{"id":2105,"title":"Aviva Jana Suraksha - Gujarati","purpose":"proposal","insurer":{"slug":"aviva-life-insurance","name":"Aviva Life Insurance Company India Limited"},"source_pdf":"https://www.avivaindia.com/sites/default/files/JS_Gujarati.pdf","sha256":"862f5a0f1d9215c5f019c786f133aa6000effea5a3526ba56121f102257bfba5","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is a proposal form for the Aviva Jana Suraksha insurance plan, to be filled by the proposer who may be the life to be insured or a different person.","notes":["This is a specimen form and not valid for application.","Nomination details are to be completed only when the proposer and the life to be insured are the same.","If the nominee is a minor, appointee details must be provided and the appointee must sign.","Refer to the Insurance Act, 1938 (as amended) for full legal provisions including Section 45.","Use correct date formats and provide complete address details."],"title":"Aviva Jana Suraksha - Gujarati","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer's Details (If different from life to be insured)","fields":[{"help":"","type":"choice","label":"Mr/Mrs/Miss/Ms","options":["Mr","Mrs","Miss","Ms"],"required":null,"pdf_field":""},{"help":"Enter the surname of the proposer","type":"text","label":"Surname","options":[],"required":null,"pdf_field":""},{"help":"Enter the forenames of the proposer","type":"text","label":"Forenames","options":[],"required":null,"pdf_field":""},{"help":"Enter the father's or husband's name of the proposer","type":"text","label":"Father's/Husband's Name","options":[],"required":null,"pdf_field":""},{"help":"Enter the current address including village, P.O., Taluka/Mandal/Town, District, State, and Pincode","type":"text","label":"Present Address","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth in dd/mm/yyyy format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Select the relationship of the proposer to the life to be insured","type":"choice","label":"Relationship to the Life to be insured","options":["Father","Mother","Spouse","Legal Guardian","Others"],"required":null,"pdf_field":""},{"help":"Enter annual income in rupees","type":"number","label":"Income per annum (Rs. in figures)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Details","fields":[{"help":"Enter the sum insured amount in rupees","type":"amount","label":"Sum Insured (Rs. in figures)","options":[],"required":null,"pdf_field":""},{"help":"Enter the premium amount in rupees","type":"amount","label":"Premium (Rs. in figures)","options":[],"required":null,"pdf_field":""},{"help":"Select the term of the policy in years","type":"number","label":"Term in years","options":["5 Years","10 Years"],"required":null,"pdf_field":""},{"help":"Select the premium payment frequency","type":"choice","label":"Premium frequency","options":["Annual Premium","Single Premium"],"required":null,"pdf_field":""},{"help":"Select the preferred mode of payment","type":"choice","label":"Preferred Mode of Payment","options":["Cash","Demand Draft","Cheque"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nomination Details (To be completed only when the proposer and the life to be insured are the same)","fields":[{"help":"Enter the full name of the nominee","type":"text","label":"Name of the Nominee (Under section 39 of the Insurance Act 1938)","options":[],"required":null,"pdf_field":""},{"help":"Enter the relationship of the nominee to the life to be insured","type":"text","label":"Relationship to the Life to be insured","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth of nominee in dd/mm/yyyy format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Enter the address of the nominee","type":"text","label":"Address","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Appointee Details (If Nominee is a Minor)","fields":[{"help":"Enter the name of the appointee","type":"text","label":"Name of the Appointee","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth of appointee in dd/mm/yyyy format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Enter the relationship of the appointee to the minor nominee","type":"text","label":"Relationship to the Minor","options":[],"required":null,"pdf_field":""},{"help":"Enter the address of the appointee","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Appointee must sign here","type":"signature","label":"Signature of the Appointee","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Aviva Jana Suraksha insurance policy proposal","attachments":[],"declarations":["No person shall offer or accept any rebate of commission or premium except as allowed by the insurer's published prospectuses or tables.","Any default in complying with the rebate provisions may lead to a penalty up to ten lakh rupees.","A life insurance policy cannot be questioned after three years from the date of issuance, commencement of risk, revival, or rider, whichever is later.","A policy may be questioned within three years on grounds of fraud, with written communication of grounds by the insurer.","Misstatements or suppression of material facts may lead to repudiation within three years, with premiums refunded if not fraud.","Proof of age may be called for at any time and policy terms adjusted accordingly.","The insurer cannot repudiate a policy on fraud if the insured proves no deliberate intention or that the insurer had knowledge.","In case of repudiation on misstatement (not fraud), premiums collected must be paid back within ninety days."],"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/2105-aviva-jana-suraksha-gujarati"}