{"id":2102,"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/As%20Aviva%20New%20grameen%20Surksha%202015-12%20-%20Malyalam.pdf","sha256":"1eeab84a1e7020bd406b0064b275018ec0ab4d72451d224852f8e0417379aa90","pages":4,"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":["The proposer should pay attention to the Key Features brochure before submitting the proposal.","Receipt of proposal and initial payment does not create obligation until risk is underwritten and policy issued.","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 as approved by the Company.","Proof of age is mandatory.","Use CAPITAL LETTERS to fill the form.","In case of signature in vernacular or thumb impression, declaration must be made by a person of standing unconnected with Aviva Life Insurance.","The form includes a vernacular declaration to be handwritten by the proposer.","The Customer Information Report section is to be filled by the adviser only."],"title":"Proposal Form for Aviva Nayi Grameen Suraksha","submit":{"to":"Branch Office or any other manner as may be 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":"Write in CAPITAL LETTERS","type":"text","label":"Surname","options":[],"required":true,"pdf_field":""},{"help":"Write 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":"","type":"text","label":"Mailing Address","options":[],"required":true,"pdf_field":""},{"help":"Village name","type":"text","label":"Village","options":[],"required":true,"pdf_field":""},{"help":"Post Office","type":"text","label":"P.O.","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Mandal/Taluka/Town","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":"6 digit postal code","type":"number","label":"Pincode","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Permanent Address","options":[],"required":true,"pdf_field":""},{"help":"Village name","type":"text","label":"Village","options":[],"required":true,"pdf_field":""},{"help":"Post Office","type":"text","label":"P.O.","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Mandal/Taluka/Town","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":"6 digit postal code","type":"number","label":"Pincode","options":[],"required":true,"pdf_field":""},{"help":"Attach proof of address document","type":"text","label":"Proof of Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Gender","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"Annual income in rupees","type":"amount","label":"Life Insured'S Annual Income Rs.","options":[],"required":true,"pdf_field":""},{"help":"Current occupation","type":"text","label":"Occupation","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status","options":["Single","Married","Widow(er)","Divorced"],"required":true,"pdf_field":""},{"help":"Specify type and number","type":"text","label":"Voter ID/Ration Card","options":["Voter ID","Ration Card","Others"],"required":false,"pdf_field":""},{"help":"Enter sum assured in rupees","type":"amount","label":"Sum Assured (Rs. in figures)","options":[],"required":true,"pdf_field":""},{"help":"Enter premium amount in rupees","type":"amount","label":"Premium (Rs. in figures)","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Preferred Mode of Payment","options":["Cheque","Cash","Demand Draft","Others"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Policy Term (PT)","options":["5 Years","10 Years"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have Aadhar Number","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide 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":"","type":"text","label":"Name of the Nominee (Under section 39 of the Insurance Act 1938)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Relationship to the Life to be Insured","options":[],"required":true,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Fill only if nominee is minor","type":"section","label":"If Nominee is a Minor, please give appointee details below.","options":[],"required":null,"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":"DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Appointee","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":"D. Any illness that has caused you to be absent from work for 7 days or more in the last 2 years or placed restrictions on your daily activities?","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":"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":"","type":"signature","label":"Signature/Thumb impression of Life to be Insured","options":[],"required":true,"pdf_field":""},{"help":"Handwritten declaration in local language","type":"text","label":"Vernacular Declaration (to be handwritten by the life to be insured/proposer)","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature/Thumb impression of Life to be Insured (again)","options":[],"required":true,"pdf_field":""},{"help":"Declarant confirms explanation of form contents","type":"text","label":"Declaration by the person filling in the form","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Declarant's Name and Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of declarant","options":[],"required":true,"pdf_field":""},{"help":"","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":"1. Did you personally meet the life to be insured?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Specify if Others","type":"choice","label":"2. What proof of identity have you seen of the Life Insured?","options":["Driving License","Aadhar Card","Voter ID Card","Others"],"required":true,"pdf_field":""},{"help":"","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":"","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 if Others","type":"choice","label":"a. If yes, what proofs of income have you checked?","options":["Form 16","Income Tax Return","Property/Land Holding Detail","Others"],"required":false,"pdf_field":""},{"help":"If Yes, provide details","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":"If No, provide details of insurable interest","type":"yes-no","label":"6. Is the nominee dependent of the proposer?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Details of insurable interest if nominee is not dependent","type":"text","label":"If Yes, please give details","options":[],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"I hereby declare that the foregoing statements are true and correct to the best of my knowledge and belief.","options":["Agree"],"required":true,"pdf_field":""}],"filled_by":"adviser"}],"deadlines":[],"applies_to":"Aviva Nayi Grameen Suraksha insurance policy proposals","attachments":["Proof of age","Proof of address","Proof of income","Key Features brochure of the product"],"declarations":["The proposer confirms understanding of the proposal form and submits it on own accord.","Statements and declarations form the basis of contract and untrue statements can lead to policy cancellation.","Any changes in statements 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 collect and share personal and medical information 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.","The adviser declares that the proposal form contents were fully explained to the proposer and answers truthfully recorded.","The adviser confirms satisfaction with the proposer’s identity, income proof, and responses.","The adviser declares that all statements are true and correct to the best of their knowledge."],"dropped_labels":0},"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/2102-proposal-form-for-aviva-nayi-grameen-suraksha"}