{"id":2768,"title":"THIRD-PARTY LONG-TERM PRIVATE CAR INSURANCE POLICY – 3 YEARS PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/motor-insurance/third-party-long-term-private-car-insurance-policy-3-years/proposal-forms/third-party-long-term-private-car-insurance-policy-3-years-proposal-form.pdf","sha256":"da9c7ed8ba750acd287cb3667124ad5a9c1b6775bb2adbc9091ed913623eaef5","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer or owner to apply for a third-party long-term private car insurance policy for 3 years with Generali Central Insurance Company Limited.","notes":["Use capital letters for names and addresses.","Attach separate signed and dated sheet if additional space is needed.","Cover commences only after acceptance and receipt of premium.","Personal Accident cover for Owner Driver is compulsory with minimum sum insured for two wheelers.","Compulsory PA cover not granted if vehicle owned by company or owner-driver lacks valid driving license.","Maximum Capital Sum Insured for named persons is Rs. 2 Lakhs for private cars and Rs. 1 Lakh for two wheelers.","Maximum Capital Sum Insured for un-named persons is Rs. 2 Lakhs for private cars and Rs. 1 Lakh for two wheelers.","Submit request for authorization form to receive claim/refund payments directly via NEFT if premium > Rs. 10,000.","Company reserves right to reject proposal or terminate contract if proposer or associated persons are on blacklist.","Section 41 of Insurance Act prohibits rebates except as per published prospectuses or tables."],"title":"THIRD-PARTY LONG-TERM PRIVATE CAR INSURANCE POLICY – 3 YEARS 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":"Provide PAN or Aadhar number","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 if available","type":"text","label":"eIA","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Mail Id","options":[],"required":false,"pdf_field":""},{"help":"If blank, 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":"","type":"text","label":"Occupation / Business","options":[],"required":false,"pdf_field":""},{"help":"Central KYC Registry number if available","type":"text","label":"CKYC No. (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 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":"Select 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":""}],"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":"Name and location of registering authority","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 if vehicle uses alternative fuel","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":"Indicate if vehicle is under hire purchase, lease or hypothecation and provide party details","type":"text","label":"Details of Hire Purchase / Hypothecation / Lease (IMT-5)/(IMT-7)/(IMT-6)","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 covered","type":"table","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":"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","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 Endorsement","fields":[{"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 insurer name if applicable","type":"text","label":"If yes please provide the policy copy of the same - Name of the Insurance Company","options":[],"required":false,"pdf_field":""},{"help":"Provide policy number if applicable","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Sum insured amount if applicable","type":"amount","label":"Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Policy period if applicable","type":"text","label":"Policy Period","options":[],"required":false,"pdf_field":""},{"help":"Relationship of nominee","type":"text","label":"Relationship","options":[],"required":false,"pdf_field":""},{"help":"Appointee name if nominee is 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":"List names, CSI, nominee and relationship for up to 5 persons","type":"table","label":"If YES, give name and Capital Sum Insured (CSI) opted for","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 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":"Other Vehicle Related Information","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":"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":"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":""}],"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":"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":"Tick Yes or No and provide details if Yes","type":"yes-no","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":"Provide driver’s name 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":"Select payment mode","type":"choice","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":"Date payment was 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) if applicable","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":"Provide bank account holder name","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":false,"pdf_field":""},{"help":"Provide bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":false,"pdf_field":""},{"help":"Provide bank account number","type":"text","label":"Bank Account Number","options":[],"required":false,"pdf_field":""},{"help":"Provide IFSC 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":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":"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 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 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/owner"},{"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":"Third-party long-term private car insurance policies for 3 years","attachments":["Copies of R.C. & Fitness Certificate","Policy copy if existing CPA or Personal Accident Cover","Request for authorization form to receive Claim/Refund payments if premium > Rs. 10,000","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 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 policy if otherwise.","Consent to receive policy communications electronically and for processing of personal data as per privacy policy.","Consent for insurer to access CKYC records for verification and communication.","Agreement to abide by insurer's privacy policy and acceptance that insurer may reject or terminate policy if sanctions list is violated.","KYC records are current and proposer will inform insurer of any changes."],"dropped_labels":5},"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/2768-third-party-long-term-private-car-insurance-policy-3-years-proposal-form"}