{"id":1306,"date":"2018-12-03T12:21:54","date_gmt":"2018-12-03T06:51:54","guid":{"rendered":"http:\/\/myinsurer.in\/?page_id=1306"},"modified":"2020-08-03T21:41:35","modified_gmt":"2020-08-03T16:11:35","slug":"pahe","status":"publish","type":"page","link":"https:\/\/myinsurer.in\/index.php\/home\/forms\/pahe\/","title":{"rendered":"PA with Hospitalization Expense"},"content":{"rendered":"<h2>Personal Accident With Hospitalization Expense<\/h2>\n<p>The policy offers Personal Accident compensation cover including reimbursement of Hospitalization expenses incurred due to an accident.<\/p>\n<p><i style=\"box-sizing: border-box; font-style: italic; color: #7a7a7a; font-family: 'Varela Round', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 500; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial;\">This is not the proposal form for any insurance product. This form is using to collect data from our tie-up Financiers and customers for further proceedings and or to get Quotation. This is not a public page.<\/i><\/p>\n<div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f1305-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1306#wpcf7-f1305-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1305\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.5.3\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1305-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p>Name of the Insured<br \/>\n<span class=\"wpcf7-form-control-wrap Cust\"><input type=\"text\" name=\"Cust\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Name of Insured\" \/><\/span><\/p>\n<p>Gender<br \/>\n<span class=\"wpcf7-form-control-wrap Genter\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><span class=\"wpcf7-list-item-label\">Male<\/span><input type=\"radio\" name=\"Genter\" value=\"Male\" \/><\/label><\/span><span class=\"wpcf7-list-item last\"><label><span class=\"wpcf7-list-item-label\">Female<\/span><input type=\"radio\" name=\"Genter\" value=\"Female\" \/><\/label><\/span><\/span><\/span><\/p>\n<p>Address<br \/>\n<span class=\"wpcf7-form-control-wrap Address1\"><input type=\"text\" name=\"Address1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Address of Insured With State and Pin Code\" \/><\/span><\/p>\n<p>Date of Birth: (18 to 80 Year)<br \/>\n<span class=\"wpcf7-form-control-wrap IDOB\"><input type=\"date\" name=\"IDOB\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"1946-05-16\" max=\"2008-04-30\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Date of Birth Of Insured\" \/><\/span><\/p>\n<p>Mobile Number<br \/>\n<span class=\"wpcf7-form-control-wrap MobileNumber\"><input type=\"tel\" name=\"MobileNumber\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Mobile Number\" \/><\/span><\/p>\n<p>Occupation of the Insured<br \/>\n<span class=\"wpcf7-form-control-wrap IOccupation\"><input type=\"text\" name=\"IOccupation\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Occupation of the Insured\" \/><\/span><\/p>\n<p>Any Physical Defects ?<br \/>\n<span class=\"wpcf7-form-control-wrap PhysicalDefects\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><span class=\"wpcf7-list-item-label\">Yes<\/span><input type=\"radio\" name=\"PhysicalDefects\" value=\"Yes\" \/><\/label><\/span><span class=\"wpcf7-list-item last\"><label><span class=\"wpcf7-list-item-label\">No<\/span><input type=\"radio\" name=\"PhysicalDefects\" value=\"No\" checked=\"checked\" \/><\/label><\/span><\/span><\/span><\/p>\n<p>If Any Physical Defects, Details<br \/>\n<span class=\"wpcf7-form-control-wrap PhysicalDefectsDetails\"><input type=\"text\" name=\"PhysicalDefectsDetails\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Details of Physical Defects if any\" \/><\/span><\/p>\n<p>Sum Insured for Personal accident (Accident death Cover)<br \/>\n<span class=\"wpcf7-form-control-wrap PASI\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><span class=\"wpcf7-list-item-label\">1,00,000<\/span><input type=\"radio\" name=\"PASI\" value=\"1,00,000\" checked=\"checked\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">2,00,000<\/span><input type=\"radio\" name=\"PASI\" value=\"2,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">5,00,000<\/span><input type=\"radio\" name=\"PASI\" value=\"5,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item last\"><label><span class=\"wpcf7-list-item-label\">10,00,000<\/span><input type=\"radio\" name=\"PASI\" value=\"10,00,000\" \/><\/label><\/span><\/span><\/span><\/p>\n<p>Sum Insured for hospital expenses due to road accident<br \/>\n<span class=\"wpcf7-form-control-wrap HESI\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><span class=\"wpcf7-list-item-label\">1,00,000<\/span><input type=\"radio\" name=\"HESI\" value=\"1,00,000\" checked=\"checked\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">2,00,000<\/span><input type=\"radio\" name=\"HESI\" value=\"2,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">5,00,000<\/span><input type=\"radio\" name=\"HESI\" value=\"5,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item last\"><label><span class=\"wpcf7-list-item-label\">10,00,000<\/span><input type=\"radio\" name=\"HESI\" value=\"10,00,000\" \/><\/label><\/span><\/span><\/span><\/p>\n<p>Sum Insured for hospital expenses due to accident in course of employment extension<br \/>\n<span class=\"wpcf7-form-control-wrap EESI\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><span class=\"wpcf7-list-item-label\">1,00,000<\/span><input type=\"radio\" name=\"EESI\" value=\"1,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">2,00,000<\/span><input type=\"radio\" name=\"EESI\" value=\"2,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">5,00,000<\/span><input type=\"radio\" name=\"EESI\" value=\"5,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">10,00,000<\/span><input type=\"radio\" name=\"EESI\" value=\"10,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item last\"><label><span class=\"wpcf7-list-item-label\">Not Opting<\/span><input type=\"radio\" name=\"EESI\" value=\"Not Opting\" \/><\/label><\/span><\/span><\/span><\/p>\n<p>Sum Insured for hospital expenses for any other accident<br \/>\n<span class=\"wpcf7-form-control-wrap OASI\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><span class=\"wpcf7-list-item-label\">1,00,000<\/span><input type=\"radio\" name=\"OASI\" value=\"1,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">2,00,000<\/span><input type=\"radio\" name=\"OASI\" value=\"2,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">5,00,000<\/span><input type=\"radio\" name=\"OASI\" value=\"5,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">10,00,000<\/span><input type=\"radio\" name=\"OASI\" value=\"10,00,000\" \/><\/label><\/span><span class=\"wpcf7-list-item last\"><label><span class=\"wpcf7-list-item-label\">Not Opting<\/span><input type=\"radio\" name=\"OASI\" value=\"Not Opting\" \/><\/label><\/span><\/span><\/span><\/p>\n<p>Policy Duration<br \/>\n<span class=\"wpcf7-form-control-wrap PolicyDuration\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><span class=\"wpcf7-list-item-label\">One Year<\/span><input type=\"radio\" name=\"PolicyDuration\" value=\"One Year\" checked=\"checked\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">Two Years<\/span><input type=\"radio\" name=\"PolicyDuration\" value=\"Two Years\" \/><\/label><\/span><span class=\"wpcf7-list-item last\"><label><span class=\"wpcf7-list-item-label\">Three Years<\/span><input type=\"radio\" name=\"PolicyDuration\" value=\"Three Years\" \/><\/label><\/span><\/span><\/span><\/p>\n<p>Nominee<br \/>\n<span class=\"wpcf7-form-control-wrap Nominee\"><input type=\"text\" name=\"Nominee\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Name of Nominee\" \/><\/span><\/p>\n<p>Relationship with the Nominee<br \/>\n<span class=\"wpcf7-form-control-wrap NomineeRelation\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><span class=\"wpcf7-list-item-label\">Spouse<\/span><input type=\"radio\" name=\"NomineeRelation\" value=\"Spouse\" checked=\"checked\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">Son<\/span><input type=\"radio\" name=\"NomineeRelation\" value=\"Son\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">Daughter<\/span><input type=\"radio\" name=\"NomineeRelation\" value=\"Daughter\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">Father<\/span><input type=\"radio\" name=\"NomineeRelation\" value=\"Father\" \/><\/label><\/span><span class=\"wpcf7-list-item last\"><label><span class=\"wpcf7-list-item-label\">Mother<\/span><input type=\"radio\" name=\"NomineeRelation\" value=\"Mother\" \/><\/label><\/span><\/span><\/span><\/p>\n<p>Submitted By<br \/>\n<span class=\"wpcf7-form-control-wrap SubmitedBy\"><input type=\"text\" name=\"SubmitedBy\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Contact Number\/ Name of submitter\" \/><\/span><\/p>\n<p><span class=\"wpcf7-form-control-wrap Callmeforfurtherdiscussion\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Callmeforfurtherdiscussion\" value=\"1\" aria-invalid=\"false\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Call me for further discussion<\/span><\/label><\/span><\/span><\/span><br \/>\n<input type=\"submit\" value=\"Submit\" class=\"wpcf7-form-control has-spinner wpcf7-submit button name mob file\" id=\"form-submit\" \/><\/p>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div>\n<p style=\"text-align: center;\"><i>Insurance is the subject matter of solicitation<\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Personal Accident With Hospitalization Expense The policy offers Personal Accident compensation cover including reimbursement of Hospitalization expenses incurred due to an accident. This is not the proposal form for any insurance product. This form is using to collect data from our tie-up Financiers and customers for further proceedings and or to get Quotation. This is [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1316,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-1306","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/pages\/1306","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/comments?post=1306"}],"version-history":[{"count":10,"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/pages\/1306\/revisions"}],"predecessor-version":[{"id":1405,"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/pages\/1306\/revisions\/1405"}],"up":[{"embeddable":true,"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/pages\/1316"}],"wp:attachment":[{"href":"https:\/\/myinsurer.in\/index.php\/wp-json\/wp\/v2\/media?parent=1306"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}