{"id":2764,"title":"STANDALONE THIRD-PARTY LONG-TERM TWO-WHEELER INSURANCE POLICY PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/motor-insurance/standalone-third-party-long-term-two-wheeler-insurance-policy/proposal-forms/standalone-third-party-long-term-tw-proposal-form.pdf","sha256":"2107348d8b0f0d679e16f999f1d396b16e80e34a9f49a61601f396270f9b76da","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer/owner to apply for a standalone third-party long-term insurance policy for a two-wheeler vehicle.","notes":["Insurance is a contract of utmost good faith requiring full disclosure of material facts.","Answer all questions; attach separate signed and dated sheet if more space is needed.","Cover commences only after acceptance and receipt of premium.","Personal Accident cover for Owner Driver is compulsory with minimum sum insured Rs. 15,00,000 for two wheelers.","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 may reject proposal or freeze funds if proposer or associated persons are on any blacklist.","Section 41 of Insurance Act prohibits rebates as inducement for insurance."],"title":"STANDALONE THIRD-PARTY LONG-TERM TWO-WHEELER INSURANCE POLICY PROPOSAL FORM","submit":{"to":"Generali Central Insurance Company Limited","how":"post / e-mail / upload / in person (not explicitly stated)","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 your full name in capital letters","type":"text","label":"Proposer’s (Owner’s) Full Name (In capital letters)","options":[],"required":true,"pdf_field":""},{"help":"Write your present address in capital letters including 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":"Enter the pin code of your present address","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter your telephone number","type":"phone","label":"Telephone No","options":[],"required":false,"pdf_field":""},{"help":"Enter your PAN Card or Aadhar number","type":"text","label":"PAN Card/Aadhar","options":[],"required":false,"pdf_field":""},{"help":"Enter fax number if any","type":"text","label":"Fax","options":[],"required":false,"pdf_field":""},{"help":"Enter your mobile number","type":"phone","label":"Mobile No.","options":[],"required":true,"pdf_field":""},{"help":"Enter eIA if applicable","type":"text","label":"eIA","options":[],"required":false,"pdf_field":""},{"help":"Enter your email address","type":"email","label":"Mail Id","options":[],"required":false,"pdf_field":""},{"help":"Enter permanent address or leave blank if same as present address","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":"Enter your occupation or business","type":"text","label":"Occupation / Business","options":[],"required":true,"pdf_field":""},{"help":"Select the type of cover","type":"choice","label":"Type of Cover Liability Only Policy","options":["Liability Only Policy"],"required":true,"pdf_field":""},{"help":"Enter CKYC number if available","type":"text","label":"CKYC No. (Central Know Your Customer Registry No) number (if available)","options":[],"required":false,"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 Yes above, specify type of impairment","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes above, specify percentage","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes above, provide UDID number","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""},{"help":"Enter start date and time of insurance","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Vehicle Details","fields":[{"help":"Enter vehicle registration number","type":"text","label":"Registration Number of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"Enter vehicle registration date","type":"date","label":"Date of Registration of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"Enter registering authority and location","type":"text","label":"Registering Authority & Location","options":[],"required":true,"pdf_field":""},{"help":"Enter year vehicle was manufactured","type":"number","label":"Year of Manufacture","options":[],"required":true,"pdf_field":""},{"help":"Enter engine number","type":"text","label":"Engine Number","options":[],"required":true,"pdf_field":""},{"help":"Enter chassis number","type":"text","label":"Chassis Number","options":[],"required":true,"pdf_field":""},{"help":"Enter vehicle make","type":"text","label":"Make of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"Enter vehicle model","type":"text","label":"Model","options":[],"required":true,"pdf_field":""},{"help":"Enter type of vehicle body","type":"text","label":"Type of Body","options":[],"required":true,"pdf_field":""},{"help":"Enter cubic capacity","type":"number","label":"Cubic Capacity of the Vehicle","options":[],"required":true,"pdf_field":""},{"help":"Enter seating capacity including driver","type":"number","label":"Seating Capacity including driver","options":[],"required":true,"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":"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 applicable","type":"text","label":"Details of Hire Purchase / Hypothecation / Lease (IMT-5)/(IMT-7)/(IMT-6)","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Under Lease Agreement?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Under Hypothecation?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide name and address if applicable","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: (i) 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: (ii) Any person other than Paid Driver","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"List names of other persons if applicable","type":"text","label":"If ‘YES’, give details of such other persons","options":[],"required":false,"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":"Enter number of drivers","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":"Enter number of employees/workmen","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":""}],"filled_by":"proposer/owner"},{"title":"Additional Covers as per IMT Endorsements","fields":[{"help":"Tick Yes or No","type":"yes-no","label":"The Policy provides additional Third Party Property Damage liability limit of Rs.7,50,000 for private cars and Rs. 1,00,000/- for motorized Two-Wheelers. Do you wish to cover the additional limit?","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 ‘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":""},{"help":"Tick Yes or No","type":"yes-no","label":"Personal Accident Cover for Owner Driver: Do you have existing CPA Cover or Personal Accident Cover","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide appointee name if nominee is minor","type":"text","label":"Name of the Appointee (If Nominee is a minor)","options":[],"required":false,"pdf_field":""},{"help":"Provide relationship 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 (Rs.), nominee, and relationship for each named person","type":"table","label":"If YES, give name and Capital Sum Insured (CSI) opted for (up to 5 entries)","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":"Provide 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":""},{"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","Bhutan","Maldives","Nepal","Pakistan","Sri Lanka"],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Other Vehicle Related Information","fields":[{"help":"Enter date of purchase","type":"date","label":"Date of purchase of the vehicle by the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Select new or second hand","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":"Will the vehicle be used exclusively for (i) Private, Social, Domestic, Pleasure & Professional","options":["YES","NO"],"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":"Provide year-wise 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":""}],"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","type":"yes-no","label":"Does the driver suffer from defective vision or hearing or any physical infirmity?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If ‘YES’, please give details of such infirmity","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Has the driver ever been involved / convicted for causing any accident or loss?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details of accidents if applicable","type":"text","label":"If ‘YES’, give details as under including the pending prosecutions: Driver’s Name, Date of Accident, Loss/ Cost (Rs.), Circumstances of Accident","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Payment Details","fields":[{"help":"Specify mode of payment","type":"text","label":"Mode of Payment","options":[],"required":true,"pdf_field":""},{"help":"Provide payment details","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Enter amount paid","type":"amount","label":"Amount in (Rs.)","options":[],"required":true,"pdf_field":""},{"help":"Enter payment date","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Provide PAN if premium is 1 lakh or above","type":"text","label":"PAN (If premium is 1 Lac and Above.)","options":[],"required":false,"pdf_field":""},{"help":"Provide GSTIN or attach annexure if multiple","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":"Enter bank account holder name","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":true,"pdf_field":""},{"help":"Enter bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"Nominee Details","fields":[{"help":"Enter nominee name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee date of birth","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Enter relationship with proposer","type":"text","label":"Relationship with the proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee mobile number","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee email address","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee present address","type":"text","label":"Address of Nominee: Present address","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee permanent address or leave blank if same","type":"text","label":"Permanent address (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee bank account holder name","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee bank account number","type":"text","label":"Bank Account Number","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee IFSC code","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":"Sign the form","type":"signature","label":"Signature of the Proposer(s) (Affix stamp, where proposer is a juridical person)","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer/owner"},{"title":"For Intermediary Use Only","fields":[{"help":"Enter intermediary name","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":"Enter intermediary code","type":"text","label":"Intermediary’s Code","options":[],"required":true,"pdf_field":""},{"help":"Intermediary to sign","type":"signature","label":"Intermediary’s Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"insurance agent/intermediary"}],"deadlines":[],"applies_to":"Standalone Third-Party Long-Term Two-Wheeler Insurance Policy","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.","The proposer and related persons will assist the insurer with records to address anti-financial crime practices.","Premium is paid from legitimate sources and insurer may verify source of funds and reject or terminate policy if otherwise.","Consent to receive policy and service communications electronically and for processing of personal data.","Consent for insurer to access CKYC records for verification and communication.","Agreement to abide by insurer's Privacy Policy.","Insurer reserves the right to reject or terminate policy if proposer or associated persons are named in sanctions lists."],"dropped_labels":11},"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/2764-standalone-third-party-long-term-two-wheeler-insurance-policy-proposal-form"}