{"id":2088,"title":"Proposal Form for Aviva CSC Bima Laabh Yojana","purpose":"proposal","insurer":{"slug":"aviva-life-insurance","name":"Aviva Life Insurance Company India Limited"},"source_pdf":"https://www.avivaindia.com/sites/default/files/BLY%20Bengali.pdf","sha256":"58b51ac020b7281dfb63c6e32e5f5408b79c8140e717d444bde68f75180cdaaa","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals applying for the Aviva CSC Bima Laabh Yojana insurance policy. The proposer fills it to provide personal, nominee, and health details for underwriting.","notes":["Proposer must pay initial payment with the proposal by cash, cheque or demand draft payable to Aviva Life Insurance Account Proposal Number.","Proof of age is mandatory.","Use capital letters to fill the form.","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 methods.","Section 41 and 45 of Insurance Act 1938 apply regarding rebates and policy contestability.","Office use only sections are not to be filled by the proposer."],"title":"Proposal Form for Aviva CSC Bima Laabh Yojana","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposal Deposit Details","fields":[{"help":"Enter cheque or demand draft number for initial payment","type":"text","label":"Cheque/DD No.","options":[],"required":null,"pdf_field":""},{"help":"Enter the amount paid","type":"amount","label":"Amount","options":[],"required":null,"pdf_field":""},{"help":"If you are an existing customer, enter your ID","type":"text","label":"Customer ID (for existing customer)","options":[],"required":false,"pdf_field":""},{"help":"Enter voucher number if applicable","type":"text","label":"Voucher Number","options":[],"required":false,"pdf_field":""},{"help":"Date of payment","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Name of bank or drawee","type":"text","label":"Drawn on","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of the Life Assured","fields":[{"help":"Select appropriate title","type":"choice","label":"Mr/Mrs/Miss/Ms","options":["Mr","Mrs","Miss","Ms"],"required":true,"pdf_field":""},{"help":"Enter surname/family name","type":"text","label":"Surname","options":[],"required":true,"pdf_field":""},{"help":"Enter given names","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 permanent residential address","type":"text","label":"Permanent Address","options":[],"required":true,"pdf_field":""},{"help":"Enter village name","type":"text","label":"Village","options":[],"required":false,"pdf_field":""},{"help":"Enter post office","type":"text","label":"P.O.","options":[],"required":false,"pdf_field":""},{"help":"Enter Mandal, Taluka or Town","type":"text","label":"Mandal/Taluka/Town","options":[],"required":false,"pdf_field":""},{"help":"Enter district","type":"text","label":"District","options":[],"required":false,"pdf_field":""},{"help":"Enter state","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Enter postal code","type":"number","label":"Pincode","options":[],"required":false,"pdf_field":""},{"help":"Provide proof of address document","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","Divorced","Widow(er)","Others"],"required":true,"pdf_field":""},{"help":"Select document provided as proof of age","type":"choice","label":"Age Proof","options":["School Certificate","Voter ID/Ration 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":false,"pdf_field":""},{"help":"Enter surname/family name","type":"text","label":"Surname","options":[],"required":false,"pdf_field":""},{"help":"Enter given names","type":"text","label":"Forenames","options":[],"required":false,"pdf_field":""},{"help":"Enter father's or husband's name","type":"text","label":"Father's/Husband's Name","options":[],"required":false,"pdf_field":""},{"help":"Enter current mailing address","type":"text","label":"Mailing Address","options":[],"required":false,"pdf_field":""},{"help":"Enter permanent residential address","type":"text","label":"Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"Enter village name","type":"text","label":"Village","options":[],"required":false,"pdf_field":""},{"help":"Enter post office","type":"text","label":"P.O.","options":[],"required":false,"pdf_field":""},{"help":"Enter Mandal, Taluka or Town","type":"text","label":"Mandal/Taluka/Town","options":[],"required":false,"pdf_field":""},{"help":"Enter district","type":"text","label":"District","options":[],"required":false,"pdf_field":""},{"help":"Enter state","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Enter postal code","type":"number","label":"Pincode","options":[],"required":false,"pdf_field":""},{"help":"Provide proof of address document","type":"text","label":"Proof of Address","options":[],"required":false,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female"],"required":false,"pdf_field":""},{"help":"Enter annual income in rupees","type":"amount","label":"Life Insured's Annual Income Rs.","options":[],"required":false,"pdf_field":""},{"help":"Enter occupation","type":"text","label":"Occupation","options":[],"required":false,"pdf_field":""},{"help":"Enter date of birth (dd/mm/yyyy)","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"Marital Status","options":["Single","Married","Divorced","Widow(er)","Others"],"required":false,"pdf_field":""},{"help":"Select document provided as proof of age","type":"choice","label":"Age Proof","options":["School Certificate","Voter ID/Ration Card","Others"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Details","fields":[{"help":"Enter sum assured amount 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":["Cash","Demand","Others"],"required":true,"pdf_field":""},{"help":"Enter policy term in years","type":"number","label":"Policy Term (PT)","options":[],"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 applicable","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 with 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":"Fill appointee details if nominee is minor","type":"section","label":"If Nominee is a Minor, please give appointee details below.","options":[],"required":false,"pdf_field":""},{"help":"Enter name of appointee","type":"text","label":"Name of the Appointee","options":[],"required":false,"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","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 to sign here","type":"signature","label":"Signature of the Appointee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration of Good Health of the life to be insured","fields":[{"help":"Select yes or no","type":"yes-no","label":"A. Are you in good health?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select 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":"Select 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":"Select 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":"Select 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 here","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":"life to be insured"},{"title":"Declaration by the Res (Rural Authorized Person)","fields":[{"help":"RAP to sign here","type":"signature","label":"Signature of RAP","options":[],"required":true,"pdf_field":""}],"filled_by":"RAP (Rural Authorized Person)"},{"title":"Customer Information Report for FAT1","fields":[{"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":"Select 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":["Income Tax Return","Form 16","Others"],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Is there anything in the life to be insured's occupation, life style, 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":"Select yes or no","type":"yes-no","label":"Is the nominee dependent of the proposer? If No, please give details","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details if nominee not dependent","type":"text","label":"Give details of the insurable interest that exist between the proposer and the nominee.","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Did you personally meet the life to be Insured?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"adviser"}],"deadlines":[],"applies_to":"Aviva CSC Bima Laabh Yojana life insurance policy proposal","attachments":["Proof of age document","Proof of address document","Income proof documents if applicable"],"declarations":["The proposer confirms understanding and voluntary submission of the proposal.","Statements and declarations form the basis of the contract and 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 obtain and share medical and personal information for underwriting and promotional purposes.","If the proposal is not filled by the proposer, contents have been explained and understood fully."],"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/2088-proposal-form-for-aviva-csc-bima-laabh-yojana"}