{"id":2037,"title":"SARAL SURAKSHA BIMA, ACKO POLICY PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"acko-life-insurance","name":"Acko Life Insurance Limited"},"source_pdf":"https://acko-cms.ackoassets.com/4_Proposal_Form_3_1e020b1854.pdf","sha256":"f6a054a92c24b6c1b170baa20c8af02b11dee26800316027a2d3c901717a8211","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is for individuals proposing to purchase the Saral Suraksha Bima insurance policy from Acko General Insurance Limited. The proposer fills this form to provide personal, family, and previous insurance details for underwriting the policy.","notes":["Complete the form in CAPITAL LETTERS.","Submit the original proposal form; copies will not be accepted.","Pan No./TAN No. is mandatory for premium payments above specified thresholds.","All nominations will be in accordance with Section 39 of the Insurance Act 1938.","A minor should not be declared as nominee.","Excluded occupations are listed in Section VIII and persons in these categories are not eligible.","Section 41 of Insurance Act 1938 prohibits rebates as inducements for insurance.","Use self-attested copies for income proof attachments."],"title":"SARAL SURAKSHA BIMA, ACKO POLICY PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter the start date of the proposed policy period in DD/MM/YYYY format","type":"date","label":"Proposed Policy Period From","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of the proposer in capital letters","type":"text","label":"Proposer Name","options":[],"required":true,"pdf_field":""},{"help":"Enter name of the principal contact person","type":"text","label":"Principal Contact Person Name","options":[],"required":true,"pdf_field":""},{"help":"Enter full correspondence address","type":"text","label":"Correspondence Address","options":[],"required":true,"pdf_field":""},{"help":"Enter city name","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Enter state name","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter postal pin code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Telephone Number Mobile","options":[],"required":true,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E-mail","options":[],"required":null,"pdf_field":""},{"help":"Enter first identification document number","type":"text","label":"ID 1","options":[],"required":null,"pdf_field":""},{"help":"Enter second identification document number","type":"text","label":"ID 2","options":[],"required":null,"pdf_field":""},{"help":"Mandatory if premium is INR 50,000+ in cash/DD or INR 100,000+ by cheque/credit/debit card","type":"text","label":"Pan No. / TAN No.","options":[],"required":null,"pdf_field":""},{"help":"Enter total number of insured persons","type":"number","label":"Please state the total number of Insured Persons to be covered on an individual basis (including self / spouse / parents / parents in law / dependent children)","options":[],"required":true,"pdf_field":""},{"help":"Enter occupation","type":"text","label":"Occupation of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Attach self-attested copy of income proofs","type":"amount","label":"Monthly Income (in ₹ per annum)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Previous Insurer(s) (If Renewal of Saral Suraksha Bima Policy)","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Are all insured Indian nationals and Indian residents? Yes/No","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Benefits and Sum Insured Applicable to the Proposer","fields":[{"help":"Select premium payment mode","type":"choice","label":"Premium Payment Mode (Single / Quarterly / Semi-Annually)","options":["Single","Quarterly","Semi-Annually"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration & Authorisation","fields":[{"help":"Enter name of principal contact person","type":"text","label":"Principle Contact Person Name","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sales Person/Insurance Agent/Intermediary Declaration","fields":[{"help":"Enter full name of the agent/intermediary","type":"text","label":"Full Name","options":[],"required":true,"pdf_field":""},{"help":"Enter license or ID number","type":"text","label":"License No. / ID (Agent / Corporate Agent / Broker / Sales Person)","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Signature of proposer or intermediary","type":"signature","label":"Signature of Proposer/ Intermediary","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"insurance agent/intermediary"}],"deadlines":[],"applies_to":"Saral Suraksha Bima individual insurance policy proposals","attachments":["Self-attested copy of income proofs","Copies of policy certificates from previous insurer(s)","Additional sheet if required for previous insurer details"],"declarations":["The proposer declares that all information provided is true and complete to the best of their knowledge.","False statements or concealment of material facts will forfeit claim rights under the policy.","The policy will commence only after full payment of premium and acceptance by the company.","The proposer will notify any change in occupation or health after submission but before risk acceptance.","The proposer consents to the company seeking medical and insurance information for underwriting and claims.","The company may share proposal and medical information with government or regulatory authorities.","The proposer confirms not belonging to any excluded occupation categories listed in Section VIII.","The insurance agent/intermediary declares having explained the proposal form contents and consequences of untrue statements or non-disclosure."],"dropped_labels":6},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"1800-210-1992","label":"Customer Care Number","level":null,"hours":"Monday to Sunday: 9:00 AM – 8:00 PM","applies_to":"life","source_url":"https://www.acko.com/life/contact-us/","quote":"t us\nSupport\nRenewals\nNew to ACKO?\nRenew life insurance\nExisting ACKO Customer\nLogin and renew policy\nClaims\nCall us at\n1800-210-1992\nEmail us at\n[email protected]\nLogin\nACKO Life Home\n/\nLife Insurance\n/\nAcko Life Insurance Customer Care | Customer Care","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"+91 8069067215","label":"Customer Care Phone Number for PERSONS WITH DISABILITIES (PwD)","level":null,"hours":"Monday to Sunday: 9:00 AM – 8:00 PM","applies_to":"life","source_url":"https://www.acko.com/life/contact-us/","quote":"y to Sunday: 9:00 AM – 8:00 PM\nACKO Life Insurance Customer Care Phone Number for PERSONS WITH DISABILITIES (PwD)\nCall: +91 8069067215\nMonday to Sunday: 9:00 AM – 8:00 PM\nProducts\nLife insurance\nTerm insurance\n1 crore term insurance\nCompany\nAbout us\nCare","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-210-1992","label":"Grievance desk phone number","level":1,"hours":null,"applies_to":"life","source_url":"https://www.acko.com/life/customer-service/grievance-redressal/","quote":"t us\nSupport\nRenewals\nNew to ACKO?\nRenew life insurance\nExisting ACKO Customer\nLogin and renew policy\nClaims\nCall us at\n1800-210-1992\nEmail us at\n[email protected]\nLogin\nACKO Life Home\n/\nACKO Life Insurance Customer Service\n/\nACKO Life Insurance Grievan","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Ms. Komal Arawat (Grievance Redressal Officer) Acko Life Insurance Limited, 36/5 Hustlehub One East, Somasandrapalya, 27th Main Road, Sector 2, HSR Layout, Bangalore – 560102","label":"Grievance Redressal Officer postal address","level":2,"hours":null,"applies_to":"life","source_url":"https://www.acko.com/life/customer-service/grievance-redressal/","quote":null,"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/acko-life-insurance/2037-saral-suraksha-bima-acko-policy-proposal-form"}