{"id":2111,"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/gujrati.pdf","sha256":"5dd85510cf50a3ccbed51371a261dfb71bce324c9733beb7d3cd6dfba6dc1340","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) applying for the Aviva AnnuityPlus insurance plan to provide personal, nominee, and plan details for policy issuance.","notes":["Use capital letters to fill the form.","Proof of age is mandatory.","Counter sign any alterations, overwriting or ink changes.","Only NEFT mode of payment is allowed for Quarterly and Monthly annuity frequency.","Existence certificate submission is required as per annuity option selected.","In case of signature in vernacular or thumb impression, declaration must be made by a person of standing unconnected with Aviva Life Insurance."],"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":"","type":"text","label":"Surname","options":[],"required":true,"pdf_field":""},{"help":"Attach a recent passport size photo.","type":"photo","label":"Affix Photo","options":[],"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":"","type":"choice","label":"No. of Children","options":["1","2","3","Greater than 3","NA"],"required":false,"pdf_field":""},{"help":"Specify nationality if other than Indian.","type":"choice","label":"Nationality","options":["Indian","Foreign National","Person of Indian Origin"],"required":true,"pdf_field":""},{"help":"Fill if nationality is not Indian.","type":"text","label":"Specify Nationality","options":[],"required":false,"pdf_field":""},{"help":"Specify country of residence if not residing in India.","type":"choice","label":"Residential Status","options":["Residing in India","Not Residing in India"],"required":true,"pdf_field":""},{"help":"Fill if not residing in India.","type":"text","label":"Specify Country of residence","options":[],"required":false,"pdf_field":""},{"help":"Provide full communication address including c/o, s/o, w/o, d/o, h/o, f/o as applicable.","type":"text","label":"Communication Address","options":[],"required":true,"pdf_field":""},{"help":"Provide full current residential address with spaces between parts.","type":"text","label":"Current Residential Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Educational Qualification","options":["Below 12th","12th Pass","Graduate","Post Graduate","Diploma","Others (Specify)"],"required":false,"pdf_field":""},{"help":"Fill course name if student.","type":"text","label":"If student (a) Course presently pursuing","options":[],"required":false,"pdf_field":""},{"help":"Fill institution name if student.","type":"text","label":"(b) Name of Institution","options":[],"required":false,"pdf_field":""},{"help":"Fill duration if student.","type":"text","label":"(c) Duration of Course","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Occupation","options":["Salaried","Business Owner","Self-employed","Student","Housewife","Retired/Pensioner","Agriculturist","Others (Specify)"],"required":true,"pdf_field":""},{"help":"Describe your job duties or business nature.","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":"Provide 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":true,"pdf_field":""},{"help":"Provide name of your employer or business.","type":"text","label":"Name of Organisation/Business","options":[],"required":false,"pdf_field":""},{"help":"Provide full address of organisation/business.","type":"text","label":"Address","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.","type":"text","label":"Income Tax PAN Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nomination/Beneficiary Details (Applicable for option II,III & IV only)","fields":[{"help":"Provide full name of nominee or beneficiary.","type":"text","label":"Name of the Nominee/Beneficiary (*Under section 39 of the Insurance Act 1938)","options":[],"required":true,"pdf_field":""},{"help":"Use DD-MM-YYYY format if nominee is minor.","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Provide full address of nominee.","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Provide name of appointee 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","options":[],"required":false,"pdf_field":""},{"help":"Specify relationship of appointee to minor nominee.","type":"text","label":"b. Relationship to the Minor","options":[],"required":false,"pdf_field":""},{"help":"Date of birth of appointee.","type":"date","label":"c. Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Address of appointee.","type":"text","label":"d. Address","options":[],"required":false,"pdf_field":""},{"help":"Appointee must sign here.","type":"signature","label":"Signature of the Appointee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"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":"","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.","type":"amount","label":"Purchase price (Not applicable for Aviva Pension policyholders)","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.","type":"choice","label":"Annuity frequency","options":["Yearly","Half-Yearly","Quarterly","Monthly"],"required":true,"pdf_field":""},{"help":"Only NEFT allowed for Quarterly and Monthly frequency.","type":"choice","label":"Preferred mode of payout","options":["Cheque","NEFT (National Electronic Fund Transfer)"],"required":true,"pdf_field":""},{"help":"Provide bank account number for annuity payout.","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Provide bank name.","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Account Type","options":["Saving Account","Current Account"],"required":true,"pdf_field":""},{"help":"Attach cancelled cheque and NEFT mandate if NEFT selected.","type":"checkbox","label":"For NEFT mode of payment, please enclose cancelled cheque and submit the duly completed and signed NEFT mandate.","options":[],"required":true,"pdf_field":""},{"help":"Submit existence certificate as per annuity option selected.","type":"checkbox","label":"Existence certificate is required to be submitted on every policy anniversary for option I & V to receive annuity in the following year. For option-II, III & IV, this is required at the end of year-5, year-10 & year-15 respectively and every year thereafter.","options":[],"required":true,"pdf_field":""},{"help":"Fill if applicable.","type":"date","label":"Date of maturity","options":[],"required":false,"pdf_field":""},{"help":"Provide fund value on maturity date.","type":"amount","label":"Fund Value as on","options":[],"required":false,"pdf_field":""},{"help":"If yes, specify percentage of commutation.","type":"choice","label":"Commutation opted","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If yes, mention additional amount below.","type":"yes-no","label":"Do you want to increase the purchase price","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify additional amount to pay.","type":"amount","label":"If yes, please mention the additional amount you want to pay Rs.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"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.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing.","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by the person filling in the form","fields":[{"help":"Fill pincode of declarant's address.","type":"text","label":"Pincode","options":[],"required":true,"pdf_field":""},{"help":"Declarant must sign here.","type":"signature","label":"Signature of declarant","options":[],"required":true,"pdf_field":""}],"filled_by":"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)","Existence certificate as per annuity option"],"declarations":["The proposer declares that all information given is true and complete and understands the importance of full disclosure.","The proposer authorizes release of relevant medical and employment information to the company 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."],"dropped_labels":11},"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/2111-aviva-annuityplus-proposal-form"}