{"id":2728,"title":"Common Proposal Form","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/health-insurance/common-proposal-form/proposal-forms/common-proposal-form-health.pdf","sha256":"60716ec39682f5900586dba57ae4ba12496c92ca1cca901830c83d35fae8c7c8","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for health and accident insurance policies with Generali Central Insurance Company Limited. The proposer fills it to provide personal, health, and insurance details for underwriting.","notes":["Fields marked with * are mandatory.","Answer health questions with 'Yes' or 'No' only; dashes are not sufficient.","Nominee for primary insured must be father, mother, son, daughter, or spouse.","For Accident Suraksha policy, income declaration and occupation are mandatory.","Use original documents for age proof.","For instalment payment, submit duly filled ACH or E-Mandate/E-NACH form.","Premium for floater plans is based on eldest member's age.","Sum insured options vary by zone and age for children.","Loyalty discount requires existing separate retail health insurance policy with insurer.","Read and understand product prospectus available on insurer's website.","Intermediary must explain product features and proposal form contents to proposer.","Section 41 of Insurance Act prohibits rebates except as per published prospectus."],"title":"Common Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter the desired insurance coverage period","type":"text","label":"DESIRED PERIOD OF INSURANCE*","options":[],"required":true,"pdf_field":""},{"help":"Enter surname, first name, and middle name","type":"text","label":"Name of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Enter complete postal address","type":"text","label":"Full Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter 6-digit postal code","type":"number","label":"Pin code*","options":[],"required":true,"pdf_field":""},{"help":"Provide mobile number; landline optional","type":"phone","label":"Contact Number*","options":[],"required":true,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email Id*","options":[],"required":true,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Birth*","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":null,"pdf_field":""},{"help":"","type":"text","label":"Aadhaar Number","options":[],"required":null,"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":"","type":"choice","label":"Occupation","options":["Service","Self Employed","Others: ______________________________"],"required":null,"pdf_field":""},{"help":"If yes, provide Existing Policy No. and Customer ID No.","type":"yes-no","label":"Are you an existing Generali Central customer*?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Product Option","fields":[{"help":"Tick if opting for this product","type":"checkbox","label":"Health Total","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this product","type":"checkbox","label":"Advantage Top Up","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this product","type":"checkbox","label":"Health Suraksha","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this product","type":"checkbox","label":"Accident Suraksha","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Insured","fields":[{"help":"","type":"text","label":"Relationship with the Nominee","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Other Insurance Details","fields":[{"help":"Provide policy number, insurer name and address, sum insured, period, claim details, and portability option for each insured","type":"table","label":"Other ongoing Health insurance / Personal accident / Critical illness policy information","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Product Section - Coverage and Plan Details","fields":[{"help":"Tick the policy term","type":"choice","label":"Health Total - Policy term*","options":["1 Year","2 Years","3 Years"],"required":true,"pdf_field":""},{"help":"Tick the policy term","type":"choice","label":"Advantage Top-Up - Policy term*","options":["1 Year","2 Years","3 Years"],"required":true,"pdf_field":""},{"help":"Tick the policy term","type":"choice","label":"Health Suraksha - Policy term*","options":["1 Year","2 Years","3 Years"],"required":true,"pdf_field":""},{"help":"Tick the policy term","type":"choice","label":"Accident Suraksha - Policy term*","options":["1 Year","2 Years","3 Years"],"required":true,"pdf_field":""},{"help":"Provide payment mode, cheque number, date, bank name, amount in figures and words, GSTIN if applicable, PAN if premium ≥ 1 lakh","type":"text","label":"Payment Details*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration","fields":[{"help":"Format DD/MM/YYYY","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Proposer’s Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Proposer’s Signature/ Thumb Impression","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Intermediary Declaration","fields":[{"help":"","type":"text","label":"Intermediary Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Sales Manager Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Sales Manager Code","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary"},{"title":"Vernacular Declaration","fields":[{"help":"If proposer signed by thumb impression and is not literate","type":"text","label":"Witness Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Witness Signature","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary / Agent Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Intermediary / Agent Signature","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"POSP Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"POSP Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"POSP PAN No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Date and place","options":[],"required":null,"pdf_field":""}],"filled_by":"witness"}],"deadlines":[],"applies_to":"Health Total, Advantage Top Up, Health Suraksha, Accident Suraksha insurance products","attachments":["Age proof document for each insured","Policy copy for loyalty discount (if applicable)","Request for authorization form for NEFT payment (if premium > ₹10,000)","Portability/Migration Request form (if applicable)"],"declarations":["The proposer declares all information is true and complete to the best of their knowledge.","The policy will commence only after full payment of premium and acceptance by the insurer.","The proposer will notify any change in occupation or health before risk acceptance.","The proposer consents to the 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; false information may void the policy and forfeit premium.","The proposer agrees to receive service information electronically and consents to data storage and use by insurer.","The proposer confirms premium is paid from legal sources and understands insurer's rights regarding source verification.","The proposer declares their status (HNI, NRI, Politically Exposed Person, etc.) as applicable.","The proposer consents to sharing ABHA number for medical record access and claims facilitation.","The proposer consents to CKYC record verification and receiving related communications.","The proposer may opt for Bima-ASBA facility to block premium payment from bank account upon proposal acceptance."],"dropped_labels":22},"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/2728-common-proposal-form"}