{"id":2086,"title":"Proposal Form for Aviva Nayi Grameen Suraksha","purpose":"proposal","insurer":{"slug":"aviva-life-insurance","name":"Aviva Life Insurance Company India Limited"},"source_pdf":"https://www.avivaindia.com/sites/default/files/NGS%20Oriya.pdf","sha256":"1a6d0806230da555ac2f6403f0d83eccde080d7d7a0a1a8c269b1bfb4ed65a58","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for the Aviva Nayi Grameen Suraksha insurance policy. The proposer fills it to provide personal, nominee, and health details for underwriting.","notes":["Use CAPITAL LETTERS to fill the form.","Proof of age is mandatory.","Initial payment must accompany the proposal.","Receipt of proposal and payment does not create obligation until underwriting and policy issuance.","Refunds for cash deposits will be made by cheque or other approved manner.","Misrepresentation can lead to contract cancellation as per Insurance Act section 45.","In case of vernacular signature or thumb impression, declaration must be made by a person of standing unconnected with the insurer."],"title":"Proposal Form for Aviva Nayi Grameen Suraksha","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Life to be Insured Details","fields":[{"help":"Write in CAPITAL LETTERS","type":"text","label":"Surname","options":[],"required":null,"pdf_field":""},{"help":"Write in CAPITAL LETTERS","type":"text","label":"Forenames","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Father's/Husband's Name","options":[],"required":null,"pdf_field":""},{"help":"Include Village, P.O., Mandal/Taluka/Town, District, State, Pincode","type":"text","label":"Mailing Address","options":[],"required":null,"pdf_field":""},{"help":"Provide document proof of address","type":"text","label":"Proof of Address","options":[],"required":true,"pdf_field":""},{"help":"","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":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status","options":["Single","Married","Widow(er)","Divorced"],"required":null,"pdf_field":""},{"help":"Attach proof of age document","type":"choice","label":"Age Proof","options":["School Certificate","Voter Id Card","Others"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Details","fields":[{"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":["Cheque","Demand","Cash","Others"],"required":true,"pdf_field":""},{"help":"Select policy term","type":"choice","label":"Policy Term (PT)","options":["5 Years","10 Years"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have Aadhar Number","options":["Yes","No"],"required":null,"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":"","type":"text","label":"Name of the Nominee (Under section 39 of the Insurance Act 1938)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Relationship to the Life to be Insured","options":[],"required":true,"pdf_field":""},{"help":"If nominee is minor, provide date of birth","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Provide name, relationship, date of birth, address and signature of appointee","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","fields":[{"help":"","type":"yes-no","label":"A. Are you in good health?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","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":"","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":"","type":"yes-no","label":"E. Are you currently pregnant? (If applicable)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","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":""},{"help":"Handwrite the declaration in vernacular language in the box provided","type":"text","label":"Vernacular Declaration (to be handwritten by the life to be insured/proposer)","options":[],"required":true,"pdf_field":""},{"help":"Sign or thumb impression if vernacular declaration is used","type":"signature","label":"Signature/Thumb impression of Life to be Insured (vernacular)","options":[],"required":true,"pdf_field":""},{"help":"Person who filled the form declares they explained contents to proposer","type":"text","label":"Declaration by the person filling in the form","options":[],"required":true,"pdf_field":""},{"help":"Name and address of declarant","type":"text","label":"Declarant's Name and Address","options":[],"required":true,"pdf_field":""},{"help":"Declarant's signature","type":"signature","label":"Signature of declarant","options":[],"required":true,"pdf_field":""},{"help":"Adviser's signature","type":"signature","label":"Signature of Adviser","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Customer Information Report (to be filled by Adviser)","fields":[{"help":"","type":"yes-no","label":"Did you personally meet the life to be insured?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Specify proof seen","type":"choice","label":"What proof of identity have you seen of the Life Insured?","options":["Driving License","Aadhar Card","Voter ID Card","Others please specify"],"required":true,"pdf_field":""},{"help":"","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":"","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":"Specify proof checked","type":"choice","label":"If yes, what proof of income have you checked?","options":["Income Tax Return","Form 16","Property/Land Holding Detail","Others please specify"],"required":false,"pdf_field":""},{"help":"If yes, give details","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":"If no, give details and insurable interest","type":"yes-no","label":"Is the nominee dependent of the proposer?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Adviser Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Adviser Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Adviser","options":[],"required":true,"pdf_field":""}],"filled_by":"adviser"}],"deadlines":[],"applies_to":"Aviva Nayi Grameen Suraksha insurance policy proposal","attachments":["Proof of age","Proof of address","Proof of income","Age proof document"],"declarations":["The proposer confirms understanding of the proposal form and submits it on own accord.","Statements and declarations form the basis of contract; untrue statements may lead to policy cancellation.","Any changes in statements 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 in time.","Consent is given for the company to collect and share personal and medical information for underwriting and promotional purposes.","If the proposal was not filled by the proposer, the contents have been fully explained and understood.","The declarant confirms having explained the proposal form contents truthfully to the proposer."],"dropped_labels":1},"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/2086-proposal-form-for-aviva-nayi-grameen-suraksha"}