{"id":2084,"title":"Proposal Form for Doiva CE Bima Laabh Hojana","purpose":"proposal","insurer":{"slug":"aviva-life-insurance","name":"Aviva Life Insurance Company India Limited"},"source_pdf":"https://www.avivaindia.com/sites/default/files/BLY%20Tamil.pdf","sha256":"a8b43278f0623c68f0e36968749de03ed7ea09f9e2260f5ece82893c0ed93ff6","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for life insurance under the Aviva CSC Bima Laabh Yojana, to be filled by the proposer and the life to be insured.","notes":["Use capital letters to fill the form.","Proof of age is mandatory.","Initial payment must accompany the proposal and can be paid by cash, crossed cheque or demand draft payable to Aviva Life Insurance Account Proposal Number.","Refunds for cash deposits will be made by cheque or other approved methods.","The proposer must provide full and accurate information as per Section 45 of the Insurance Act 1938.","The form includes sections in Tamil and English; ensure all required fields are completed.","Office use only sections are not to be filled by the proposer."],"title":"Proposal Form for Doiva CE Bima Laabh Hojana","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Life Assured Details","fields":[{"help":"Tick if the life assured is the same as the proposer","type":"checkbox","label":"Life Assured same as Proposer","options":["Yes"],"required":null,"pdf_field":""},{"help":"Select appropriate title","type":"choice","label":"Mr/Mrs/MIss/Ms","options":["Mr","Mrs","Miss","Ms"],"required":true,"pdf_field":""},{"help":"Enter surname in capital letters","type":"text","label":"Surname","options":[],"required":true,"pdf_field":""},{"help":"Enter first names in capital letters","type":"text","label":"Forenames","options":[],"required":true,"pdf_field":""},{"help":"Enter father's or husband's name","type":"text","label":"Father's/Husband's Name","options":[],"required":true,"pdf_field":""},{"help":"Enter current mailing address","type":"text","label":"Mailing Address","options":[],"required":true,"pdf_field":""},{"help":"Enter village name","type":"text","label":"Village","options":[],"required":null,"pdf_field":""},{"help":"Enter post office","type":"text","label":"P.O.","options":[],"required":null,"pdf_field":""},{"help":"Enter mandal, taluka or town","type":"text","label":"Mandal/Taluka/Town","options":[],"required":null,"pdf_field":""},{"help":"Enter district","type":"text","label":"District","options":[],"required":null,"pdf_field":""},{"help":"Enter state name","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter postal pin code","type":"number","label":"Pin code","options":[],"required":true,"pdf_field":""},{"help":"Enter permanent address","type":"text","label":"Permanent Address","options":[],"required":true,"pdf_field":""},{"help":"Select proof of address document","type":"choice","label":"Proof of Address","options":["School Certificate","Others","Voter ID Card","Family Card"],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"Enter annual income in rupees","type":"amount","label":"Life Insured's Annual Income Rs.","options":[],"required":true,"pdf_field":""},{"help":"Enter occupation","type":"text","label":"Occupation","options":[],"required":true,"pdf_field":""},{"help":"Enter date of birth (dd/mm/yyyy)","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Select document used as age proof","type":"choice","label":"Age Proof","options":["School Certificate","Others","Voter ID Card","Family Card"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of the Proposer (if different from life to be insured)","fields":[{"help":"Select appropriate title","type":"choice","label":"Mr/Mrs/Miss/Ms","options":["Mr","Mrs","Miss","Ms"],"required":null,"pdf_field":""},{"help":"Enter surname","type":"text","label":"Surname","options":[],"required":null,"pdf_field":""},{"help":"Enter first names","type":"text","label":"Forenames","options":[],"required":null,"pdf_field":""},{"help":"Enter father's or husband's name","type":"text","label":"Father's/Husband's Name","options":[],"required":null,"pdf_field":""},{"help":"Enter current mailing address","type":"text","label":"Mailing Address","options":[],"required":null,"pdf_field":""},{"help":"Enter village name","type":"text","label":"Village","options":[],"required":null,"pdf_field":""},{"help":"Enter post office","type":"text","label":"P.O.","options":[],"required":null,"pdf_field":""},{"help":"Enter mandal, taluka or town","type":"text","label":"Mandal/Taluka/Town","options":[],"required":null,"pdf_field":""},{"help":"Enter district","type":"text","label":"District","options":[],"required":null,"pdf_field":""},{"help":"Enter state name","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter postal pin code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Enter permanent address","type":"text","label":"Permanent Address","options":[],"required":null,"pdf_field":""},{"help":"Select proof of address document","type":"choice","label":"Proof of Address","options":["School Certificate","Others","Voter ID Card","Family Card"],"required":null,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Enter annual income in rupees","type":"amount","label":"Life Insured's Annual Income Rs.","options":[],"required":null,"pdf_field":""},{"help":"Enter occupation","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth (dd/mm/yyyy)","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Select document used as age proof","type":"choice","label":"Age Proof","options":["School Certificate","Others","Voter ID Card","Family Card"],"required":null,"pdf_field":""},{"help":"Describe relationship","type":"text","label":"Relationship of the proposer to the life to be insured","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Details","fields":[{"help":"Enter sum assured in rupees","type":"amount","label":"Sum Assured(Rs. In figures)","options":[],"required":true,"pdf_field":""},{"help":"Enter premium amount in rupees","type":"amount","label":"Premium (Rs. in figures)","options":[],"required":true,"pdf_field":""},{"help":"Enter policy term in years","type":"number","label":"Policy Term (PT)","options":[],"required":true,"pdf_field":""},{"help":"Select mode of payment","type":"choice","label":"Preferred Mode of Payment","options":["Cash","Cheque","Others"],"required":true,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Do you have Aadhar Number","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter Aadhar number if available","type":"text","label":"If yes please provide Aadhar Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nomination Details","fields":[{"help":"Enter nominee's full name","type":"text","label":"Name of the Nominee (Under section 39 of the Insurance Act 1938)","options":[],"required":true,"pdf_field":""},{"help":"Enter relationship of nominee to life insured","type":"text","label":"Relationship to the Life to be Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's date of birth (dd/mm/yyyy)","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Tick if nominee is minor and fill appointee details","type":"checkbox","label":"If Nominee is a Minor, please give appointee details below","options":["Yes"],"required":null,"pdf_field":""},{"help":"Enter relationship of appointee to minor nominee","type":"text","label":"Relationship to the Minor","options":[],"required":false,"pdf_field":""},{"help":"Enter appointee's date of birth (dd/mm/yyyy)","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Enter appointee's address","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Appointee must sign here","type":"signature","label":"Signature of the Appointee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration of Good Health","fields":[{"help":"Answer yes or no","type":"yes-no","label":"A. Are you in good health?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"B. Have you ever had a heart condition, a stroke, hypertension, paralysis, cancer, diabetes, kidney disease, liver disease, mental illness, HIV infection or AIDS, high cholesterol, blood disorder, respiratory disorder, and nervous disorder?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"C. Are you currently taking any medication or drugs, other than for minor conditions, or have you suffered from any illness, disorder, disability or injury during the past 5 years which required medical examination, consultation, hospitalisation or surgery?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer yes or no if applicable","type":"yes-no","label":"E. Are you currently pregnant? (If applicable)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"life to be insured"},{"title":"Declaration and Signature","fields":[{"help":"Sign or provide thumb impression","type":"signature","label":"Signature/Thumb impression of Life to be Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"life to be insured"},{"title":"Declaration by Adviser (Customer Information Report)","fields":[{"help":"Answer yes or no","type":"yes-no","label":"Did you personally meet the life to be insured?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select proof of identity seen","type":"choice","label":"What proof of identity have you seen of the Life Insured?","options":["Driving License","Voter ID Card","Aadhar Card","Others"],"required":true,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Are you satisfied with the responses given by the proposer on proposal form including the DGH section?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Proof of Income: Are you satisfied with the income declaration made by the Life Insured?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select income proofs checked","type":"choice","label":"If yes, what proofs of income have you checked?","options":["Form 16","Income Tax Return","Property/Land Holding Detail","Others"],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Is there anything in the life to be insured's occupation, lifestyle, financial or social position or other circumstances that you feel the underwriter should be aware of?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if yes","type":"text","label":"If Yes, please give details","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Is the nominee dependent of the proposer?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if no","type":"text","label":"If No, please give details","options":[],"required":false,"pdf_field":""},{"help":"Provide insurable interest details","type":"text","label":"Give details of the insurable interest that exist between the proposer and the nominee","options":[],"required":false,"pdf_field":""}],"filled_by":"adviser"}],"deadlines":[],"applies_to":"Life insurance proposal under Doiva CE Bima Laabh Yojana","attachments":["Proof of age document","Proof of address document","Income proof documents (if applicable)"],"declarations":["The proposer confirms understanding of the proposal form and submits it voluntarily without inducement.","Statements and declarations form the basis of the contract; false information may lead to policy cancellation.","Any changes in information before policy issuance must be informed in writing to the company.","Future premium payments made through advisers are only valid if received by the company in time.","Consent is given to share personal and medical information with the insurer and related parties for underwriting and promotional purposes.","If the proposal is not filled by the proposer, contents have been explained and understood.","Policy sent by post is deemed received after three business days.","The proposer authorizes release of employment, medical, and insurance information to the company and related parties.","Section 41 prohibits inducements or rebates in insurance policies except as allowed by insurer's published terms.","Section 45 limits contestability of life insurance policies to three years from policy issuance or related dates.","Misstatements or suppression of material facts may lead to policy repudiation within three years, with written communication required.","Fraudulent claims are subject to repudiation unless proven otherwise by the insured or beneficiaries.","Premiums collected till repudiation must be returned within ninety days if repudiation is not due to fraud.","Insurer may call for proof of age anytime; policy terms may be adjusted accordingly."],"dropped_labels":2},"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/2084-proposal-form-for-doiva-ce-bima-laabh-hojana"}