{"id":1862,"title":"Saral Suraksha Bima, Navi General Insurance - CHANGE REQUEST FORM","purpose":"service","insurer":{"slug":"navi-general-insurance","name":"Navi General Insurance Limited"},"source_pdf":"https://public-navi-docs.s3.ap-south-1.amazonaws.com/NaviInsurance/SaralSurakshaBima/2020-2021/January/SaralSurakshaBima%2011.%20Change%20Request%20Form.pdf","sha256":"9de917eb1cd400f6dcb6e64d9defdef0fd8918241e274b1220b7bf753e06a89c","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by policyholders to request changes to their Saral Suraksha Bima insurance policy details such as address, tenure, members, name, date of birth, contact details, nominee, or other information.","notes":["Fill the form in block letters.","Put a tick mark wherever applicable.","Any alteration in form must be countersigned by the Policyholder.","All details marked * are mandatory.","Any change requested for Name/Date of Birth/Address/Contact Details/health condition will be incorporated for all policies with the insurer.","Married women changing name due to marriage must submit Marriage Certificate.","Certified true copy of supporting documents must be enclosed.","Nominee should be 18 years or older.","For member addition, allowed only for child(ren) on birth or spouse on marriage; fresh proposal form is requested for additions."],"title":"Saral Suraksha Bima, Navi General Insurance - CHANGE REQUEST FORM","submit":{"to":"","how":"","address":""},"purpose":"service","sections":[{"title":"Policy Details and Change Request Type","fields":[{"help":"Enter the date you are filling this form in DD/MM/YYYY format","type":"date","label":"Date of Request","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the Product","options":[],"required":false,"pdf_field":""},{"help":"Enter your policy number","type":"text","label":"Policy Number*","options":[],"required":true,"pdf_field":""},{"help":"Enter the name of the policyholder or proposer","type":"text","label":"Name of Policyholder / Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Tick the box(es) for the changes you want to request","type":"checkbox","label":"Please tick the appropriate box and fill the details in the corresponding section: 1. Change in Address ☐ 2. Change in Tenure ☐ 3. Member Addition/ Deletion ☐ 4. Others ☐","options":["Change in Address","Change in Tenure","Member Addition/ Deletion","Others"],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"1. Change in Address","fields":[{"help":"Enter your new address","type":"text","label":"New Address","options":[],"required":false,"pdf_field":""},{"help":"Enter the city of your new address","type":"text","label":"City*","options":[],"required":true,"pdf_field":""},{"help":"Enter the state of your new address","type":"text","label":"State*","options":[],"required":true,"pdf_field":""},{"help":"Enter the postal pin code","type":"number","label":"Pin Code*","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"2. Change in Tenure","fields":[{"help":"Tick if you want to change to 3-year plan","type":"checkbox","label":"I want to opt for 3-year plan ☐","options":["3-year plan"],"required":false,"pdf_field":""},{"help":"Tick if you want to change to 2-year plan","type":"checkbox","label":"I want to opt for 2-year plan ☐","options":["2-year plan"],"required":false,"pdf_field":""},{"help":"Tick if you want to change to 1-year plan","type":"checkbox","label":"I want to opt for 1-year plan ☐","options":["1-year plan"],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"3a. Addition of Member","fields":[{"help":"Enter the name of the member to add","type":"text","label":"Name of Insured*","options":[],"required":true,"pdf_field":""},{"help":"Select the gender of the member","type":"choice","label":"Gender*","options":["Male","Female","Other"],"required":true,"pdf_field":""},{"help":"Enter date of birth of the member","type":"date","label":"DOB (DD/MM/YYYY)*","options":[],"required":true,"pdf_field":""},{"help":"Enter relationship with policyholder","type":"text","label":"Relationship","options":[],"required":false,"pdf_field":""},{"help":"State reason for adding member (allowed only for child on birth or spouse on marriage)","type":"text","label":"Reason for Addition *","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"3b. Deletion of Member","fields":[{"help":"Enter the name of the member to delete","type":"text","label":"Name of Insured*","options":[],"required":true,"pdf_field":""},{"help":"Select the gender of the member","type":"choice","label":"Gender*","options":["Male","Female","Other"],"required":true,"pdf_field":""},{"help":"Enter date of birth of the member","type":"date","label":"DOB(DD/MM/YYYY)*","options":[],"required":true,"pdf_field":""},{"help":"Enter relationship with policyholder","type":"text","label":"Relationship","options":[],"required":false,"pdf_field":""},{"help":"State reason for deleting member","type":"text","label":"Reason for deletion","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"4a. Change in Name","fields":[{"help":"Tick if name change is for policyholder","type":"checkbox","label":"Change in Name - Policyholder ☐","options":["Policyholder"],"required":false,"pdf_field":""},{"help":"Enter current name as per policy","type":"text","label":"From (Name as per the current policy)","options":[],"required":false,"pdf_field":""},{"help":"Enter new name","type":"text","label":"To (To be changed to)","options":[],"required":false,"pdf_field":""},{"help":"Tick the document you are submitting as proof","type":"choice","label":"Document Submitted*","options":["Pan Card","Gazetted Notification","Driving License","Election Card","Aadhar Card","Others"],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"4b. Change in Date of Birth","fields":[{"help":"Tick if DOB change is for policyholder","type":"checkbox","label":"Change in Date of Birth - Policyholder ☐","options":["Policyholder"],"required":false,"pdf_field":""},{"help":"Enter name of insured whose DOB is changing","type":"text","label":"Name of Insured","options":[],"required":false,"pdf_field":""},{"help":"Enter old date of birth","type":"date","label":"From (DOB as per policy)","options":[],"required":false,"pdf_field":""},{"help":"Enter new date of birth","type":"date","label":"To (To be changed to)","options":[],"required":false,"pdf_field":""},{"help":"Tick the document you are submitting as proof","type":"choice","label":"Document Submitted*","options":["Pan Card","Passport","Driving License","Others"],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"4c. Change in Contact Details","fields":[{"help":"Enter new mobile number","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter new landline number","type":"phone","label":"Landline Number","options":[],"required":false,"pdf_field":""},{"help":"Enter new email address","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"4d. Change of Nominee","fields":[{"help":"Enter name of new nominee (must be 18 years or older)","type":"text","label":"Name of Nominee","options":[],"required":false,"pdf_field":""},{"help":"Enter relationship of nominee with policyholder","type":"text","label":"Relationship with Policyholder","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"4e. Any Other Change Request","fields":[{"help":"Tick if change request is for policyholder","type":"checkbox","label":"Policyholder ☐","options":["Policyholder"],"required":false,"pdf_field":""},{"help":"Tick if change request is for insured","type":"checkbox","label":"Insured ☐","options":["Insured"],"required":false,"pdf_field":""},{"help":"Enter name of person for whom change is requested","type":"text","label":"Name*","options":[],"required":true,"pdf_field":""},{"help":"Enter old information","type":"text","label":"Change From","options":[],"required":false,"pdf_field":""},{"help":"Enter new information","type":"text","label":"Change To","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration","fields":[{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Sign or put thumb impression here","type":"signature","label":"Signature/Thumb impression of Policyholder","options":[],"required":false,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Saral Suraksha Bima policies","attachments":["Address Proof (for Change in Address)","Certified true copy of supporting document for name change","Marriage Certificate (for married women changing name due to marriage)","Gazetted notification (for significant name changes)","Document proof for name change (Pan Card, Gazetted Notification, Driving License, Election Card, Aadhar Card, Others)","Document proof for DOB change (Pan Card, Passport, Driving License, Others)"],"declarations":["I/We confirm having read and understood all policy terms and conditions including those applicable to this request.","I/We declare that all information provided is true and complete and no relevant information has been suppressed."],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"grievance","channel":"email","value":"gro@navi.com","label":"Second Escalation - Grievance Redressal Officer","level":2,"hours":null,"applies_to":"all","source_url":"https://public-navi-docs.s3.ap-south-1.amazonaws.com/NaviCommercialVehicleLiabilityOnlyInsurance%20CIS.pdf","quote":"t Customer Experience Team at - insurance.help@navi.com • Second Escalation - Email to Grievance Redressal Officer at – gro@navi.com Turn Around Time (TAT) for claims settlement 30 days from the date of last document receipt Claim Registration Notify o","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"022-40018100","label":"Level 2 Escalation - Grievance Redressal Officer phone","level":2,"hours":null,"applies_to":"all","source_url":"https://public-navi-docs.s3.ap-south-1.amazonaws.com/NaviCommercialVehicleLiabilityOnlyInsurance%20Policy%20Wordings.pdf","quote":"e to our Head Customer Experience and Grievance Redressal Officer at Head.CustomerExperience@navi.com or contact GRO at 022-40018100. Level 3: If you are not happy with the resolution, you may approach IRDAI by calling on the Toll-Free no. 155255\n(or)","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Navi General Insurance Limited Registered Office: Vaishnavi Tech Square, 10th Floor, Iballur Village, Begur Hobli, Bengaluru, Karnataka- 560102","label":"Grievance Redressal Officer Address","level":null,"hours":null,"applies_to":"all","source_url":"https://public-navi-docs.s3.ap-south-1.amazonaws.com/NaviCommercialVehicleLiabilityOnlyInsurance%20CIS.pdf","quote":"https://www.naviinsurance.com/service/ 5. Walk in for assistance 6. Dispatch your letters to us at – Corporate Office: Navi General Insurance Limited, Vaishnavi Tech Square, 10th Floor, Iballur Village, Begur Hobli, Bengaluru, Karnataka- 560102 7. Escalation – • First Escalation – Contact Customer Experience Team at - insurance.help@navi.com • Second Escalation - Email to Grievan","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800 123 0004","label":"Grievance Redressal Officer Toll free","level":null,"hours":null,"applies_to":"all","source_url":"https://public-navi-docs.s3.ap-south-1.amazonaws.com/NaviCommercialVehicleLiabilityOnlyInsurance%20CIS.pdf","quote":"nses - paid amount under own damage claim\n12 | Policy Servicing Claim Intimation and Processing | 1. Call Us: Toll Free 1800 123 0004 2. Email: insurance.help@navi.com 3. Email for Senior Citizens- seniorcare@navi.com 4. Visit our website: https://www.n","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/navi-general-insurance/1862-saral-suraksha-bima-navi-general-insurance-change-request-form"}