{"id":2092,"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%20Bengali.pdf","sha256":"41a7f33b8cc89f2b7859ad84f3b358081ada9b579a66ac719bc0bac2e2406b00","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) to apply for the Aviva Nayi Grameen Suraksha insurance policy by providing personal, nominee, and health details.","notes":["Use capital letters to fill personal details.","Proof of age is mandatory.","Initial payment must be made by cash, crossed cheque or demand draft payable to Aviva Life Insurance Account Proposal Number.","Receipt of proposal and payment does not create obligation until underwriting and policy issuance.","Refunds for cash deposits will be made by cheque or as approved by the Company.","Section 41 and 45 of Insurance Act 1938 apply regarding rebates and policy contestability.","Vernacular declaration must be handwritten by the proposer if applicable.","In case of vernacular signature or thumb impression, declaration must be made by a person of standing unconnected with Aviva Life Insurance."],"title":"Proposal Form for Aviva Nayi Grameen Suraksha","submit":{"to":"Branch Office or any other manner approved by the Company","how":"in person or as approved by the Company","address":""},"purpose":"proposal","sections":[{"title":"Life to be Insured Details","fields":[{"help":"","type":"choice","label":"Mr/Mrs/Miss/Ms","options":["Mr","Mrs","Miss","Ms"],"required":null,"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":"","type":"text","label":"Father's/Husband's Name","options":[],"required":true,"pdf_field":""},{"help":"Include village, P.O., Mandal/Taluka/Town, District, State, Pincode","type":"text","label":"Mailing Address","options":[],"required":true,"pdf_field":""},{"help":"Include village, P.O., Mandal/Taluka/Town, District, State, Pincode","type":"text","label":"Permanent Address","options":[],"required":true,"pdf_field":""},{"help":"Select one proof of address document","type":"choice","label":"Proof of Address","options":["School Certificate","Others","Voter ID/Ration Card"],"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":true,"pdf_field":""},{"help":"Enter occupation","type":"text","label":"Occupation","options":[],"required":true,"pdf_field":""},{"help":"Enter date in dd/mm/yyyy format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status","options":["Single","Widow(er)","Divorced","Married"],"required":true,"pdf_field":""},{"help":"Select one proof of age document","type":"choice","label":"Age Proof","options":["School Certificate","Others","Voter ID/Ration Card"],"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":"","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":""},{"help":"Enter sum assured in rupees","type":"amount","label":"Sum Assured(Rs. In figures)","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Policy Term (PT)","options":["5 Years","10 Years"],"required":true,"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 the 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":"Enter nominee's address","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Provide appointee's name, relationship, 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","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 as given in the 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 for vernacular declaration","type":"signature","label":"Signature/Thumb impression of Life to be Insured (for vernacular declaration)","options":[],"required":true,"pdf_field":""},{"help":"Declarant to confirm explanation of form contents","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 and declarant"},{"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":"Select all that apply","type":"choice","label":"What proof of identity have you seen of the Life Insured?","options":["Driving License","Voter ID Card","Aadhar Card","Others please specify"],"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":"Select all that apply","type":"choice","label":"If yes, what proofs of income have you checked?","options":["Income Tax Return","Form 16","Property/Land Holding Detail"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is there anything in the life to be insured's occupation, lifestyle, financial or social position or other circumstances that 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":"","type":"yes-no","label":"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":""},{"help":"Explain insurable interest","type":"text","label":"Give details of the insurable interest that exist between the proposer and the nominee.","options":[],"required":false,"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":"Date of filling","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":["Initial payment must accompany the proposal form"],"applies_to":"Aviva Nayi Grameen Suraksha insurance policy proposals","attachments":["Proof of age document","Proof of address document","Proof of income documents (if applicable)","Initial payment (cash, cheque, or demand draft)"],"declarations":["The proposer confirms understanding of the proposal form and submits it on own accord.","Statements and declarations form the basis of the contract and untrue statements may lead to cancellation.","Any changes in information 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 medical and personal information for underwriting.","The proposer declares full explanation and understanding of the application contents.","The declarant confirms having explained the form contents truthfully to the proposer.","The adviser confirms meeting the life insured and satisfaction with the information provided."],"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/2092-proposal-form-for-aviva-nayi-grameen-suraksha"}