{"id":2106,"title":"Aviva Jana Suraksha - Tamil","purpose":"proposal","insurer":{"slug":"aviva-life-insurance","name":"Aviva Life Insurance Company India Limited"},"source_pdf":"https://www.avivaindia.com/sites/default/files/JS_Tamil.pdf","sha256":"9ec5d4f66d617989084f235185258dea36885904002844bb9066024f8440b9d8","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is a life insurance proposal form to be filled by the proposer and the life to be insured, including nominee and appointee details if applicable.","notes":["Form is specimen only and not valid for application.","Nomination details to be filled only if proposer and life insured are the same person.","If nominee is a minor, appointee details and signature must be provided.","Signatures/thumb impressions required from life insured and proposer (if different).","If signing in vernacular or illiterate, a declaration by the person filling the form is required.","Use date format dd/mm/yyyy where applicable.","Section 41 and 45 of the Insurance Act, 1938 are printed for reference regarding rebates and policy contestability."],"title":"Aviva Jana Suraksha - Tamil","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":"","type":"text","label":"குடும்பபெயர் /Surname","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"முதல் பெயர் /Forenames","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"தந்தை ஃ கணவன் பெயர் / Father's/Husband's Name","options":[],"required":null,"pdf_field":""},{"help":"Include Village, P.O., Taluka/Mandal/Town, District, State, Pincode","type":"text","label":"தற்போதைய முகவரி /Present Address","options":[],"required":null,"pdf_field":""},{"help":"Enter date in dd/mm/yyyy format","type":"date","label":"Date of Birth /பிறந்த தேதி (தேதி /dd geag:/mm வருடம்/yyyy)","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"காப்பீடு எடுப்பவருடனான உறவு / 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":"amount","label":"வருட வருமானம் (புள்ளி விவரங்களில் ரூ.) / Income per annum (Rs. in figures)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Details","fields":[{"help":"Enter sum insured in rupees","type":"amount","label":"காப்பீடு தொகை (புள்ளி விவரங்களில் ரூ.) / Sum Insured (Rs. in figures)","options":[],"required":null,"pdf_field":""},{"help":"Enter premium amount in rupees","type":"amount","label":"ப்ரீமியம்(புள்ளி விவரங்களில் ரூ.) / Premium (Rs. in figures)","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"ஆண்டுகளில் காலம் / Term in years","options":["5 Years","10 Years"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"ப்ரீமியம் நிகழ்வெண் / Premium frequency","options":["Single Premium","Annual Premium"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"பணம் செலுத்த விருப்பமான முறை / Preferred Mode of Payment","options":["Cash","Cheque","Demand Draft"],"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":"","type":"text","label":"வாரிசுதாரராக நியமிக்கப்பட்டவர் பெயர் / Name of the Nominee (Under section 39 of the Insurance Act 1938)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"காப்பீடு எடுப்பவருடனான உறவு / Relationship to the Life to be insured","options":[],"required":null,"pdf_field":""},{"help":"Enter date in dd/mm/yyyy format","type":"date","label":"Date of Birth /பிறந்த தேதி (தேதி /dd ge;/mm வருடம்/yyyy)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"முகவரி / Address","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Appointee Details (If Nominee is a Minor)","fields":[{"help":"","type":"text","label":"நியமனம் செய்யப்பட்டவர் பெயர் / Name of the Appointee","options":[],"required":null,"pdf_field":""},{"help":"Enter date in dd/mm/yyyy format","type":"date","label":"Date of Birth /பிறந்த தேதி","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"வயது வராதவருடனான உறவுமுறை / Relationship to the Minor","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"முகவரி / Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"நியமனம் செய்யப்பட்டவர் கையொப்பம் / Signature of the Appointee","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration of good health","fields":[{"help":"","type":"yes-no","label":"Have you had a heart condition, diabetes, a stroke, cancer, HIV infection or AIDS? Are you currently in hospital and/or receiving medical treatment or advice?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you been absent from work or taken leave for ten days or more on health grounds over the last one year?","options":["YES","NO"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration","fields":[{"help":"","type":"signature","label":"Signature/Thumb impression of Life to be insured / ஆயுள் காப்பீடு எடுப்பவரின் கையொப்பம் / பெருவிரல் ரேகை","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature/Thumb impression of proposer (If other than Life to be Insured) / முன்மொழிபவரின் கையொப்பம் ஃ பெருவிரல் ரேகை","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"தேதி/Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place / இடம்","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by the person filling in the form","fields":[{"help":"","type":"text","label":"Declarant's name & address / உறுதிகூறுபவர் பெயர் மற்றும் முகவரி","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pincode / அஞ்சலக எண்","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of declarant / உறுதிகூறுபவர் கையொப்பம்","options":[],"required":null,"pdf_field":""},{"help":"Type of photo ID provided","type":"text","label":"ID available / கிடைக்கக்கூடிய அடையாளம்","options":[],"required":null,"pdf_field":""},{"help":"Photo ID number","type":"text","label":"ID No. / அடையாள எண்","options":[],"required":null,"pdf_field":""},{"help":"Date of issue of photo ID","type":"date","label":"Date of issue / வழங்கப்பட்ட தேதி","options":[],"required":null,"pdf_field":""}],"filled_by":"person filling the form"}],"deadlines":[],"applies_to":"","attachments":["Photo ID card copy of the declarant","Illustration shown by the company representative"],"declarations":["I fully understand the meaning and scope of the Proposal Form and submit it on my own accord without inducement.","The statements and declarations form the basis of the contract and any untrue information may lead to policy cancellation and forfeiture of payments.","I will inform the company in writing of any changes in the information until the policy is issued, else the policy may be cancelled.","The company is not liable for payments made through an adviser unless received within the stipulated time.","I consent to the company accessing and sharing my personal and medical information for underwriting and verification purposes.","If the policy is sent by post, it is deemed delivered within three business days of posting.","An illustration has been shown to me by the company representative.","The person filling the form declares that they have explained the form contents to the proposer/life insured and recorded answers truthfully."],"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/2106-aviva-jana-suraksha-tamil"}