{"id":2085,"title":"Proposal Form for Liva CC Bima Laabh Vajana","purpose":"proposal","insurer":{"slug":"aviva-life-insurance","name":"Aviva Life Insurance Company India Limited"},"source_pdf":"https://www.avivaindia.com/sites/default/files/BLY%20Oriya.pdf","sha256":"e051643dd35c8712a215a1b77d73c30223ec624c27f152e0c2e3d21e901ef745","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals applying for the Aviva Life Insurance Liva CC Bima Laabh Yojana policy. The proposer fills it to provide personal, nominee, and health details for underwriting.","notes":["The proposer must pay the initial premium with the proposal by cash, crossed cheque or demand draft payable to Aviva Life Insurance Account Proposal Number.","Proof of age is mandatory.","The proposer should read the Key Features brochure carefully before applying.","Receipt of proposal and payment does not create any obligation on the company until underwriting is complete and policy issued.","Refunds for cash deposits will be made by cheque or as approved by the company.","Use capital letters to fill the form.","Section 41 and 45 of the Insurance Act 1938 apply to this proposal."],"title":"Proposal Form for Liva CC Bima Laabh Vajana","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposal Deposit Details","fields":[{"help":"","type":"text","label":"Cheque/DD No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Amount","options":[],"required":null,"pdf_field":""},{"help":"If you are an existing customer, provide your Customer ID","type":"text","label":"Customer ID (for existing customer)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Voucher Number","options":[],"required":false,"pdf_field":""},{"help":"Date of deposit","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Bank on which cheque/DD is drawn","type":"text","label":"Drawn on","options":[],"required":null,"pdf_field":""}],"filled_by":""},{"title":"Details of the Life Assured","fields":[{"help":"Tick if the life assured is the same as the proposer","type":"yes-no","label":"Life Assured same as Proposer","options":["Yes","No"],"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 forenames 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":"Full mailing address including village, P.O., Mandal/Taluka/Town, District, State, Pincode","type":"text","label":"Mailing Address","options":[],"required":true,"pdf_field":""},{"help":"Full permanent address including village, P.O., Mandal/Taluka/Town, District, State, Pincode","type":"text","label":"Permanent Address","options":[],"required":true,"pdf_field":""},{"help":"Specify document used as proof of address","type":"text","label":"Proof of Address","options":[],"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 marital status","type":"choice","label":"Marital Status","options":["Single","Married","Widow(er)","Divorced"],"required":true,"pdf_field":""},{"help":"Select document submitted as proof of age","type":"choice","label":"Age Proof","options":["School Certificate","Voter Id Card","Others"],"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 forenames","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":"Full mailing address","type":"text","label":"Mailing Address","options":[],"required":null,"pdf_field":""},{"help":"Full permanent address","type":"text","label":"Permanent Address","options":[],"required":null,"pdf_field":""},{"help":"Specify proof of address document","type":"text","label":"Proof of Address","options":[],"required":null,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Enter annual income","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":"Select marital status","type":"choice","label":"Marital Status","options":["Single","Married","Widow(er)","Divorced"],"required":null,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of Birth","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":"Select mode of payment","type":"choice","label":"Preferred Mode of Payment","options":["Demand","Cheque","Cash"],"required":true,"pdf_field":""},{"help":"Select policy term","type":"choice","label":"Policy Term (PT)","options":["5 Years","10 Years"],"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":"Provide Aadhar number if applicable","type":"text","label":"If yes please provide Aadhar Number :","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nomination Details","fields":[{"help":"Enter full name of nominee","type":"text","label":"Name of the Nominee (Under section 39 of the Insurance Act 1938)","options":[],"required":true,"pdf_field":""},{"help":"Specify 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 (if minor)","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Provide appointee's name, relationship to minor, date of birth, address and signature","type":"text","label":"If Nominee is a Minor, please give appointee details below.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration of Good Health of the life to be insured","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, (eg. colds and flu), either prescribed or not prescribed by a doctor, or have you suffered from any illness, disorder, disability or injury during the past 5 years which has required any form of medical or specialised examination (Including chest X-rays, gynaecological investigations, pap smear, or blood tests), consultation, hospitalisation or surgery or physician has not been consulted or treatment received for the same?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"D. Any illness that has caused you to be absent from work for a continuous period of 7 days or more in the last 2 years or has your health placed any restrictions on your normal daily activities?","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":"proposer"},{"title":"Declaration","fields":[{"help":"Sign or provide thumb impression","type":"signature","label":"Signature/Thumb impression of Life to be Insured","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","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"},{"title":"Declaration by the (Rural Authorized Person) (RAP)","fields":[{"help":"Signature of the Rural Authorized Person","type":"signature","label":"Signature of RAP","options":[],"required":true,"pdf_field":""}],"filled_by":"Rural Authorized Person"}],"deadlines":[],"applies_to":"Life insurance proposal for Liva CC 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.","Statements and declarations form the basis of the contract and untrue statements may lead to policy cancellation.","Any changes in statements or material facts before policy issuance must be informed to the company in writing.","Payments made through advisers are only valid when received and realized by the company within stipulated time.","Consent is given for the company to obtain personal and medical information from various sources for underwriting.","If the proposal is not filled by the proposer, the contents have been explained and understood fully."],"dropped_labels":3},"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/2085-proposal-form-for-liva-cc-bima-laabh-vajana"}