{"id":2090,"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%20Malayalam.pdf","sha256":"e247f24c69bee95b20e67daee4f238bc28802fbec4b81f84ab7ac3afa24511a7","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) to apply for the Aviva CSC Bima Laabh Yojana insurance policy by providing personal, nominee, and health details.","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.","Receipt of completed proposal and initial payment does not create obligation until underwriting and policy issuance.","Section 41 and 45 of the 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":"Details of the Life Assured","fields":[{"help":"Check if the life assured is the same as the proposer","type":"checkbox","label":"Life Assured same as Proposer","options":[],"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 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":"Enter full mailing address","type":"text","label":"Mailing Address","options":[],"required":true,"pdf_field":""},{"help":"Enter village name","type":"text","label":"Village","options":[],"required":true,"pdf_field":""},{"help":"Enter post office","type":"text","label":"P.O.","options":[],"required":true,"pdf_field":""},{"help":"Enter Mandal, Taluka or Town","type":"text","label":"Mandal/Taluka/Town","options":[],"required":true,"pdf_field":""},{"help":"Enter district","type":"text","label":"District","options":[],"required":true,"pdf_field":""},{"help":"Enter state","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter postal code","type":"number","label":"Pincode","options":[],"required":true,"pdf_field":""},{"help":"Enter permanent address if different from mailing address","type":"text","label":"Permanent 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 in dd/mm/yyyy format","type":"date","label":"Date of Birth (dd/mm/yyyy)","options":[],"required":true,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"Marital Status","options":["Single","Married","Divorced","Widow(er)"],"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":null,"pdf_field":""},{"help":"Enter surname","type":"text","label":"Surname","options":[],"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":"Enter mailing address","type":"text","label":"Mailing Address","options":[],"required":null,"pdf_field":""},{"help":"Enter village","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","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter postal code","type":"number","label":"Pincode","options":[],"required":null,"pdf_field":""},{"help":"Enter permanent address if different","type":"text","label":"Permanent 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":"Enter date of birth","type":"date","label":"Date of Birth (dd/mm/yyyy)","options":[],"required":null,"pdf_field":""},{"help":"Select age proof document","type":"choice","label":"Age Proof","options":["School Certificate","Voter ID/Ration Card","Others"],"required":null,"pdf_field":""},{"help":"Specify 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 amount","type":"amount","label":"Sum Assured (Rs. in figures)","options":[],"required":true,"pdf_field":""},{"help":"Select mode of payment","type":"choice","label":"Preferred Mode of Payment","options":["Cash","Cheque","Demand","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":"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","type":"date","label":"Date of Birth (dd/mm/yyyy)","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's address","type":"text","label":"Address","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 appointee's date of birth","type":"date","label":"Date of Birth (dd/mm/yyyy)","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","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 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":"Declaration and Signature","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":"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":"proposer"},{"title":"Declaration by RAP (Rural Authorised Person)","fields":[{"help":"RAP to sign here","type":"signature","label":"Signature of RAP","options":[],"required":true,"pdf_field":""}],"filled_by":"RAP"},{"title":"Customer Information Report (to be filled by Adviser)","fields":[{"help":"Adviser to confirm personal meeting","type":"yes-no","label":"1. Did you personally meet the life to be insured?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify 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","Others"],"required":true,"pdf_field":""},{"help":"Adviser to confirm satisfaction with proposer responses","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":"Adviser to confirm 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":"Specify income proofs checked","type":"choice","label":"If yes, what proofs of income have you checked?","options":["Income Tax Return","Property/Land Holding Detail","Form 16","Others"],"required":false,"pdf_field":""},{"help":"Adviser to disclose any relevant information","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":"Adviser to confirm nominee dependency","type":"yes-no","label":"6. Is the nominee dependent of the proposer?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if nominee is not dependent","type":"text","label":"If No, please give details","options":[],"required":false,"pdf_field":""}],"filled_by":"adviser"},{"title":"Adviser Details and Signature","fields":[{"help":"Enter adviser name","type":"text","label":"Adviser Name","options":[],"required":true,"pdf_field":""},{"help":"Enter adviser code","type":"text","label":"Adviser Code","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Adviser to sign here","type":"signature","label":"Signature of Adviser","options":[],"required":true,"pdf_field":""}],"filled_by":"adviser"}],"deadlines":[],"applies_to":"Aviva CSC Bima Laabh Yojana insurance policy proposal","attachments":["Proof of age document","Proof of address document","Proof of income documents (Income Tax Return, Property/Land Holding Detail, Form 16, or others as applicable)"],"declarations":["The proposer confirms understanding of the proposal form and submits it on own accord without inducement.","Statements and material facts in the proposal form 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.","The proposer consents to sharing of personal and medical information with Aviva Life Insurance and related parties for underwriting and promotional purposes.","If the proposal form is filled by someone else, the proposer confirms the contents have been fully explained and understood."],"dropped_labels":4},"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/2090-proposal-form-for-aviva-csc-bima-laabh-yojana"}