{"id":2109,"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%20Oriya.pdf","sha256":"26047b8fe407488c1313b77b1072678f113220a82a1a5255cde2f49deb21804a","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals applying for the Aviva AnnuityPlus insurance policy. 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 or overwriting in the form.","Proof of age is mandatory.","Only NEFT mode is allowed for quarterly and monthly annuity payments.","Attach original documents as proof where required.","Existence certificate must be submitted as per policy anniversary schedule for annuity payment continuation.","If annuity payable is less than Rs. 500, annuity frequency will be changed automatically to a higher level.","For signatures in vernacular or thumb impression, a declarant unrelated to Aviva must make the declaration."],"title":"Aviva AnnuityPlus Proposal Form","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":"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":"Fill only if applicable.","type":"text","label":"Maiden Name (in case of married female life to be insured)","options":[],"required":false,"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 '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 'Specify Country of residence' is chosen.","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":"Include landmark, pin code, city/village, district, state, phone, mobile.","type":"text","label":"Current Residential Address","options":[],"required":true,"pdf_field":""},{"help":"Specify if 'Others' 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' selected.","type":"choice","label":"Occupation","options":["Salaried","Business Owner","Student","Self-employed","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 (b) Name of Institution (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":false,"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":false,"pdf_field":""},{"help":"Provide address, landmark, pin code, city/village, district, state, phone, mobile.","type":"text","label":"Name of Organisation/Business","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":"proposer (annuitant)"},{"title":"Nomination/Beneficiary Details (Applicable for option II, III & IV only)","fields":[{"help":"Use DD/MM/YYYY format.","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Include landmark, pin code, city/village, district, state, phone, mobile.","type":"text","label":"Address","options":[],"required":true,"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 details if nominee is minor.","type":"text","label":"If Nominee/Beneficiary is a Minor, please give details of the appointee (should be a Major): a. Name of the Appointee b. Relationship to the Minor c. Date of Birth d. Address","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer (annuitant)"},{"title":"Details of the plan applied for","fields":[{"help":"Plan name is 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":"Enter the purchase price amount in rupees.","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, frequency will be changed to higher level automatically. Quarterly and Monthly require NEFT payment mode.","type":"choice","label":"Annuity frequency","options":["Yearly","Half-Yearly","Quarterly*","Monthly*"],"required":true,"pdf_field":""},{"help":"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":"Fill all bank details accurately for annuity payout.","type":"text","label":"Bank Details (For Annuity Payout): Bank Account Number, Bank Name, Account Type (Saving Account, Current Account, NRO/NRE), Address of Branch, MICR Code (9 digits)","options":[],"required":true,"pdf_field":""},{"help":"Use DD/MM/YYYY format.","type":"date","label":"Date of maturity","options":[],"required":false,"pdf_field":""},{"help":"Enter fund value on maturity date.","type":"amount","label":"Fund Value as on","options":[],"required":false,"pdf_field":""},{"help":"If yes, specify 1/3rd or less than 1/3rd of fund value at vesting and percentage if less.","type":"choice","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":""}],"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 in DD/MM/YYYY format.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place where form is signed.","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"If nominee is minor, appointee signs here.","type":"signature","label":"Signature of the Appointee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer (annuitant)"},{"title":"Declaration by the person filling in the form","fields":[{"help":"Name and address of the person who explained the form contents.","type":"text","label":"Declarant's Name and Address","options":[],"required":true,"pdf_field":""},{"help":"Pincode of declarant's address.","type":"number","label":"Pincode","options":[],"required":true,"pdf_field":""},{"help":"Declarant signs here.","type":"signature","label":"Signature of declarant","options":[],"required":true,"pdf_field":""}],"filled_by":"person filling the form if proposer cannot sign or uses vernacular signature"}],"deadlines":[],"applies_to":"Aviva AnnuityPlus annuity insurance policy proposal","attachments":["Proof of age document","Cancelled cheque (if NEFT mode selected)","Duly completed and signed NEFT mandate (if NEFT mode selected)","Existence certificate as per policy anniversary requirements"],"declarations":["The proposer declares that 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 filled by another person, the proposer confirms the contents have been fully explained and understood.","The proposer agrees that this proposal form will be part of the insurance contract if accepted by the company.","The proposer agrees to the terms under Insurance Act Sections 41 and 45 regarding rebates, fraud, and policy contestability.","The proposer consents to the vernacular declaration handwritten by them confirming understanding of the contract.","The declarant confirms having explained the proposal form contents truthfully to the proposer."],"dropped_labels":8},"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/2109-aviva-annuityplus-proposal-form"}