{"id":2739,"title":"SECURE PREMIUM PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/health-insurance/secure-premium/proposal-forms/secure-premium-proposal-form.pdf","sha256":"63c75c3cd49e292bb18833aa5fa854e40cd7a812cd762213a275df94dc1441cd","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for an insurance policy under the Secure Premium product. The proposer fills it out with policy and insured details.","notes":["Complete all sections in capital letters and tick appropriate boxes.","Fields marked with an asterisk [*] are mandatory.","All proposer and insured details, nominee details, medical and health information, premium payment and bank details, electronic insurance account details, declarations and terms and conditions as per the base policy proposal form apply.","The policy document will be sent digitally by default as part of the Go Green initiative."],"title":"SECURE PREMIUM PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Policy Details","fields":[{"help":"Enter the name of the base product for the insurance policy.","type":"text","label":"Base Product Name*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured Details","fields":[{"help":"Enter the names of all insured persons (up to 9).","type":"text","label":"Name of Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Go Green Initiative and Declaration","fields":[{"help":"Tick Yes to receive a physical copy of the policy document; otherwise, it will be sent digitally.","type":"choice","label":"If you still wish for a physical copy, you may tick on this box     Yes ☐   No ☐","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter the date of filling the form.","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Enter the place where the form is filled.","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter the full name of the proposer.","type":"text","label":"Proposer Name","options":[],"required":null,"pdf_field":""},{"help":"Sign or provide thumb impression here.","type":"signature","label":"Signature / Thumb Impression of Proposer","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Secure Premium insurance product","attachments":[],"declarations":["The proposer must disclose all material facts and not suppress any information.","The proposal form is the basis of the policy contract if issued.","Failure to disclose material facts or providing misleading information may lead to rejection or cancellation of the policy.","The proposer must sign the proposal form.","The insurer is not obliged to accept any proposal; liability starts only when the proposal is accepted and premium received."],"dropped_labels":0},"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/2739-secure-premium-proposal-form"}