{"id":2052,"title":"Service Contract Liability Insurance Policy PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"acko-life-insurance","name":"Acko Life Insurance Limited"},"source_pdf":"https://acko-cms.ackoassets.com/Proposal_Form_SCLIP_134821edd3.pdf","sha256":"b2f766c56a2c328804d81c757d225391099d4230b58e58d49bf0aa7e16e0a43c","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is for the proposer to apply for a Service Contract Liability Insurance Policy with Acko General Insurance Limited. The proposer fills it to provide details about themselves, previous insurance, covered assets, and other relevant information for underwriting.","notes":["Complete the form in CAPITAL LETTERS.","Submit the original proposal form; copies will not be accepted.","Attach additional sheets if space is insufficient.","Attach separate sheet for claim details if applicable."],"title":"Service Contract Liability Insurance Policy PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"I. 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 the full name of the proposer","type":"text","label":"Proposer Name","options":[],"required":null,"pdf_field":""},{"help":"Describe the nature of the proposer’s business","type":"text","label":"Description of the Proposer’s Business","options":[],"required":null,"pdf_field":""},{"help":"Enter the name of the principal contact person","type":"text","label":"Principal Contact Person Name","options":[],"required":null,"pdf_field":""},{"help":"Enter the full correspondence address","type":"text","label":"Correspondence Address","options":[],"required":null,"pdf_field":""},{"help":"Enter the city of the correspondence address","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"Enter the state of the correspondence address","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter the postal pin code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Telephone Number Mobile","options":[],"required":null,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E-mail","options":[],"required":null,"pdf_field":""},{"help":"Enter identification number 1","type":"text","label":"ID 1","options":[],"required":null,"pdf_field":""},{"help":"Enter identification number 2","type":"text","label":"ID 2","options":[],"required":null,"pdf_field":""},{"help":"Enter GSTIN if applicable","type":"text","label":"Customer Goods & Service Tax Identification Number (if any)","options":[],"required":false,"pdf_field":""},{"help":"Enter total number of assets to be covered","type":"number","label":"Please state the total number of Covered Asset","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"II. DETAILS OF PREVIOUS INSURER(S) (IF RENEWAL)","fields":[{"help":"Enter name of previous insurer if renewal","type":"text","label":"Name of Insurer","options":[],"required":false,"pdf_field":""},{"help":"Enter previous policy number","type":"text","label":"Policy Number","options":[],"required":false,"pdf_field":""},{"help":"Enter expiring terms of cover","type":"text","label":"Expiring terms of cover","options":[],"required":false,"pdf_field":""},{"help":"Enter period of previous insurance","type":"text","label":"Period of insurance","options":[],"required":false,"pdf_field":""},{"help":"Enter premium amount paid","type":"amount","label":"Premium paid","options":[],"required":false,"pdf_field":""},{"help":"Attach separate sheet with claim details","type":"attachment","label":"Claim details (Please attach separate sheet providing complete details of claims with individual claim records)","options":[],"required":false,"pdf_field":""},{"help":"Enter incurred claims ratio","type":"number","label":"Incurred Claims Ratio","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"III. DETAILS OF COVERED ASSET","fields":[{"help":"Select whether asset is New or Old","type":"choice","label":"Asset Category","options":["New","Old"],"required":null,"pdf_field":""},{"help":"Fill details of assets in table columns: Coverage Category, Covered Asset Type, Number of Covered Asset, Value of Covered Asset","type":"table","label":"Coverage Category, Covered Asset Type, No of Covered Asset, Value of Covered Asset (Table)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"IV. COVERED LOSS","fields":[{"help":"Fill details of covered losses and limits in table format","type":"table","label":"Covered Loss (Description of perils covered by this Policy with respect to the underlying Service Contract), Category/Asset Type, Limit of Liability for any one (1) Covered Asset, Deductible, Number of Claims Allowed (for each Covered Asset), Sub-Limits (Table)","options":[],"required":null,"pdf_field":""}],"filled_by":""},{"title":"V. BASIS OF CLAIM SETTLEMENT","fields":[{"help":"Specify agreed condition for salvage if any","type":"text","label":"Agreed condition for Salvage","options":[],"required":false,"pdf_field":""}],"filled_by":""},{"title":"VI. LIMIT OF LIABILITY IN THE AGGREGATE FOR THE POLICY","fields":[{"help":"Specify aggregate limit of liability","type":"text","label":"Limit of Liability in the Aggregate","options":[],"required":false,"pdf_field":""}],"filled_by":""},{"title":"VII. SPECIAL CONDITIONS AND WARRANTIES","fields":[{"help":"List any special conditions and warranties applicable","type":"text","label":"Special Conditions and Warranties","options":[],"required":false,"pdf_field":""}],"filled_by":""},{"title":"VIII. DECLARATION & AUTHORISATION","fields":[{"help":"Enter name of principal contact person signing the declaration","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":"IX. 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 number or ID","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":"Service Contract Liability Insurance Policy","attachments":["Separate sheet providing complete details of claims with individual claim records","Annexure 1: List of Covered Asset","Appendix A: Copy of Service Contract Terms & Conditions"],"declarations":["The proposer declares that all statements and particulars are true and complete to the best of their knowledge.","The policy will come into force only after full payment of the premium chargeable.","The proposer authorizes the company to share information pertaining to the proposal for underwriting and claims settlement purposes.","If any information is found untrue or there is non-disclosure, the company may alter or cancel coverage.","The liability of the company does not commence until full premium is received and proposal acceptance is intimated.","The insurance agent/intermediary declares that they have explained the proposal form contents and consequences of untrue statements or non-disclosure.","No person shall offer or accept rebates as inducement to take or continue insurance except as allowed by insurer's prospectus or tables.","Non-compliance with rebate prohibition may lead to penalty up to 10 lakh rupees."],"dropped_labels":4},"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/2052-service-contract-liability-insurance-policy-proposal-form"}