{"id":2043,"title":"ACKO 360 PROTECT PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"acko-life-insurance","name":"Acko Life Insurance Limited"},"source_pdf":"https://acko-cms.ackoassets.com/Proposal_Form_Acko_360_Protect_f907372c25.pdf","sha256":"f1a93c82b6c10c00eb2f88f305b9ca38f302b7ba84538171ba462caf1ae21af6","pages":11,"collected":"2026-10-17","instructions":{"about":"This form is for groups, associations, institutions, or corporate bodies to propose insurance coverage under the Acko 360 Protect policy. It is filled by the proposer representing the group.","notes":["Complete the form in CAPITAL LETTERS.","Submit the original form only; copies will not be accepted.","Pan No./TAN No. is mandatory for premium payments above specified limits.","Minor should not be declared as nominee.","All nominations will comply with Section 39 of the Insurance Act 1938.","Use separate sheets or annexures if space is insufficient.","The liability of the company does not commence until premium is fully received and proposal accepted.","The form includes a prohibition of rebates as per Section 41 of the Insurance Act, 1938."],"title":"ACKO 360 PROTECT PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer (Group) Details","fields":[{"help":"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":"Name of the group or corporate body proposing insurance","type":"text","label":"Proposer Name","options":[],"required":true,"pdf_field":""},{"help":"Brief description of the business activity of the proposer","type":"text","label":"Description of the Proposer’s Business","options":[],"required":true,"pdf_field":""},{"help":"Name of the main contact person for correspondence","type":"text","label":"Principal Contact Person Name","options":[],"required":true,"pdf_field":""},{"help":"Full postal address for correspondence","type":"text","label":"Correspondence Address","options":[],"required":true,"pdf_field":""},{"help":"City of correspondence address","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"State of correspondence address","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Postal code of correspondence address","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Mobile phone number of principal contact","type":"phone","label":"Telephone Number Mobile","options":[],"required":true,"pdf_field":""},{"help":"Email address of principal contact","type":"email","label":"E-mail","options":[],"required":true,"pdf_field":""},{"help":"Any identification number","type":"text","label":"ID 1","options":[],"required":null,"pdf_field":""},{"help":"Any second identification 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/card","type":"text","label":"Pan No. / TAN No.","options":[],"required":null,"pdf_field":""},{"help":"GSTIN if applicable","type":"text","label":"Customer Goods & Service Tax Identification Number (if any)","options":[],"required":false,"pdf_field":""},{"help":"Select the nature of the group","type":"choice","label":"Nature of Group","options":["Employer/employee","Non-employer/employee"],"required":true,"pdf_field":""},{"help":"Select policy type","type":"choice","label":"Nature of Policy","options":["Named basis","Unnamed basis"],"required":true,"pdf_field":""},{"help":"Indicate if all eligible persons are proposed","type":"yes-no","label":"Please state whether all eligible Insured Persons/families of the Group / Association / Institution / Corporate Body are proposed for insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Total count of insured persons including dependents","type":"number","label":"Please state the total number of Insured Persons to be covered (including families / dependents wherever covered)","options":[],"required":true,"pdf_field":""},{"help":"List all parties with insurable interest","type":"text","label":"Policy to be issued in favor of (List of all the parties who have insurable interest including the financial institutions)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Previous Insurer(s) (If Renewal)","fields":[{"help":"Indicate if current insurance exists","type":"yes-no","label":"Are your employees/ Insured Persons at present insured under any similar product?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Name of previous insurer if applicable","type":"text","label":"Name of Insurer","options":[],"required":null,"pdf_field":""},{"help":"Previous policy number","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Terms of expiring coverage","type":"text","label":"Expiring terms of cover","options":[],"required":null,"pdf_field":""},{"help":"Insurance period of previous policy","type":"text","label":"Period of insurance","options":[],"required":null,"pdf_field":""},{"help":"Premium amount paid for previous policy","type":"amount","label":"Premium paid","options":[],"required":null,"pdf_field":""},{"help":"Attach separate sheet with claim details","type":"attachment","label":"Claim details","options":[],"required":false,"pdf_field":""},{"help":"Claims ratio if known","type":"number","label":"Incurred Claims Ratio","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Insured Persons","fields":[{"help":"Attach separate list for unnamed members","type":"text","label":"For unnamed members / Employees","options":[],"required":null,"pdf_field":""},{"help":"Fill Annexure 1 with details of named members","type":"attachment","label":"For Named member / Employees","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Benefits","fields":[{"help":"Fill details of optional covers opted with sum insured and special conditions","type":"table","label":"Optional Benefits","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration & Authorisation","fields":[{"help":"Name of the principal contact person signing the declaration","type":"text","label":"Principle Contact Person Name","options":[],"required":true,"pdf_field":""},{"help":"Date of signing the declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Signature of authorized proposer","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sales Person/Insurance Agent/Intermediary Declaration","fields":[{"help":"Name of the agent or intermediary","type":"text","label":"Full Name","options":[],"required":true,"pdf_field":""},{"help":"Agent or intermediary license or ID number","type":"text","label":"License No. / ID (Agent / Corporate Agent / Broker / Sales Person)","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","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":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"agent"},{"title":"Annexure - Home Building and Home Content","fields":[{"help":"Indicate if existing policy for the property","type":"yes-no","label":"Is there any policy in place for the same property?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Details of existing policy if any","type":"text","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Select cover type","type":"choice","label":"Cover/s required","options":["Home Building & Home Contents","Home Building Only","Home Contents Only"],"required":true,"pdf_field":""},{"help":"Tick if opting for additional cover","type":"checkbox","label":"Additional Cover: Cover for Valuable Contents on Agreed Value Basis","options":[],"required":false,"pdf_field":""},{"help":"Full address of home building","type":"text","label":"Location of Home Building Address","options":[],"required":true,"pdf_field":""},{"help":"Postal code of home building","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Specify building type","type":"text","label":"Is it a multi-storey building or is it a standalone house?","options":[],"required":true,"pdf_field":""},{"help":"Floor number if applicable","type":"number","label":"In case of multi-storey building, please provide the floor number of your house","options":[],"required":false,"pdf_field":""},{"help":"Indicate presence of basement","type":"yes-no","label":"Is there a basement to Your house?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select age category","type":"choice","label":"Age of Home Building","options":["Less than 5 years","5-10 years","10-20 years","Above 20 years"],"required":true,"pdf_field":""},{"help":"Carpet area in square meters","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":true,"pdf_field":""},{"help":"Cost rate per square meter","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date","options":[],"required":true,"pdf_field":""},{"help":"Sum insured for loss of rent","type":"amount","label":"Loss of Rent Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Sum insured for rent of alternative accommodation","type":"amount","label":"Rent for Alternative Accommodation Sum Insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Asset Protection Related Covers","fields":[{"help":"Fill depreciation percentages applicable by asset age and option chosen","type":"table","label":"Depreciation Schedule","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Group insurance proposals for Acko 360 Protect policy","attachments":["Separate sheet with claim details if applicable","Annexure 1 with named insured persons details","Additional sheets for insured persons if space insufficient"],"declarations":["The proposer declares that all information provided is true, accurate, and complete to the best of their knowledge.","The policy will come into force only after full payment of premium and acceptance by the company.","The proposer will notify any changes in occupation or health after submission but before acceptance.","The proposer consents to the company seeking medical and insurance information for underwriting and claims.","The company may share proposal and claim information with governmental or regulatory authorities.","If information is found untrue or undisclosed, the company may cancel or alter coverage and forfeit premiums."],"dropped_labels":15},"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/2043-acko-360-protect-proposal-form"}