{"id":2079,"title":"Aviva AnnuityPlus Proposal Form","purpose":"proposal","insurer":{"slug":"aviva-life-insurance","name":"Aviva Life Insurance Company India Limited"},"source_pdf":"https://www.avivaindia.com/sites/default/files/TIA%20Punjabi%20img.pdf","sha256":"ddcbd586d6db36aeb2ba970830f552be59ca6b06817a26adcb5444337a055dd8","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals applying for the Aviva AnnuityPlus life insurance product. The proposer (annuitant) fills it to provide personal, occupational, and plan details for underwriting and policy issuance.","notes":["Use capital letters and leave spaces between name parts and address parts.","Proof of age is mandatory.","Counter sign any alterations or overwriting in the form.","Only NEFT mode is allowed for quarterly and monthly annuity payments.","Existence certificate must be submitted on policy anniversaries as per annuity option.","In case of signature in vernacular or thumb impression, a declarant of standing unconnected with Aviva must make the declaration."],"title":"Aviva AnnuityPlus Proposal Form","submit":{"to":"Aviva Life Insurance Company India Ltd.","how":"","address":"Aviva Tower, Sector Road, Opp. Golf Course, DLF Phase-V, Sector 43, Gurgaon 122 003 Haryana"},"purpose":"proposal","sections":[{"title":"Details of the Annuitant","fields":[{"help":"Write your full name in capital letters with spaces between name parts.","type":"text","label":"Full Name : THIS IS HOW YOUR NAME WILL APPEAR ON THE POLICY CERTIFICATE. PLEASE LEAVE A SPACE BETWEEN EACH PART OF THE NAME.","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Title : Mr. / Mrs. / Ms. / Dr.","options":["Mr.","Mrs.","Ms.","Dr."],"required":true,"pdf_field":""},{"help":"","type":"text","label":"First Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Middle Name","options":[],"required":false,"pdf_field":""},{"help":"Fill only if applicable for married female proposer.","type":"text","label":"Malden Name (in case of married female life to be insured)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Father's Name","options":[],"required":true,"pdf_field":""},{"help":"Use DD/MM/YYYY format.","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Gender","options":["Male","Female","Unmarried"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status","options":["Married","Widow(er)","Divorced","NA"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"No. of Children","options":["1","2","3","Greater than 3","NA"],"required":false,"pdf_field":""},{"help":"Specify nationality if not Indian or PIO.","type":"choice","label":"Nationality","options":["Indian","Foreign National","Person of Indian Origin","Specify Nationality"],"required":true,"pdf_field":""},{"help":"Specify country of residence if not residing in India.","type":"choice","label":"Residential Status","options":["Residing in India","Not Residing in India"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Communication Address","options":["Residence","Permanent","Office"],"required":true,"pdf_field":""},{"help":"Include c/o, s/o, w/o, d/o, h/o, f/o as applicable. Leave spaces between address parts.","type":"text","label":"Current Residential Address","options":[],"required":true,"pdf_field":""},{"help":"Include c/o, s/o, w/o, d/o, h/o, f/o as applicable.","type":"text","label":"Permanent Address (IF DIFFERENT FROM CURRENT RESIDENTIAL ADDRESS)","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Educational Qualification","options":["Post Graduate","Graduate","Diploma","12th Pass","Below 12th","Others (Specify)"],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Occupation","options":["Self-employed","Salaried","Business Owner","Student","Retired/Pensioner","Housewife","Agriculturist","Others (Specify)"],"required":true,"pdf_field":""},{"help":"Fill only if occupation is student.","type":"text","label":"If student (a) Course presently pursuing","options":[],"required":false,"pdf_field":""},{"help":"Fill only if occupation is student.","type":"text","label":"(b) Name of Institution","options":[],"required":false,"pdf_field":""},{"help":"Fill only if occupation is student.","type":"text","label":"(c) Duration of Course","options":[],"required":false,"pdf_field":""},{"help":"Describe your job duties clearly.","type":"text","label":"Exact Nature of Duties (Give Description e.g: Trading In Food Grain / Textiles, Driving Taxi / Business of Diamond Export etc.)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Your Designation","options":[],"required":false,"pdf_field":""},{"help":"If yes, provide details.","type":"yes-no","label":"Is your occupation associated with any specific hazard (e.g. Chemical factory, mines, explosives, corrosive chemicals etc.) If yes, please give details.","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name of Organisation/Business","options":[],"required":false,"pdf_field":""},{"help":"Include landmark, city/village, district, state, pin code.","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Include STD code if applicable.","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Attach proof of age document.","type":"choice","label":"Age proof","options":["School/College Certificate","Municipal Records","Defence ID Card","Passport","Others (Specify)"],"required":true,"pdf_field":""},{"help":"Provide PAN number if available.","type":"text","label":"Income Tax PAN Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer (annuitant)"},{"title":"Nomination/Beneficiary Details (Applicable for option II, III & IV only)","fields":[{"help":"","type":"text","label":"Name of the Nominee / Beneficiary (*Under section 39 of the Insurance Act 1938)","options":[],"required":true,"pdf_field":""},{"help":"Use DD/MM/YYYY format.","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Include landmark, city/village, district, state, pin code.","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Include STD code if applicable.","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Fill if nominee is minor.","type":"text","label":"If Nominee/Beneficiary is a Minor, please give details of the appointee (should be a Major): a. Name of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"Fill if nominee is minor.","type":"text","label":"b. Relationship to the Minor","options":[],"required":false,"pdf_field":""},{"help":"Fill if nominee is minor. Use DD/MM/YYYY format.","type":"date","label":"c. Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Fill if nominee is minor.","type":"text","label":"d. Address","options":[],"required":false,"pdf_field":""},{"help":"Fill if nominee is minor.","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"Fill if nominee is minor.","type":"signature","label":"Signature of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"Fill if nominee is minor.","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer (annuitant)"},{"title":"Details of the plan applied for","fields":[{"help":"Pre-filled with plan name.","type":"text","label":"Name of the Plan: Aviva AnnuityPlus","options":[],"required":true,"pdf_field":""},{"help":"Select one annuity option.","type":"choice","label":"Annuity Option:","options":["Life Annuity","Annuity guaranteed for 5 years and life thereafter","Annuity guaranteed for 10 years and life thereafter","Annuity guaranteed for 15 years and life thereafter","Annuity for life increasing @ 3% per annum simple"],"required":true,"pdf_field":""},{"help":"Enter the purchase price amount.","type":"amount","label":"Purchase price (Not applicable for Aviva Pension policyholders)","options":[],"required":true,"pdf_field":""},{"help":"Select yes or no.","type":"yes-no","label":"Are you funding the purchase price through the maturity proceed of an existing pension policy.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Quarterly and Monthly payments require NEFT mode only.","type":"choice","label":"Annuity frequency:","options":["Yearly","Half-Yearly","Quarterly","Monthly"],"required":true,"pdf_field":""},{"help":"Select preferred payout mode.","type":"choice","label":"Preferred mode of payout:","options":["Cheque","NEFT (National Electronic Fund Transfer)"],"required":true,"pdf_field":""},{"help":"Provide bank account number for annuity payout.","type":"text","label":"Bank Details (For Annuity Payout) - Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Provide bank name.","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Provide branch address.","type":"text","label":"Address of Branch","options":[],"required":false,"pdf_field":""},{"help":"Select account type.","type":"choice","label":"Account Type","options":["Saving Account","Current Account","NRO/NRE"],"required":true,"pdf_field":""},{"help":"Provide MICR code if available.","type":"number","label":"MICR Code (9 digits)","options":[],"required":false,"pdf_field":""},{"help":"Use DD/MM/YYYY format.","type":"date","label":"Date of maturity","options":[],"required":false,"pdf_field":""},{"help":"Select if commutation is opted.","type":"yes-no","label":"Commutation opted","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want to pay additional amount.","type":"yes-no","label":"Do you want to increase the purchase price","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify additional amount if increasing purchase price.","type":"amount","label":"If yes, please mention the additional amount you want to pay Rs.","options":[],"required":false,"pdf_field":""},{"help":"Enter fund value date and amount if applicable.","type":"amount","label":"Fund Value as on","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer (annuitant)"},{"title":"Declaration & Authorization","fields":[{"help":"Sign or provide thumb impression here.","type":"signature","label":"Signature* / thumb impression* of the Annuitant","options":[],"required":true,"pdf_field":""},{"help":"Date of signing in DD/MM/YYYY format.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing.","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer (annuitant)"},{"title":"Vernacular Declaration","fields":[{"help":"Handwrite the declaration in your own language.","type":"text","label":"The Annuitant should fill in the following declaration in the box given below","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer (annuitant)"},{"title":"Declaration by the person filling in the form","fields":[{"help":"Fill pincode of declarant's address.","type":"number","label":"Pincode","options":[],"required":true,"pdf_field":""},{"help":"Declarant must sign here.","type":"signature","label":"Signature of declarant*","options":[],"required":true,"pdf_field":""}],"filled_by":"person filling the form if proposer cannot sign or uses vernacular"}],"deadlines":[],"applies_to":"Aviva AnnuityPlus life insurance annuity proposals","attachments":["Proof of age document","Cancelled cheque for NEFT mode","Duly completed and signed NEFT mandate","Existence certificate as required on policy anniversaries"],"declarations":["The proposer declares that all information given is true and complete and understands the importance of full disclosure.","The proposer authorizes release of medical and employment information to the company for risk assessment.","If the proposal is filled by another person, the proposer confirms the contents have been fully explained and understood.","The proposal form will form part of the insurance contract if accepted by the company."],"dropped_labels":9},"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/2079-aviva-annuityplus-proposal-form"}