{"id":2752,"title":"MOTOR PROTECT PRIVATE CAR (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-private-car-liability-only/proposal-forms/motor-protect-private-car-liability-only-proposal-form.pdf","sha256":"696b7050b56fd503530e1232c218a6cc0dbfa88de0d09caad01a245cca083703","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer/owner of a private car to apply for Motor Protect Private Car Liability Only insurance coverage.","notes":["Answer all questions; attach separate signed and dated sheet if more space is needed referencing question number.","Insurance cover commences only after acceptance and receipt of premium.","Personal Accident cover for Owner Driver is compulsory with minimum sum insured as specified.","Compulsory PA cover not granted if vehicle owned by company/firm or owner-driver lacks valid driving license.","Use capital letters for names and addresses.","Attach copies of Registration Certificate and Fitness Certificate with proposal form.","For premium above Rs 10,000, fill authorization form for NEFT payments.","Company reserves right to reject proposal or terminate contract if proposer or associated persons are blacklisted.","Physical copy of policy available on request; otherwise digital copy sent via email/phone link."],"title":"MOTOR PROTECT PRIVATE CAR (LIABILITY ONLY) PROPOSAL FORM","submit":{"to":"","how":"","address":""},"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":"text","label":"PAN Card/Aadhar","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Fax","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":true,"pdf_field":""},{"help":"Electronic Insurance Account number","type":"text","label":"eIA","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":false,"pdf_field":""},{"help":"Central KYC number if available","type":"text","label":"CKYC No. (if available)","options":[],"required":false,"pdf_field":""},{"help":"Select the type of cover","type":"choice","label":"Type of Cover","options":["Liability Only Policy"],"required":true,"pdf_field":""},{"help":"Start date and time of insurance","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""},{"help":"Tick all applicable categories","type":"checkbox","label":"I am (please tick all that are applicable)","options":["High Net Worth Individual/s","Non-Residential Indian/s","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":"Tick Yes or No","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 impairment 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":""}],"filled_by":"proposer/owner"},{"title":"Vehicle Details","fields":[{"help":"Vehicle registration number","type":"text","label":"Registration Number of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"Date vehicle was registered","type":"date","label":"Date of Registration of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"Authority and location where vehicle registered","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":"Engine number of the vehicle","type":"text","label":"Engine Number","options":[],"required":true,"pdf_field":""},{"help":"Chassis number of the vehicle","type":"text","label":"Chassis Number","options":[],"required":true,"pdf_field":""},{"help":"Manufacturer of the vehicle","type":"text","label":"Make of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"Model of the vehicle","type":"text","label":"Model","options":[],"required":true,"pdf_field":""},{"help":"Body type of the vehicle","type":"text","label":"Type of Body","options":[],"required":true,"pdf_field":""},{"help":"Engine cubic capacity","type":"number","label":"Cubic Capacity of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"Total seating capacity including driver","type":"number","label":"Seating Capacity including driver","options":[],"required":true,"pdf_field":""},{"help":"Specify details if applicable","type":"text","label":"Whether vehicle is driven by non-conventional source of power /CNG/LPG/Bi-Fuel? If ‘YES’, please give details.","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Whether the use of vehicle is limited to own premises?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Whether the vehicle is used for commercial purpose?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Whether the vehicle is used for driving tuition? (GR-44)","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details if vehicle is under hire purchase, lease or hypothecation","type":"text","label":"Details of Hire Purchase / Hypothecation / Lease (IMT-5)/(IMT-7)/(IMT-6)","options":[],"required":false,"pdf_field":""},{"help":"Provide name and address of party 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":""}],"filled_by":"proposer/owner"},{"title":"Liability Section: Coverage","fields":[{"help":"Tick Yes or No","type":"yes-no","label":"Coverage for liability against Third Party Risks (Death or Bodily Injury) required in respect of: Owner Driver only","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Coverage for liability against Third Party Risks (Death or Bodily Injury) required in respect of: 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’ (number of Drivers)","options":[],"required":false,"pdf_field":""},{"help":"Number of employees/workmen employed","type":"number","label":"Legal liability to persons employed in connection with operation of the vehicle, who are ‘workmen’ (number of Employees (Workmen))","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","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":"Tick Yes or No","type":"yes-no","label":"Do you wish to cover wider legal liability to employees who are NOT ‘Employees’?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Personal Accident Cover","fields":[{"help":"Tick Yes or No","type":"yes-no","label":"Do you have existing CPA Cover or Personal Accident Cover?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide policy number","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Sum insured amount","type":"amount","label":"Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Policy period details","type":"text","label":"Policy Period","options":[],"required":false,"pdf_field":""},{"help":"Relationship to proposer","type":"text","label":"Relationship","options":[],"required":false,"pdf_field":""},{"help":"Appointee name if nominee minor","type":"text","label":"Name of the Appointee (If Nominee is a minor)","options":[],"required":false,"pdf_field":""},{"help":"Relationship of appointee to nominee","type":"text","label":"Relationship to the Nominee","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Do you wish to include Personal Accident cover for named persons?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide name, CSI, nominee, relationship for each person","type":"table","label":"If YES, give name and Capital Sum Insured (CSI) opted for (up to 5 persons)","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Do you wish to include Personal Accident cover for Un-named Passengers/hirer/pillion passengers (Two Wheelers)?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Number of persons and CSI per person","type":"text","label":"If YES, give number of persons and Capital Sum Insured (CSI) Opted","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Previous History","fields":[{"help":"Date vehicle was purchased","type":"date","label":"Date of purchase of the vehicle by the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Select one","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":"Tick Yes or No","type":"yes-no","label":"Is the vehicle in good condition?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details if vehicle not in good condition","type":"text","label":"If NO, please give details","options":[],"required":false,"pdf_field":""},{"help":"Provide previous insurer details","type":"text","label":"Name and Address of the previous insurance company","options":[],"required":false,"pdf_field":""},{"help":"Provide previous policy number","type":"text","label":"Previous policy number","options":[],"required":false,"pdf_field":""},{"help":"Previous policy start date","type":"date","label":"Period of Insurance From","options":[],"required":false,"pdf_field":""},{"help":"List claims with year, number, and amount","type":"table","label":"Claims lodged during the preceding 3 years (Year, No. of Claims, Claim Amount (Rs.))","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Driver Details","fields":[{"help":"Provide age in years and date of birth","type":"text","label":"Age and Date of Birth of the Owner","options":[],"required":true,"pdf_field":""},{"help":"Provide age in years and date of birth","type":"text","label":"Age and Date of Birth of the Driver","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No and provide details if Yes","type":"text","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":"Tick Yes or No and provide details if Yes","type":"text","label":"Has the driver ever been involved / convicted for causing any accident or loss? If ‘YES’, give details including pending prosecutions","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Name of driver involved in accident if applicable","type":"text","label":"Driver’s Name","options":[],"required":false,"pdf_field":""},{"help":"Date of accident if applicable","type":"date","label":"Date of Accident","options":[],"required":false,"pdf_field":""},{"help":"Loss amount in rupees if applicable","type":"amount","label":"Loss/ Cost (Rs.)","options":[],"required":false,"pdf_field":""},{"help":"Describe accident circumstances if applicable","type":"text","label":"Circumstances of Accident","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Payment 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":"Amount paid","type":"amount","label":"Amount in (₹)","options":[],"required":true,"pdf_field":""},{"help":"Date payment made","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Provide PAN if premium ≥ 1 lakh","type":"text","label":"PAN (If premium is 1 Lac and above)","options":[],"required":false,"pdf_field":""},{"help":"Provide GSTIN(s)","type":"text","label":"GSTIN (If more than one GSTIN, kindly attach an annexure with details)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Bank Details of Proposer for Refund or Claim Purpose","fields":[{"help":"Name on bank account","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":true,"pdf_field":""},{"help":"Bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Nominee Details","fields":[{"help":"Nominee full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Nominee date of birth","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Relationship to proposer","type":"text","label":"Relationship with the proposer","options":[],"required":true,"pdf_field":""},{"help":"Nominee mobile number","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Nominee email address","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"Nominee present address","type":"text","label":"Address of Nominee: Present address","options":[],"required":true,"pdf_field":""},{"help":"Nominee permanent address","type":"text","label":"Permanent address (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"Nominee bank account holder name","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":false,"pdf_field":""},{"help":"Nominee bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":false,"pdf_field":""},{"help":"Nominee bank account number","type":"text","label":"Bank Account Number","options":[],"required":false,"pdf_field":""},{"help":"Nominee bank IFSC code","type":"text","label":"IFS Code","options":[],"required":false,"pdf_field":""},{"help":"Provide authorized person details if nominee 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":"Sign and date the form","type":"signature","label":"Signature of the Proposer(s) (Affix stamp, where proposer is a juridical person)","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":"For Intermediary Use Only","fields":[{"help":"Name of intermediary","type":"text","label":"Name of Insurance Agent/POSP/Specified Person of the Corporate Agent/Authorized Person of the Broker/IMF","options":[],"required":true,"pdf_field":""},{"help":"Code of intermediary","type":"text","label":"Intermediary’s Code","options":[],"required":true,"pdf_field":""},{"help":"Signature of intermediary","type":"signature","label":"Intermediary’s Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary"}],"deadlines":[],"applies_to":"Private Car (Liability Only)","attachments":["Copies of R.C. & Fitness Certificate","Policy copy of existing CPA or Personal Accident Cover if applicable","Annexure with GSTIN details if more than one GSTIN"],"declarations":["All statements and information provided are complete and accurate with no material facts withheld.","Misrepresentation or suppression of material facts may render the policy void and premium forfeited.","Policyholder and related persons will assist insurer with anti-financial crime compliance.","Premium paid is from legitimate sources and not from crime proceeds.","Consent to receive policy and service communications electronically and for data processing as per privacy policy.","Consent for insurer to access CKYC records for verification.","Insurer may reject proposal or terminate contract if persons are named in any recognized sanctions list.","KYC records are current and proposer will inform insurer of any changes."],"dropped_labels":17},"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/2752-motor-protect-private-car-liability-only-proposal-form"}