
2,00,0003393/-4242/-
2,50,0004063/-5079/-
3,00,0004734/-5917/-
4,00,0005906/-7382/-
5,00,0007079/-8848/-

Note: Premium amount is same irrespective of number of members joining the policy i.e. either the policy is taken for 1+1 or 1+2 or 1+3 or even one member only

9. Details of Persons to be covered:

Sr No Name of the insured person Age M/F Relationship Existing Disease/ illness/injury Treatment received for the last 3 years
1
2
3
4

*Details may be given in a separate sheet, if space is not sufficient.

10. Photographs of the insured Persons:

Account Holder

D.O.B.

Spouse

D.O.B.

Child - 1

D.O.B.

Child - 2

D.O.B.

11. I have existing Medical insurance:

If Yes, 1) Name of Insurer, Policy No., Period of Ins.

2) Sum insured

(In case of existing Mediclaim, settlement will be as per rules of the insurance company.)

13. Name of the Third Party Administrator :

I hereby declare and warrant that the above statements are true and complete. Myself and family members are maintaining good health subject to item no 9. I have read the salient features of the policy mentioned in the prospectus and willing to accept the coverage subject to the terms, conditions and expectations prescribed by the insurance company as per the agreement between Bank of Baroda and National Insurance Co. Ltd. I understand that in case of any claim under the policy, Bank of Baroda will not undertake any responsibility or will not accept any correspondence and the same have to be pursued with the insurance company / TPA only. I shall personally ensure renewal of the policy. I am aware that the policy will be renewed based on the premium rates, terms and conditions at the time of renewal. In the event of Govt. of India revising the Service Tax rates, I agree to pay the difference in Service Tax amount and for debiting the same to my account mentioned above.

I have read the terms and conditions of the scheme and I shall abide by the same.

Place :

Date :

Signature of the Proposer

FOR OFFICE USE ONLY

Premium debited on for Rs.

Place:

Date:

Signature of the Branch Manager

Originals with Photos to NICL mapped office

NOTE: 1) For scope of coverage, terms and conditions refer to the Baroda Health policy (enclosed)

2) For claim procedures refer to enclosed TPA Guidebook

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What the National Insurance Proposal Form is and why it matters

The National Insurance Proposal Form is a standardized application packet insurers use to record a prospective policyholder's details, risk factors, coverage requests and declarations needed for underwriting. It collects identity and contact information, coverage selections, prior claims history, loss payee details and any required disclosures. Insurers use the form to evaluate eligibility, calculate premium, and determine policy terms. Completed proposals become part of the insurer's underwriting record and may be retained for regulatory or audit purposes under applicable federal and state requirements.

Why a formal proposal form improves insurance intake

A clear, consistent National Insurance Proposal Form reduces ambiguity during underwriting, documents applicant representations, and creates an auditable record for compliance with insurance regulations and company policy.

Why a formal proposal form improves insurance intake

Typical users and signers for this form

Responsibilities vary by role: agents gather and verify details, applicants attest to accuracy, and insurers retain the record for underwriting and regulatory audits.

  • Independent agents and brokers completing applicant sections and attestations.
  • Individual applicants providing personal and claims history information.
  • Underwriting and compliance teams reviewing submissions and authorizing terms.

Core components found in a professional proposal

A complete National Insurance Proposal Form groups applicant identification, coverage requests, risk disclosures, prior claims history, supporting documents, and signature blocks so underwriters can make prompt, documented decisions.

Applicant Details

Full legal name, business name if applicable, mailing and physical addresses, date of birth or formation, and contact information for underwriting communication.

Coverage Requested

Specific coverage lines, limits, deductibles, effective date preferences and any optional endorsements or riders the applicant is requesting for consideration.

Risk Description

Location, occupancy, operations, vehicle or asset details and other facts underwriters need to assess exposure and apply appropriate rating factors.

Prior Claims

Complete history of prior claims or losses, dates, amounts, and status to help underwriters evaluate prior loss experience and potential underwriting restrictions.

Supporting Documents

Attachments such as photos, inspection reports, prior policies, loss runs, financials or licenses that substantiate the application and speed underwriting.

Signature Blocks

Clearly labeled signature and date fields for applicant and agent, with capacity/authority statements, and optional notarization or witness lines where required.

Step-by-step: filling and submitting the proposal

Follow these core steps to complete the National Insurance Proposal Form accurately and in the proper order.

  • 01
    Gather documents: Collect IDs, prior policies, loss runs, and inspection reports before you start.
  • 02
    Complete fields: Enter applicant data, coverage choices, and claims history carefully.
  • 03
    Attach evidence: Upload supporting documents and clearly label each attachment for underwriters.
  • 04
    Sign and submit: Sign using an approved method and send to the insurer or designated intake address.

Configuring an online proposal workflow

Set workflow options to match your underwriting rules, authentication needs and notification preferences when completing the form online.

Field Configuration
Effective Date Format Enforce MM/DD/YYYY format for consistency
Required Attachments Make ID and loss runs mandatory uploads
Signer Order Applicant signs first, agent signs second
Notifications Email and optional SMS for each status

Where the completed proposal goes and what happens next

After submission, the form moves through intake, validation, underwriting review, and final disposition; each stage should be tracked for compliance and SLA reporting.

  • Intake: System validates fields and attachments
  • Verification: Underwriting checks identity and prior history
  • Decision: Underwriter issues offer, decline, or request for more info
  • Issuance: Policy documents generated if coverage is approved

Digital signing and integration considerations

Confirm the vendor meets HIPAA, SOC 2, ESIGN/UETA requirements for your workflow and supports the connectors your teams rely on.

  • Authentication Options: Email, SMS, or advanced KBA
  • Document Formats: PDF, DOCX and PDF/A exports
  • Integrations: CRM, policy admin and cloud storage

Timelines and expected processing stages

Typical timeframes vary by carrier and complexity; use these common benchmarks to set expectations for applicants and internal SLAs.

Acknowledgment of Submission:

Within 24–48 hours after receipt

Initial Underwriting Review:

2–7 business days depending on complexity

Request for Additional Information:

Issued within initial review period if needed

Final Underwriting Decision:

Typically 5–15 business days for standard risks

Policy Issuance:

Issued within 1–3 business days after approval

Common mistakes that delay underwriting

  • Incomplete identity details or mismatched names that prevent verification and trigger manual follow-up from underwriting.
  • Missing or poorly labeled attachments such as loss runs and inspection reports that require resubmission and slow decision timelines.
  • Handwritten or ambiguous entries where dates or amounts are unclear; typed fields with MM/DD/YYYY and exact numerals reduce friction.
  • Using informal descriptions for assets or operations rather than standardized codes or classifications, which complicates rating and exposure assessment.

Consequences of inaccurate or incomplete proposals

Coverage Denial: May follow material misrepresentation
Policy Rescission: Possible for fraudulent statements
Regulatory Fines: State insurance regulators may assess penalties
Claim Reduction: Payments reduced if misstatements found
Delayed Coverage: Applications returned for correction
Contract Disputes: Increased legal and administrative costs

Key data points the form must capture

Policyholder Name: Legal name
Contact Information: Phone and email
Risk Location: Street address
Coverage Type: Line requested
Claims History: Loss dates/amounts
Agent Details: Producer name/license

Comparing eSignature options for proposal intake

Vendor pricing and core features vary. signNow is shown first for straightforward comparison across common criteria without date references.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial, no credit card required Yes, trial varies Yes, trial varies Yes, limited Yes, limited
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No cap 100 envelopes/user/year Varies by plan Varies by plan Varies by plan

Real-world examples of electronic proposal intake

Practical examples show how electronic forms and signatures reduce turnaround and improve recordkeeping for insurance workflows.

Optica Ventures

The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers.

  • Faster customer completion rates improved our submission pipeline by removing paper steps.
  • As a result, the broker reported shorter underwriting cycles and fewer follow-ups, improving processing predictability and client satisfaction.

Martin Properties

I can process and execute all of these documents online with 100% compliance and built-in security.

  • Mobile signing allowed execution from job sites and remote offices.
  • This eliminated delays from in-person signings, reduced travel costs and ensured consistent retention of signed proposals for audits and claims handling.

Practical tips to complete proposals efficiently

Adopting consistent data entry, verification and retention steps reduces errors and improves underwriting throughput.

Verify identity early
Confirm the applicant's legal name and ID before completing the form. Early verification prevents downstream mismatches that delay underwriting or require re-signatures.
Use structured attachments
Label and attach loss runs, photos and prior policies with clear filenames and dates so underwriters can locate supporting evidence without manual searching.
Enforce field formats
Require MM/DD/YYYY for dates and standardized state abbreviations to reduce validation errors and ensure consistency across systems and exports.
Keep auditable trails
Ensure every signature event captures timestamp, IP, authentication method, and a downloadable certificate of completion for regulatory and claims purposes.

Frequently asked questions and common troubleshooting

Answers to common submission and signature issues that arise with National Insurance Proposal Forms and electronic workflows.


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