{"id":2098,"title":"Aviva AnnuityPlus Proposal Form","purpose":"proposal","insurer":{"slug":"aviva-life-insurance","name":"Aviva Life Insurance Company India Limited"},"source_pdf":"https://www.avivaindia.com/sites/default/files/TIA%20Kanad.pdf","sha256":"ba792353ec4655d48cd83db280f6c43a7a28de0e9131443ad150f35a46306dd6","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals applying for the Aviva AnnuityPlus insurance product. The proposer (annuitant) fills it to provide personal, nominee, and plan details for policy issuance.","notes":["Use capital letters for names and addresses.","Leave spaces between parts of names and addresses.","Counter sign any alterations, overwriting, or ink changes in the form.","Proof of age is mandatory.","If the annuity payable is less than Rs. 500, annuity frequency mode will be changed automatically to a higher level.","Only NEFT mode of payment is allowed for Quarterly and Monthly annuity frequency.","Existence certificate is required annually for certain annuity options as specified.","Attach original documents as proof where required.","Section 41 and 45 of the Insurance Act 1938 apply to this proposal."],"title":"Aviva AnnuityPlus Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Details of the Annuitant","fields":[{"help":"Write your full name in capital letters with spaces between 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":"First Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Middle Name","options":[],"required":false,"pdf_field":""},{"help":"Attach a recent passport size photo.","type":"photo","label":"Affix Photo","options":[],"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"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"No. of Children","options":["1","3","Greater than 3","NA"],"required":false,"pdf_field":""},{"help":"Specify nationality if 'Specify Nationality' is chosen.","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' is chosen.","type":"choice","label":"Residential Status","options":["Residing in India","Not Residing in India","Specify Country of residence"],"required":true,"pdf_field":""},{"help":"Select the address type for communication.","type":"choice","label":"Communication Address","options":["Residence","Permanent","Office"],"required":true,"pdf_field":""},{"help":"Leave space between each part of the address; include c/o, s/o, w/o, d/o, h/o, f/o as applicable.","type":"text","label":"Current Residential Address","options":[],"required":true,"pdf_field":""},{"help":"Provide a nearby landmark for easier identification.","type":"text","label":"Landmark","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City/Village","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"District","options":[],"required":true,"pdf_field":""},{"help":"6 digit postal code.","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Landline phone number.","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"Mobile phone number.","type":"phone","label":"Mobile","options":[],"required":true,"pdf_field":""},{"help":"Fill only if different from current address; include c/o, s/o, w/o, d/o, h/o, f/o as applicable.","type":"text","label":"Permanent Address (IF DIFFERENT FROM CURRENT RESIDENTIAL ADDRESS)","options":[],"required":false,"pdf_field":""},{"help":"Specify if 'Others' is selected.","type":"choice","label":"Educational Qualification","options":["Post Graduate","Graduate","Diploma","12th Pass","Below 12th","Others (Specify)"],"required":false,"pdf_field":""},{"help":"Specify if 'Others' is selected.","type":"choice","label":"Occupation","options":["Salaried","Business Owner","Self-employed","Student","Housewife","Retired/Pensioner","Agriculturist","Others (Specify)"],"required":false,"pdf_field":""},{"help":"Fill only if occupation is student.","type":"text","label":"If student (a) Course presently pursuing","options":[],"required":false,"pdf_field":""},{"help":"Fill only if occupation is student.","type":"text","label":"(b) Name of Institution","options":[],"required":false,"pdf_field":""},{"help":"Fill only if occupation is student.","type":"text","label":"(c) Duration of Course","options":[],"required":false,"pdf_field":""},{"help":"Your job title or designation.","type":"text","label":"Your Designation","options":[],"required":false,"pdf_field":""},{"help":"If yes, provide details below.","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":false,"pdf_field":""},{"help":"Describe the hazards related to your occupation.","type":"text","label":"If yes, please give details.","options":[],"required":false,"pdf_field":""},{"help":"Name of your employer or business.","type":"text","label":"Name of Organisation/Business","options":[],"required":false,"pdf_field":""},{"help":"Address of your organisation or business.","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Nearby landmark for organisation/business address.","type":"text","label":"Landmark","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"District","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Organisation/business phone number.","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"Organisation/business mobile number.","type":"phone","label":"Mobile","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 your PAN number if available.","type":"text","label":"Income Tax PAN Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/annuitant"},{"title":"Nomination/Beneficiary Details (Applicable for option II, III & IV only)","fields":[{"help":"DOB of nominee if minor.","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Address of the nominee/beneficiary.","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Nearby landmark for nominee's address.","type":"text","label":"Landmark","options":[],"required":false,"pdf_field":""},{"help":"6 digit postal code.","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"City/Village","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"District","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Nominee's phone number.","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"Nominee's mobile number.","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"Explain reason for nomination if nominee is not parent/spouse/child.","type":"text","label":"If the nominee/Beneficiary specified above Is any person other than your parent/spouse/child, give reasons for such nomination","options":[],"required":false,"pdf_field":""},{"help":"Provide appointee's details if nominee is minor.","type":"text","label":"If Nominee/Beneficiary Is a Minor, please give details of the appointee (should be a Major)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship to the Minor","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/annuitant"},{"title":"Details of the Plan Applied For","fields":[{"help":"Select one annuity option.","type":"choice","label":"Name of the Plan: Aviva AnnuityPlus","options":["(I) Life Annuity","(II) Annuity guaranteed for 5 years and life thereafter","(III) Annuity guaranteed for 10 years and life thereafter","(IV) Annuity guaranteed for 15 years and life thereafter","(V) Annuity for life increasing @ 3% per annum simple"],"required":true,"pdf_field":""},{"help":"Enter the purchase price amount in Rs. 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 to higher level.","type":"choice","label":"Annuity frequency","options":["Yearly","Half-Yearly","Quarterly","Monthly"],"required":true,"pdf_field":""},{"help":"Only NEFT allowed for Quarterly and Monthly frequency; attach cancelled cheque and NEFT mandate if NEFT selected.","type":"choice","label":"Preferred mode of payout","options":["Cheque","NEFT (National Electronic Fund Transfer)"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Account Type","options":["Saving Account","NRO/NRE"],"required":true,"pdf_field":""},{"help":"9 digit MICR code of the bank branch.","type":"number","label":"MICR Code (9 digits)","options":[],"required":false,"pdf_field":""},{"help":"Fill pension policy number, date of maturity, fund value, commutation details if applicable.","type":"text","label":"For Aviva Pension policyholders only","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Pension policy number","options":[],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY format.","type":"date","label":"Date of maturity","options":[],"required":false,"pdf_field":""},{"help":"Date for fund value calculation.","type":"date","label":"Fund Value as on","options":[],"required":false,"pdf_field":""},{"help":"If yes, specify amount and details.","type":"yes-no","label":"Commutation opted","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If yes, mention additional amount to pay.","type":"yes-no","label":"Do you want to increase the purchase price","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Additional amount you want to pay Rs.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/annuitant"},{"title":"Declaration & Authorization","fields":[{"help":"Sign or provide thumb impression here.","type":"signature","label":"Signature* / thumb impression of the Annuitant","options":[],"required":true,"pdf_field":""},{"help":"Date of signing the form.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place where form is signed.","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer/annuitant"},{"title":"Vernacular Declaration","fields":[{"help":"Person who explained the form to the annuitant fills this.","type":"text","label":"Declarant's Name and Address","options":[],"required":true,"pdf_field":""},{"help":"Attach identity proof of the declarant.","type":"attachment","label":"Enclose identity proof of the declarant","options":[],"required":true,"pdf_field":""},{"help":"Pin code of declarant's address.","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of declarant","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Advisor","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of life to be insured/proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"annuitant and declarant"}],"deadlines":[],"applies_to":"Aviva AnnuityPlus annuity plans","attachments":["Proof of age document","Cancelled cheque (if NEFT mode selected)","Duly completed and signed NEFT mandate (if NEFT mode selected)","Identity proof of the declarant"],"declarations":["The proposer declares that all information provided is true and complete and understands the importance of full disclosure.","The proposer authorizes the company to obtain and share relevant information with medical sources, insurers, and other related parties for risk assessment.","If the proposal is not filled by the proposer, the person filling it declares that the contents have been fully explained and understood by the proposer.","The proposer has read and understood the Benefits and Exclusion Sheet provided with the proposal form."],"dropped_labels":13},"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/2098-aviva-annuityplus-proposal-form"}