{"id":2096,"title":"Aviva Annuity Plus Proposal Form 6(A1000-100008 @2000)","purpose":"proposal","insurer":{"slug":"aviva-life-insurance","name":"Aviva Life Insurance Company India Limited"},"source_pdf":"https://www.avivaindia.com/sites/default/files/TIA%20Mlm.pdf","sha256":"2940c949a02c1818106ee0b49f723bee3c28a4fcb69ef79df5c98ad91a637380","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for purchasing the Aviva AnnuityPlus life insurance product. It is filled by the annuitant (the person to be insured).","notes":["Use capital letters and leave spaces between name parts.","Counter sign any alterations, overwriting or ink changes.","Original age proof is mandatory.","Only NEFT mode allowed for quarterly and monthly annuity payments.","If annuity payable is less than Rs. 500, annuity mode will be changed automatically.","Attach cancelled cheque and NEFT mandate for NEFT payments.","Existence certificate required annually or at specified years depending on annuity option.","In case of signature in vernacular or thumb impression, declaration must be made by a person of standing unconnected with Aviva."],"title":"Aviva Annuity Plus Proposal Form 6(A1000-100008 @2000)","submit":{"to":"Aviva Life Insurance Company India Ltd.","how":"","address":"Aviva Tower, Sector Road, Opp. Golf Course, DLF Phase-V, Sector 43, Gurgaon 122 003 Haryana"},"purpose":"proposal","sections":[{"title":"Annuitant Details","fields":[{"help":"Write your full name in capital letters with spaces between name parts.","type":"text","label":"Full Name : THIS IS HOW YOUR NAME WILL APPEAR ON THE POLICY CERTIFICATE. PLEASE LEAVE A SPACE BETWEEN EACH PART OF THE NAME.","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Title : Mr. / Mrs. / Ms. / Dr.","options":["Mr.","Mrs.","Ms.","Dr."],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Father's Name","options":[],"required":true,"pdf_field":""},{"help":"Use DD/MM/YYYY format.","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Gender","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status","options":["Unmarried","Married","Widow(er)","Divorced","Greater than 3","NA"],"required":true,"pdf_field":""},{"help":"Enter number of children.","type":"number","label":"No. of Children","options":[],"required":false,"pdf_field":""},{"help":"Specify nationality if other than Indian.","type":"choice","label":"Nationality","options":["Indian","Foreign National","Person of Indian Origin","Specify Nationality"],"required":true,"pdf_field":""},{"help":"Specify country if not residing in India.","type":"choice","label":"Residential Status","options":["Residing in India","Not Residing in India","Specify Country of residence"],"required":true,"pdf_field":""},{"help":"Include c/o, s/o, w/o, d/o, h/o, f/o wherever necessary.","type":"text","label":"Communication Address","options":[],"required":true,"pdf_field":""},{"help":"Leave space between each part of the address.","type":"text","label":"Current Residential Address","options":[],"required":true,"pdf_field":""},{"help":"Select your occupation.","type":"choice","label":"Occupation","options":["Salaried","Business Owner","Self-employed","Retired/Pensioner","Agriculturist","Student","Housewife","Others (Specify)"],"required":true,"pdf_field":""},{"help":"Fill if occupation is student.","type":"text","label":"If student (a) Course presently pursuing","options":[],"required":false,"pdf_field":""},{"help":"Fill if occupation is student.","type":"text","label":"(b) Name of Institution","options":[],"required":false,"pdf_field":""},{"help":"Fill if occupation is student.","type":"text","label":"(c) Duration of Course","options":[],"required":false,"pdf_field":""},{"help":"Describe your job duties.","type":"text","label":"Exact Nature of Duties (Give Description e.g: Trading In Food Grain / Textiles, Driving Taxi / Business of Diamond Export etc.)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Your Designation","options":[],"required":false,"pdf_field":""},{"help":"If yes, provide details.","type":"yes-no","label":"Is your occupation associated with any specific hazard (e.g. Chemical factory, mines, explosives, corrosive chemicals etc.)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Fill your employer or business name.","type":"text","label":"Name of Organisation/Business","options":[],"required":false,"pdf_field":""},{"help":"Address of organisation/business.","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Attach proof of age document.","type":"choice","label":"Age proof","options":["School/College Certificate","Municipal Records","Defence ID Card","Passport","Others (Specify)"],"required":true,"pdf_field":""},{"help":"Provide PAN number if available.","type":"text","label":"Income Tax PAN Number","options":[],"required":false,"pdf_field":""}],"filled_by":"annuitant"},{"title":"Nomination/Beneficiary Details (Applicable for option II, III & IV only)","fields":[{"help":"Name as per section 39 of Insurance Act 1938.","type":"text","label":"Name of the Nominee/Beneficiary","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":"Nominee's address details.","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Provide name, relationship, DOB, address and signature of appointee.","type":"text","label":"If Nominee/Beneficiary is a Minor, please give details of the appointee (should be a Major)","options":[],"required":false,"pdf_field":""}],"filled_by":"annuitant"},{"title":"Details of the Plan Applied For","fields":[{"help":"Aviva AnnuityPlus","type":"text","label":"Name of the Plan","options":[],"required":true,"pdf_field":""},{"help":"Select one annuity option.","type":"choice","label":"Annuity Option","options":["Life Annuity","Annuity guaranteed for 5 years and life thereafter","Annuity guaranteed for 10 years and life thereafter","Annuity guaranteed for 15 years and life thereafter","Annuity for life increasing @ 3% per annum simple"],"required":true,"pdf_field":""},{"help":"Not applicable for Aviva Pension policyholders.","type":"amount","label":"Purchase price","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you funding the purchase price through the maturity proceed of an existing pension policy.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If annuity payable is less than Rs. 500, mode will be changed automatically.","type":"choice","label":"Annuity frequency","options":["Yearly","Half-Yearly","Quarterly","Monthly"],"required":true,"pdf_field":""},{"help":"Only NEFT allowed for Quarterly and Monthly frequency.","type":"choice","label":"Preferred mode of payout","options":["Cheque","NEFT (National Electronic Fund Transfer)"],"required":true,"pdf_field":""},{"help":"Provide bank account number, bank name, branch address, account type, MICR code.","type":"text","label":"Bank Details (For Annuity Payout)","options":[],"required":true,"pdf_field":""},{"help":"DD/MM/YYYY format.","type":"date","label":"Date of maturity","options":[],"required":false,"pdf_field":""},{"help":"Fund value on maturity date.","type":"amount","label":"Fund Value as on","options":[],"required":false,"pdf_field":""},{"help":"If yes, specify percentage.","type":"yes-no","label":"Commutation opted","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If yes, mention additional amount.","type":"yes-no","label":"Do you want to increase the purchase price","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"annuitant"},{"title":"Declaration & Authorization","fields":[{"help":"Sign or provide thumb impression.","type":"signature","label":"Signature / thumb impression of the Annuitant","options":[],"required":true,"pdf_field":""},{"help":"Place of signing.","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing in DD/MM/YYYY format.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"annuitant"},{"title":"Declaration by the person filling in the form","fields":[{"help":"Name and address of the person who explained the form.","type":"text","label":"Declarant's Name and Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Pincode","options":[],"required":true,"pdf_field":""},{"help":"Signature of the declarant.","type":"signature","label":"Signature of declarant","options":[],"required":true,"pdf_field":""}],"filled_by":"person filling the form (if proposer unable to sign or in vernacular)"}],"deadlines":[],"applies_to":"Aviva AnnuityPlus annuity plans","attachments":["Proof of age document","Cancelled cheque for NEFT mode","Duly completed and signed NEFT mandate","Existence certificate on policy anniversary for options I & V","Existence certificate at end of year 5, 10, 15 and every year thereafter for options II, III & IV"],"declarations":["The proposer declares all information given is true and complete and understands the importance of full disclosure.","The proposer authorizes release of medical and employment information to the company and its associates for risk assessment.","If the proposal is not filled by the proposer, the contents have been fully explained and understood.","The proposal form shall be part of the insurance contract if accepted by the company.","The declarant confirms that the proposal form contents have been fully explained to the annuitant who has understood them."],"dropped_labels":10},"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/2096-aviva-annuity-plus-proposal-form-6-a1000-100008-2000"}