{"id":2751,"title":"MOTOR PROTECT COMMERCIAL VEHICLE (LIABILITY ONLY) PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/motor-insurance/motor-protect-commercial-vehicle-liability-only/proposal-forms/motor-protect-commercial-vehicle-liability-only-proposal-form.pdf","sha256":"2f9b6dbda4c91d3ad949b88a8bbdc8dd20fee0ea4b79260cec5485b46e036cea","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer or owner of a commercial vehicle to apply for liability-only motor insurance coverage.","notes":["Answer all questions; if additional space is needed, attach a separate signed and dated sheet referencing the question number.","Insurance cover starts only after acceptance and receipt of premium.","Personal Accident cover for Owner Driver is compulsory for sum insured of Rs. 2,00,000 for commercial vehicles.","Compulsory PA cover for owner driver not granted if vehicle owned by company/firm or owner-driver lacks valid license.","Use capital letters for names and addresses.","If nominee is minor, provide appointee details.","For premium above Rs 1 lakh, PAN is mandatory.","For premium above Rs 10,000, NEFT authorization form is required for claim/refund payments.","The form includes anti-money laundering and anti-financial crime compliance requirements.","Physical copy of policy available on request; otherwise policy will be sent electronically."],"title":"MOTOR PROTECT COMMERCIAL VEHICLE (LIABILITY ONLY) 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; Email ID: GCIcare@generalicentral.com"},"purpose":"proposal","sections":[{"title":"Personal Details of Proposer/Owner","fields":[{"help":"Write full name in capital letters","type":"text","label":"Proposer’s (Owner’s) Full Name (In capital letters)","options":[],"required":true,"pdf_field":""},{"help":"Include pin code","type":"text","label":"Present Address of proposer (where the vehicle is normally kept) (In capital letters, with pin code)","options":[],"required":true,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Telephone No","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Fax","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Mail Id","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Permanent address of the proposer (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Occupation / Business","options":[],"required":true,"pdf_field":""},{"help":"Central KYC Registry number if available","type":"text","label":"CKYC No. (if available)","options":[],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"I am (please tick all that are applicable)","options":["High Net Worth Individual","Non-Residential Indian","Politically Exposed Person","Non-Governmental Organisation","Non-Profit Organisation"],"required":false,"pdf_field":""},{"help":"Provide registration number if applicable","type":"text","label":"If you are an NGO/NPO, please provide Niti Ayog – Darpan Portal Registration Number","options":[],"required":false,"pdf_field":""},{"help":"If Yes, provide type, percentage of impairment and UDID number","type":"yes-no","label":"If you are Differently Abled, please tick on the checkbox to provide confirmation","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If differently abled, specify type","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If differently abled, specify percentage","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Unique Disability ID if applicable","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Type of Cover","options":["Liability Policy Only"],"required":true,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Vehicle Details","fields":[{"help":"","type":"text","label":"Registration Number of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date of Registration of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Registering Authority & Location","options":[],"required":true,"pdf_field":""},{"help":"Year vehicle was manufactured","type":"number","label":"Year of Manufacture","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Engine Number","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Chassis Number","options":[],"required":true,"pdf_field":""},{"help":"Manufacturer name","type":"text","label":"Make of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"Vehicle model","type":"text","label":"Model","options":[],"required":true,"pdf_field":""},{"help":"Body type of vehicle","type":"text","label":"Type of Body","options":[],"required":true,"pdf_field":""},{"help":"Specify GVW and engine cubic capacity","type":"text","label":"Gross Vehicle Weight (GVW) & Cubic Capacity of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"Number of passengers vehicle is licensed to carry","type":"number","label":"Max. licensed carrying capacity (No. of Passengers) in case of Passenger Carrying Vehicles?","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No and provide details if Yes","type":"text","label":"Whether vehicle is driven by non-conventional source of power /CNG/LPG/Bi-Fuel? If ‘YES’, please give details.","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether the use of vehicle is limited to own premises?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether the vehicle is used for commercial purpose?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether the vehicle is used for driving tuition? (GR-44)","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Details of Hire Purchase / Hypothecation / Lease (IMT-5)/(IMT-7)/(IMT-6) a) Is the vehicle proposed for insurance is: i) Under Hire Purchase?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"ii) Under Lease Agreement?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"iii) Under Hypothecation?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details if vehicle is under hire purchase, lease or hypothecation","type":"text","label":"If ‘YES’, give name and address of concerned party/parties","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Coverage for liability against Third Party Risks (Death or Bodily Injury) required in respect of: (i) Owner Driver only","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If Yes, give details of such other persons","type":"yes-no","label":"(ii) Any person other than Paid Driver","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Do you wish to have the statutory Third Party Property Damage (TPPD) liability of Rs. 6000/- only?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Number of drivers employed","type":"number","label":"Legal liability to persons employed in connection with operation of the vehicle, who are ‘workmen’. 1) Drivers (No. of persons)","options":[],"required":false,"pdf_field":""},{"help":"Number of employees/workmen","type":"number","label":"2) Employees (Workmen) (No. of persons)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Additional Covers as per IMT Endorsements","fields":[{"help":"","type":"yes-no","label":"The Policy provides additional Third-Party Property Damage liability limit or Rs. 7,50,000/- for commercial vehicles. Do you wish to cover the additional limit?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Covers additional liability under Fatal Accidents Act and Common Law","type":"yes-no","label":"Do you wish to cover wider legal liability to employees who are ‘workmen’?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Covers liability under Common Law and Fatal Accidents Act for non-workmen employees","type":"yes-no","label":"Do you wish to cover wider legal liability to employees who are NOT ‘workmen’?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide nominee name and age","type":"text","label":"Personal Accident Cover for Owner Driver is compulsory in the Liability Only Cover. Please give details of nomination: (a) Name of the Nominee & Age","options":[],"required":true,"pdf_field":""},{"help":"Relationship of nominee to proposer","type":"text","label":"(b) Relationship","options":[],"required":true,"pdf_field":""},{"help":"Provide if nominee is minor","type":"text","label":"(c) Name of the Appointee (If Nominee is a Minor)","options":[],"required":false,"pdf_field":""},{"help":"Relationship of appointee to nominee","type":"text","label":"(d) Relationship to the Nominee","options":[],"required":false,"pdf_field":""},{"help":"If Yes, provide name and Capital Sum Insured (CSI) opted for","type":"yes-no","label":"Do you wish to include Personal Accident cover for named persons?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide number of persons and CSI if Yes","type":"text","label":"Do you wish to include Personal Accident cover for Un-named Passengers/hirer/pillion passengers (Two Wheelers)? If YES, give number of persons and Capital Sum Insured (CSI) Opted","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Tick Yes or No for each country","type":"checkbox","label":"Whether extension of geographical area to the following countries required? (Bangladesh, Bhutan, Maldives, Nepal, Pakistan, Sri Lanka)","options":["Bangladesh YES NO","Bhutan YES NO","Maldives YES NO","Nepal YES NO","Pakistan YES NO","Sri Lanka YES NO"],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Information and Data Collection","fields":[{"help":"Date of vehicle purchase","type":"date","label":"Previous History: Date of purchase of the vehicle by the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Whether the vehicle was new or second hand at the time of purchase?","options":["NEW","SECOND HAND"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Will the vehicle be used exclusively for (i) Private, Social, Domestic, Pleasure & Professional Purpose?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If No, provide details","type":"yes-no","label":"Is the vehicle in good condition?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Explain condition if not good","type":"text","label":"If NO, please give details","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name and Address of the previous insurance company","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Previous policy number","options":[],"required":false,"pdf_field":""},{"help":"List claims details for last 3 years","type":"table","label":"Claims lodged during the preceding 3 years (Year, No. of Claims, Claim Amount (Rs.))","options":[],"required":false,"pdf_field":""},{"help":"Provide age in years and date of birth","type":"text","label":"Details of Driver: a. Age and Date of Birth of the Owner","options":[],"required":true,"pdf_field":""},{"help":"If Yes, provide details","type":"yes-no","label":"Does the driver suffer from defective vision or hearing or any physical infirmity? If ‘YES’ , please give details of such infirmity","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If Yes, provide accident details","type":"yes-no","label":"Has the driver ever been involved / convicted for causing any accident of loss? If ‘YES’ , give details as under including the pending prosecutions","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Name of driver involved in accident","type":"text","label":"Driver’s Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Date of Accident","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Loss/ Cost: [Rs.]","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Circumstances of Accident","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Payment and Bank Details","fields":[{"help":"Specify payment mode","type":"text","label":"Mode of Payment","options":[],"required":true,"pdf_field":""},{"help":"Provide payment reference/details","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Premium amount paid","type":"amount","label":"Amount in (₹)","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Permanent Account Number if premium ≥ 1 lakh","type":"text","label":"PAN (If premium is 1 Lac and Above.)","options":[],"required":false,"pdf_field":""},{"help":"Goods and Services Tax Identification Number","type":"text","label":"GSTIN (If more than one GSTIN, kindly attach an annexure with details)","options":[],"required":false,"pdf_field":""},{"help":"Name on bank account for refunds","type":"text","label":"Bank details of proposer for refund or claim purpose: Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number","options":[],"required":false,"pdf_field":""},{"help":"Indian Financial System Code","type":"text","label":"IFS Code","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Nominee Details","fields":[{"help":"Nominee full name","type":"text","label":"Name","options":[],"required":false,"pdf_field":""},{"help":"Nominee date of birth","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the proposer","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address of Nominee: Present address","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Permanent address (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"IFS Code","options":[],"required":false,"pdf_field":""},{"help":"Provide authorized person details if nominee is minor","type":"text","label":"Authorized person details (in case nominee is a minor)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Declaration by Proposer","fields":[{"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":""},{"help":"Sign here","type":"signature","label":"Signature of the Proposer(s) (Affix stamp, where proposer is a juridical person)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Commercial vehicle liability insurance policies","attachments":["Separate signed and dated sheet if additional space is needed","Annexure with GSTIN details if more than one GSTIN","Request for authorization form to receive Claim/Refund payments through NEFT if premium paid is more than Rs 10000"],"declarations":["All statements and information provided are complete and accurate with no relevant information withheld.","Misrepresentation or suppression of material facts may render the policy void and premium forfeited.","Policyholder and related persons will assist the insurer with anti-financial crime compliance.","Premium is paid from legitimate sources and insurer may verify source of funds and reject policy if otherwise.","Consent to receive policy and service communications electronically and for processing of personal data.","Consent to insurer accessing CKYC records for verification and receiving related communications.","Agreement to abide by insurer's Privacy Policy.","Insurer reserves right to reject proposal or terminate contract if proposer or related persons are on sanctions list.","KYC records are current and proposer will inform insurer of any changes."],"dropped_labels":7},"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/2751-motor-protect-commercial-vehicle-liability-only-proposal-form"}