{"id":2725,"title":"AROGYA SANJEEVANI POLICY, Generali Central Insurance Company Limited PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/health-insurance/aarogya-sanjeevani-policy/proposal-forms/arogya-sanjeevani-policy-gic-poposal-form.pdf.pdf","sha256":"f319241dde63bdd4049b3cfc1c757ff8ce01982cf9fa24dfbdb2d81eef44ea47","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or families proposing to purchase health insurance under the Arogya Sanjeevani Policy from Generali Central Insurance Company Limited. The proposer fills it to provide personal, health, and nominee details for underwriting the insurance policy.","notes":["Answer all questions carefully; incomplete or incorrect answers may lead to rejection or cancellation.","Fields marked with * are mandatory.","Use block letters where applicable.","PAN is mandatory if premium exceeds Rs. 50,000 in cash or Rs. 1 lakh in any mode.","Provide ABHA number for all insured persons or create one at https://healthid.ndhm.gov.in/register.","For portability or migration, submit respective request forms along with this proposal.","E-mandate/E-NACH activation is required for instalment payments; link sent to registered mobile.","Policy document will be sent digitally unless physical copy is requested.","Original documents may be required for verification.","The premium payment must be from legally declared sources.","The proposer must sign or provide thumb impression; if thumb impression, vernacular declaration and witness required."],"title":"AROGYA SANJEEVANI POLICY, Generali Central Insurance Company Limited PROPOSAL FORM","submit":{"to":"Generali Central Insurance Company Limited","how":"","address":"Registered Office: Unit No. 801 & 802, 8th Floor, Tower C, Embassy 247 Park, LBS Marg, Vikhroli (West), Mumbai – 400083"},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter surname, first name, and middle name","type":"text","label":"Name of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Full permanent address including state and pin code","type":"text","label":"Permanent Full Address*","options":[],"required":true,"pdf_field":""},{"help":"Fill present address or tick if same as permanent","type":"text","label":"Present Full Adress* (If same as above, Please tick here ☐)","options":[],"required":true,"pdf_field":""},{"help":"Provide landline and mandatory mobile number","type":"phone","label":"Contact Number* Landline: Mobile*:","options":[],"required":true,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email Id*","options":[],"required":true,"pdf_field":""},{"help":"Enter date of birth in DD/MM/YYYY format","type":"date","label":"Date of Birth* DD / MM / YYYY","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Gender*","options":["Male","Female","Third Gender"],"required":true,"pdf_field":""},{"help":"Mandatory if premium exceeds Rs. 50,000 in cash or Rs. 1 lakh in any mode","type":"text","label":"PAN","options":[],"required":false,"pdf_field":""},{"help":"If not available, download form from website and submit along with proposal","type":"text","label":"e-IA Number (e-Insurance Account Number)","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status*","options":["Married","Single","Widow/Widower","Divorced"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Nationality*","options":[],"required":true,"pdf_field":""},{"help":"If Others, specify","type":"choice","label":"Occupation*","options":["Service","Self Employed","Others: _____________________"],"required":true,"pdf_field":""},{"help":"If yes, provide policy and customer ID numbers","type":"choice","label":"Are you an existing Generali Central customer*? If yes, please provide: Existing Policy No., Customer ID No.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick if applicable","type":"checkbox","label":"If you are Differently Abled, please tick mark on the checkbox to provide confirmation. ☐","options":[],"required":false,"pdf_field":""},{"help":"Provide details if differently abled","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Provide percentage if differently abled","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Provide Unique Disability ID if applicable","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Family Doctor Details","fields":[{"help":"Enter surname, first name, middle name","type":"text","label":"Name of the Dr*","options":[],"required":true,"pdf_field":""},{"help":"Doctor's full address including state and pin code","type":"text","label":"Full Address*","options":[],"required":true,"pdf_field":""},{"help":"Provide contact numbers","type":"phone","label":"Contact Number Landline: Mobile:","options":[],"required":false,"pdf_field":""},{"help":"Doctor's email address","type":"email","label":"Email Id","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Term","fields":[{"help":"Tick to select 1 year policy term","type":"checkbox","label":"Policy term* available is 1 year","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Payment and Bank Details","fields":[{"help":"Select preferred instalment frequency if opting for instalments","type":"choice","label":"Instalment Frequency","options":["Monthly","Quarterly","Half Yearly"],"required":false,"pdf_field":""},{"help":"Tick to activate E-mandate/E-NACH; link will be sent to registered mobile","type":"checkbox","label":"E-mandate/E-NACH*","options":[],"required":false,"pdf_field":""},{"help":"Select payment mode; specify if Others","type":"choice","label":"Payment Option","options":["Cheque","Demand Draft","Fund Transfer","Pay Order","Debit Card","Credit Card","Others (please specify)"],"required":false,"pdf_field":""},{"help":"Enter premium amount in ₹","type":"amount","label":"Premium Amount","options":[],"required":true,"pdf_field":""},{"help":"Write premium amount in words","type":"text","label":"Amount in Words","options":[],"required":true,"pdf_field":""},{"help":"Name of account holder for payment","type":"text","label":"Account Holder Name","options":[],"required":false,"pdf_field":""},{"help":"Cheque/DD/Pay order number if applicable","type":"text","label":"Instrument Number","options":[],"required":false,"pdf_field":""},{"help":"Date of payment instrument","type":"date","label":"Instrument Date","options":[],"required":false,"pdf_field":""},{"help":"Provide transaction ID for online payments","type":"text","label":"Transaction ID (for online payments)","options":[],"required":false,"pdf_field":""},{"help":"Bank name for claim/refund payments","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration","fields":[{"help":"Enter full name","type":"text","label":"Proposer's Name","options":[],"required":true,"pdf_field":""},{"help":"Sign or provide thumb impression","type":"signature","label":"Proposer's Signature/ Thumb Impression","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date DD / MM / YYYY","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Authorized Representative or Person with Disability","fields":[{"help":"Name of authorized representative","type":"text","label":"Name of Authorized Representative","options":[],"required":false,"pdf_field":""},{"help":"Relationship of authorized representative to proposer","type":"text","label":"Relationship with the Proposer","options":[],"required":false,"pdf_field":""},{"help":"Address of authorized representative","type":"text","label":"Address","options":[],"required":false,"pdf_field":""},{"help":"Contact number of authorized representative","type":"phone","label":"Contact No","options":[],"required":false,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Name of witness","type":"text","label":"Name of Witness","options":[],"required":false,"pdf_field":""},{"help":"Signature of witness","type":"signature","label":"Signature of Witness","options":[],"required":false,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer or authorized representative"}],"deadlines":[],"applies_to":"Health insurance proposals under Arogya Sanjeevani Policy for individual or family floater plans","attachments":["Request for authorisation form to receive Claim / Refund Payments","Portability Request Form (if applicable)","Migration Request Form (if applicable)"],"declarations":["The proposer declares all information is true and complete to the best of their knowledge and is authorized to propose for all insured persons.","The policy will commence only after full premium payment and acceptance by the insurer.","The proposer will notify any change in occupation or health before risk acceptance.","The proposer consents to insurer seeking medical and insurance information for underwriting and claims.","The proposer authorizes sharing of proposal and medical information with government and regulatory authorities.","The proposer confirms no undisclosed material information and consents to electronic communication from insurer.","The premium is paid from legal sources and insurer may verify source of funds; insurer may reject proposal or terminate policy if laws are violated.","The proposer declares applicable categories such as HNI, NRI, Politically Exposed Person, etc.","The proposer agrees information will be processed as per insurer's privacy policy.","If ABHA number is shared, proposer consents to use of medical history for insurance purposes.","The proposer consents to insurer verifying KYC records from Central KYC Registry.","The proposer may opt for Bima-ASBA facility to block premium payment from bank account upon acceptance.","The proposer optionally consents to use of personal information for quality and data analysis by third parties."],"dropped_labels":10},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"grievance","channel":"email","value":"GCIcare@generalicentral.com","label":"HELPLINE Email","level":1,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"atrix given below.\nLEVEL 1\nYou Can Call On Our HELPLINE\n1800-220-233 / 1860-500-3333 / 022-67837800\nOR\nSEND US AN EMAIL\nGCIcare@generalicentral.com\nOur senior citizen policyholders can avail priority support by choosing the valid option from the helpline menu or writ","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-220-233 / 1860-500-3333 / 022-67837800","label":"HELPLINE","level":1,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"may have. You can escalate your concerns as per the\nescalation matrix given below.\nLEVEL 1\nYou Can Call On Our HELPLINE\n1800-220-233 / 1860-500-3333 / 022-67837800\nOR\nSEND US AN EMAIL\nGCIcare@generalicentral.com\nOur senior citizen policyholders can avail priority support by choosing","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Generali Central Insurance Company Ltd.\nUnit No. 301, 3rd Floor Part, Building No. 8,\nMindspace IT/ITES SEZ, MIDC Industrial Area,\nAiravali, Navi Mumbai,\nThane District – 400 708.","label":"Corporate Grievance Redressal Officer (GRO) Address","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mishra\nADDRESS\nGenerali Central Insurance Company Ltd.\nUnit No. 301, 3\nrd\nFloor Part, Building No. 8,\nMindspace IT/ITES SEZ, MIDC Industrial Area,\nAiravali, Navi Mumbai,\nThane District – 400 708.\nLEVEL 3\nIf you are still not satisfied with the solution provided, you can email\nour CEO’s office.\nEMAIL OUR CEO’s OFF","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"GCIGRO@generalicentral.com","label":"Corporate Grievance Redressal Officer (GRO) Email","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"solution provided to you does not meet your expectations,\nyou can write directly to our Corporate GRO.\nSEND US AN EMAIL\nGCIGRO@generalicentral.com\nOR\nCALL US ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mish","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"+91-79001 97777","label":"Corporate Grievance Redressal Officer (GRO) Phone","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"ur expectations,\nyou can write directly to our Corporate GRO.\nSEND US AN EMAIL\nGCIGRO@generalicentral.com\nOR\nCALL US ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mishra\nADDRESS\nGenerali Central In","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/generali-central-insurance/2725-arogya-sanjeevani-policy-generali-central-insurance-company-limited-proposal-for"}