{"id":2089,"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%20Tamil.pdf","sha256":"d313a80536a2913304985491190aabb107c9144ab6666f5487c3aba810a5fa03","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) to apply for the Aviva Nayi Grameen Suraksha life insurance policy by providing personal, health, and policy details.","notes":["Fill all details in capital letters where specified.","Proof of age is mandatory.","Initial payment must accompany the proposal form.","Payments can be made 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.","Use block letters for filling the form.","In case of vernacular signature or thumb impression, declaration must be made by a credible person unconnected with Aviva.","Office use only sections are not to be filled by the proposer."],"title":"Proposal Form for Aviva Nayi Grameen Suraksha","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposal Deposit Details","fields":[{"help":"Enter cheque or demand draft number","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, provide 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":"Bank or branch on which cheque/DD is drawn","type":"text","label":"Drawn on","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer or adviser"},{"title":"Life to be Insured Details","fields":[{"help":"Select appropriate title","type":"choice","label":"Mr/Mrs/Miss/M&","options":["Mr","Mrs","Miss","M&"],"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":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 name","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Enter postal code","type":"number","label":"Pincode","options":[],"required":false,"pdf_field":""},{"help":"Enter permanent address if different","type":"text","label":"Permanent Address","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":"Select marital status","type":"choice","label":"Marital Status","options":["Single","Married","Widow(er)","Divorced"],"required":true,"pdf_field":""},{"help":"Select type of age proof document","type":"choice","label":"Age Proof","options":["School Certificate","Others"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Details","fields":[{"help":"Enter sum assured amount","type":"amount","label":"Sum Assured (Rs. In figures)","options":[],"required":true,"pdf_field":""},{"help":"Enter premium amount","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 Cheque","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":"Indicate if you have an Aadhar number","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 insured","type":"text","label":"Relationship to the Life to be Insured","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's date of birth","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 appointee's name","type":"text","label":"Name of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"Enter relationship to minor nominee","type":"text","label":"Relationship to the Minor","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 if you are currently in good health","type":"yes-no","label":"A. Are you in good health?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer about recent medical treatments or conditions","type":"yes-no","label":"C. Are you currently taking any medication or drugs other than for minor conditions, or have you suffered any illness, disorder, disability or injury in the past 5 years requiring medical examination, consultation, hospitalisation or surgery?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer if currently pregnant","type":"yes-no","label":"E. Are you currently pregnant? (If applicable)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Signature and Vernacular Declaration","fields":[{"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":"Sign or provide thumb impression","type":"signature","label":"Signature/Thumb Impression of Life to be Insured","options":[],"required":true,"pdf_field":""},{"help":"Write the declaration in your mother tongue in the provided box","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 declaration is in vernacular","type":"signature","label":"Signature/Thumb impression of Life to be Insured (vernacular)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by the person filling in the form","fields":[{"help":"Enter name and address of declarant","type":"text","label":"Declarant's Name and Address","options":[],"required":true,"pdf_field":""},{"help":"Declarant must sign here","type":"signature","label":"Signature of declarant","options":[],"required":true,"pdf_field":""},{"help":"Adviser must sign here","type":"signature","label":"Signature of Adviser","options":[],"required":true,"pdf_field":""}],"filled_by":"declarant (person filling the form)"},{"title":"Customer Information Report (To be filled by Adviser)","fields":[{"help":"Indicate if you met the proposer","type":"yes-no","label":"1. 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":"2. What proof of identity have you seen of the Life Insured?","options":["Driving License","Voter ID Card","Aadhar Card"],"required":true,"pdf_field":""},{"help":"Indicate satisfaction with proposer's answers","type":"yes-no","label":"3. 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":"Indicate satisfaction with income proof","type":"yes-no","label":"4. 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":"a. If yes, what proofs of income have you checked?","options":["Income Tax Return","Form 16","Property/Land Holding Detail","Others"],"required":false,"pdf_field":""},{"help":"Indicate if any relevant information for underwriting","type":"yes-no","label":"5. 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 applicable","type":"text","label":"If Yes, please give details","options":[],"required":false,"pdf_field":""},{"help":"Indicate nominee dependency","type":"yes-no","label":"6. Is the nominee dependent of the proposer? If No, please give details","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide insurable interest details if nominee not dependent","type":"text","label":"a. Give details of the insurable interest that exist between the proposer and the nominee.","options":[],"required":false,"pdf_field":""},{"help":"Enter adviser's name","type":"text","label":"Adviser Name","options":[],"required":true,"pdf_field":""},{"help":"Enter adviser's code","type":"text","label":"Adviser Code","options":[],"required":true,"pdf_field":""},{"help":"Date of filling report","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Adviser must sign here","type":"signature","label":"Signature of Adviser","options":[],"required":true,"pdf_field":""},{"help":"Adviser to confirm truthfulness","type":"yes-no","label":"I hereby declare that the foregoing statements are true and correct to the best of my knowledge and belief.","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"adviser"}],"deadlines":[],"applies_to":"Aviva Nayi Grameen Suraksha life insurance policy proposals","attachments":["Proof of age document","Proof of address document","Proof of income documents","Adviser identity proof"],"declarations":["The proposer confirms understanding of the proposal form and submits it voluntarily.","Statements and material facts in the form form the basis of the contract and untrue statements may lead to policy cancellation.","Any changes in statements or 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.","The proposer consents to sharing personal and medical information with Aviva Life Insurance and related parties for underwriting and promotional purposes.","If the proposal is not filled by the proposer, the person filling it declares that contents were fully explained and understood.","Receipt of policy by ordinary post is deemed delivered within three business days."],"dropped_labels":7},"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/2089-proposal-form-for-aviva-nayi-grameen-suraksha"}