{"id":2072,"title":"अविवा जन सुरक्षा हेतु प्रस्ताव फार्म","purpose":"proposal","insurer":{"slug":"aviva-life-insurance","name":"Aviva Life Insurance Company India Limited"},"source_pdf":"https://www.avivaindia.com/sites/default/files/JS_Hindi.pdf","sha256":"d136e67ff1b1f1395ae140d7dde64c288e83e40783109e924285bdfa0998d341","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is a proposal form for the Aviva Jana Suraksha insurance policy, to be filled by the proposer who wishes to apply for the policy.","notes":["Fill the form in capital letters and black ink.","Attach proof of age document.","Initial payment must be submitted with the proposal form.","Refunds for cash payments will be made by cheque only.","The proposer should carefully read the key features brochure sections 'Additional Information' and 'Your Commitment'.","The form includes legal provisions from the Insurance Act, 1938 regarding rebates and policy repudiation."],"title":"अविवा जन सुरक्षा हेतु प्रस्ताव फार्म","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Life to be Insured Details","fields":[{"help":"Select appropriate title","type":"choice","label":"श्री/श्रीमती/सुश्री/Mr/Mrs/Miss/Ms","options":["Mr","Mrs","Miss","Ms"],"required":null,"pdf_field":""},{"help":"Enter surname in capital letters","type":"text","label":"उपनाम/Surname","options":[],"required":null,"pdf_field":""},{"help":"Enter forenames in capital letters","type":"text","label":"पूर्व नाम/Forenames","options":[],"required":null,"pdf_field":""},{"help":"Enter father's or husband's name","type":"text","label":"पिता/पति का नाम Father’s/Husband’s Name","options":[],"required":null,"pdf_field":""},{"help":"Enter full present address including village, P.O., Taluka/Mandal/Town, District, State, Pincode","type":"text","label":"वर्तमान पता/Present Address","options":[],"required":null,"pdf_field":""},{"help":"Enter permanent address if different from present address","type":"text","label":"स्थाई पता (यदि उपरोक्त पते से भिन्न हो) Permanent Address (If different from above)","options":[],"required":false,"pdf_field":""},{"help":"Enter address for correspondence","type":"text","label":"पत्र-व्यवहार के लिए पता Present Address Address for Correspondence","options":[],"required":null,"pdf_field":""},{"help":"Enter permanent address","type":"text","label":"स्थाई पता Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"Select gender","type":"choice","label":"लिंग Gender","options":["पुरुष Male","स्त्री Female"],"required":null,"pdf_field":""},{"help":"Enter date of birth in dd/mm/yyyy format","type":"date","label":"जन्म तिथि Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"वैवाहिक स्थिति Marital Status","options":["अविवाहित Single","विवाहित Married","विधवा (विधुर) Widow(er)","तलाकशुदा Divorced"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposer's Details (If different from life to be insured)","fields":[{"help":"Select appropriate title","type":"choice","label":"श्री/श्रीमती/सुश्री/Mr/Mrs/Miss/Ms","options":["Mr","Mrs","Miss","Ms"],"required":false,"pdf_field":""},{"help":"Enter surname","type":"text","label":"उपनाम/Surname","options":[],"required":false,"pdf_field":""},{"help":"Enter forenames","type":"text","label":"पूर्वनाम/Forenames","options":[],"required":false,"pdf_field":""},{"help":"Enter father's or husband's name","type":"text","label":"पिता/पति का नाम Father’s/Husband’s Name","options":[],"required":false,"pdf_field":""},{"help":"Enter full present address including village, P.O., Taluka/Mandal/Town, District, State, Pincode","type":"text","label":"वर्तमान पता Present Address","options":[],"required":false,"pdf_field":""},{"help":"Enter date of birth in dd/mm/yyyy format","type":"date","label":"जन्म तिथि/Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Select relationship to the life to be insured","type":"choice","label":"बीमाकृत व्यक्ति से संबंध Relationship to the Life to be insured","options":["पिता Father","माता Mother","पति/पत्नी Spouse","कानूनी अभिभावक Legal Guardian","अन्य Others"],"required":false,"pdf_field":""},{"help":"Enter annual income in rupees","type":"number","label":"वार्षिक आय (रुपये) Income per annum (Rs. in figures)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Details","fields":[{"help":"Enter sum insured amount in rupees","type":"amount","label":"बीमाकृत रकम (रुपये) Sum Insured (Rs. in figures)","options":[],"required":true,"pdf_field":""},{"help":"Enter premium amount in rupees","type":"amount","label":"प्रीमियम (रुपये) Premium (Rs. in figures)","options":[],"required":true,"pdf_field":""},{"help":"Select policy term","type":"choice","label":"अवधि (वर्ष) Term in years","options":["5 वर्ष 5 Years","10 वर्ष 10 Years"],"required":true,"pdf_field":""},{"help":"Select premium payment frequency","type":"choice","label":"प्रीमियम जमा करने की आवृत्ति Premium frequency","options":["एकल प्रीमियम Single Premium","वार्षिक प्रीमियम Annual Premium"],"required":true,"pdf_field":""},{"help":"Select mode of payment","type":"choice","label":"भुगतान करने की विधि Preferred Mode of Payment","options":["नकद Cash","चैक Cheque","डिमांड ड्राफ्ट Demand Draft"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nomination Details (To be completed only when the proposer and the life to be insured are the same)","fields":[{"help":"Enter name of nominee","type":"text","label":"नामांकित व्यक्ति का नाम Name of the Nominee","options":[],"required":false,"pdf_field":""},{"help":"Enter relationship of nominee to life insured","type":"text","label":"बीमाकृत व्यक्ति से संबंध Relationship to the Life to be insured","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's date of birth in dd/mm/yyyy format","type":"date","label":"जन्म तिथि Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's address","type":"text","label":"पता Address","options":[],"required":false,"pdf_field":""},{"help":"If nominee is minor, enter appointee's name","type":"text","label":"मनोनीत व्यक्ति का नाम Name of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"Enter appointee's date of birth in dd/mm/yyyy format","type":"date","label":"जन्म तिथि Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Enter relationship of appointee to minor nominee","type":"text","label":"नाबालिग से संबंध Relationship to the Minor","options":[],"required":false,"pdf_field":""},{"help":"Enter appointee's address","type":"text","label":"पता Address","options":[],"required":false,"pdf_field":""},{"help":"Appointee to sign here","type":"signature","label":"मनोनीत व्यक्ति के हस्ताक्षर Signature of the Appointee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Aviva Jana Suraksha policy proposals","attachments":["Proof of age"],"declarations":["The proposer must be satisfied with the policy details and key features brochure sections 'Additional Information' and 'Your Commitment'.","Receipt of the completed proposal and initial payment does not create any risk liability until the policy is issued.","Initial payment must accompany the proposal and can be paid by cash, cheque, or demand draft payable to Aviva Life Insurance Account Proposal Number.","Refunds for cash deposits, if any, will be made by cheque only.","If the proposer provides incomplete or incorrect information, the policy contract may be declared void.","Proof of age is mandatory.","No person shall offer or accept any rebate of commission or premium except as allowed by the insurer's published prospectus.","Policy can be called in question within three years on grounds of fraud or misstatement, with insurer required to communicate grounds in writing.","Premiums collected till repudiation shall be paid back if repudiation is not on grounds of fraud.","Insurer may call for proof of age at any time and adjust policy terms accordingly."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"email","value":"customerservices@avivaindia.com","label":"General Enquiries- Customer Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"stomer\nCall (All Days & Toll Free)\n1800-103-7766\n,\n0124-2709046\nCall (Toll Free) - For Kerala users\n1800-103-8000\nEmail\ncustomerservices@avivaindia.com\nSenior Citizen\nseniorcitizen@avivaindia.com\nGeneral Enquiries- Partner\nCall (All Days & Toll Free)\n1800-180-2111\nEmail","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"email","value":"weconnect@avivaindia.com","label":"General Enquiries- Partner Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"Senior Citizen\nseniorcitizen@avivaindia.com\nGeneral Enquiries- Partner\nCall (All Days & Toll Free)\n1800-180-2111\nEmail\nweconnect@avivaindia.com\nContact Grievance Officer\nEmail\ncomplaints@avivaindia.com\nCall (Mon-Fri, 9am-6pm)\n+91 9999346907\nCustomer\nGroup\nAdvisor","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-103-7766","label":"General Enquiries- Customer Toll Free","level":null,"hours":"All Days","applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"Jeevan Bima Plan\nGuaranteed Savings Plan\nULIP Plans\nPAY PREMIUM\nGeneral Enquiries- Customer\nCall (All Days & Toll Free)\n1800-103-7766\n,\n0124-2709046\nCall (Toll Free) - For Kerala users\n1800-103-8000\nEmail\ncustomerservices@avivaindia.com\nSenior Citizen\ns","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"0124-2709046","label":"General Enquiries- Customer","level":null,"hours":"All Days","applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"Guaranteed Savings Plan\nULIP Plans\nPAY PREMIUM\nGeneral Enquiries- Customer\nCall (All Days & Toll Free)\n1800-103-7766\n,\n0124-2709046\nCall (Toll Free) - For Kerala users\n1800-103-8000\nEmail\ncustomerservices@avivaindia.com\nSenior Citizen\nseniorcitizen@av","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-103-8000","label":"Call (Toll Free) - For Kerala users","level":null,"hours":null,"applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"eneral Enquiries- Customer\nCall (All Days & Toll Free)\n1800-103-7766\n,\n0124-2709046\nCall (Toll Free) - For Kerala users\n1800-103-8000\nEmail\ncustomerservices@avivaindia.com\nSenior Citizen\nseniorcitizen@avivaindia.com\nGeneral Enquiries- Partner\nCall (All","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-180-2111","label":"General Enquiries- Partner Toll Free","level":null,"hours":null,"applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"vices@avivaindia.com\nSenior Citizen\nseniorcitizen@avivaindia.com\nGeneral Enquiries- Partner\nCall (All Days & Toll Free)\n1800-180-2111\nEmail\nweconnect@avivaindia.com\nContact Grievance Officer\nEmail\ncomplaints@avivaindia.com\nCall (Mon-Fri, 9am-6pm)\n+91 99","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"0124-2709000/46","label":"Corporate Office Phone","level":null,"hours":null,"applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"Office\n401-A, 4th Floor,\nBlock A, DLF Cyber Park,\nSector-20, NH-8, Gurugram,\nHaryana-122 016, India.\nTelephone Number:\n0124-2709000/46\nEmail:\ncustomerservices@avivaindia.com\nToll Free Helpline:\n18001037766\n,\n0124-2709046\nGive a Missed Call:\n+91-767757677","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"+91-7677576775","label":"Give a Missed Call","level":null,"hours":null,"applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"24-2709000/46\nEmail:\ncustomerservices@avivaindia.com\nToll Free Helpline:\n18001037766\n,\n0124-2709046\nGive a Missed Call:\n+91-7677576775\nSMS\n\"Aviva\"to 5676737\nInsurance is the subject matter of the solicitation.\nIRDAI Reg No.\n122\n|\nCIN\n              :\nU660","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"sms","value":"\"Aviva\"to 5676737","label":"SMS Service","level":null,"hours":null,"applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":":\ncustomerservices@avivaindia.com\nToll Free Helpline:\n18001037766\n,\n0124-2709046\nGive a Missed Call:\n+91-7677576775\nSMS\n\"Aviva\"to 5676737\nInsurance is the subject matter of the solicitation.\nIRDAI Reg No.\n122\n|\nCIN\n              :\nU66010DL2000PLC107880\nAviv","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"complaints@avivaindia.com","label":"Contact Grievance Officer Email","level":1,"hours":null,"applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"iries- Partner\nCall (All Days & Toll Free)\n1800-180-2111\nEmail\nweconnect@avivaindia.com\nContact Grievance Officer\nEmail\ncomplaints@avivaindia.com\nCall (Mon-Fri, 9am-6pm)\n+91 9999346907\nCustomer\nGroup\nAdvisor\nsearch\nTERM","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"+91 9999346907","label":"Contact Grievance Officer Phone","level":1,"hours":"Mon-Fri, 9am-6pm","applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"0-2111\nEmail\nweconnect@avivaindia.com\nContact Grievance Officer\nEmail\ncomplaints@avivaindia.com\nCall (Mon-Fri, 9am-6pm)\n+91 9999346907\nCustomer\nGroup\nAdvisor\nsearch\nTERM\n                                                            INSURANCE\nAviva Smart Re","fetched_at":"2026-10-20"},{"purpose":"gro","channel":"address","value":"401-A, 4th Floor, Block A, DLF Cyber Park, Sector- 20, NH- 8, Gurugram, Haryana - 122016","label":"Complaint Redressal Officer (CRO) Address","level":2,"hours":null,"applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"examine your issues and provide you impartial resolution. The CRO can be reached at :\nComplaint Redressal Officer(CRO).\n401-A, 4th Floor, Block A, DLF Cyber Park, Sector- 20, NH- 8, Gurugram, Haryana - 122016\nEmail :\ncro@avivaindia.com\nLevel 3\n: Insurance Ombudsman Scheme.\nThe insurance Ombudsman is empowered to receive and co","fetched_at":"2026-10-20"},{"purpose":"gro","channel":"email","value":"cro@avivaindia.com","label":"Complaint Redressal Officer (CRO) Email","level":2,"hours":null,"applies_to":"all","source_url":"https://www.avivaindia.com/grievance-mechanism","quote":"edressal Officer(CRO).\n401-A, 4th Floor, Block A, DLF Cyber Park, Sector- 20, NH- 8, Gurugram, Haryana - 122016\nEmail :\ncro@avivaindia.com\nLevel 3\n: Insurance Ombudsman Scheme.\nThe insurance Ombudsman is empowered to receive and consider complaints from any","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/aviva-life-insurance/2072-x"}