{"id":2775,"title":"DOG HEALTH COVER PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/lifestyle-insurance/dog-health-cover/proposal-forms/dog-health-cover-proposal-form.pdf","sha256":"cf7a261b7c254f6220130e14e86c4ada529db23b9ccbe859b94bd1d089c0be43","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer (dog owner) to apply for Dog Health Cover insurance with Generali Central Insurance Co. Ltd. It collects details about the proposer, their pet dogs, and the desired coverage.","notes":["Insurance contract is based on utmost good faith; all material facts must be disclosed.","If additional space is needed, attach a separate signed and dated sheet referencing the question number.","Cover starts only after acceptance and premium receipt.","If more than one dog, insurance must be taken for each dog subject to eligibility; cannot select specific dogs.","Micro-chip number eligibility provides discount.","Use the attached authorization form to receive claim/refund payments directly via NEFT if premium > Rs.10,000/-.","Section for intermediary use only is not to be filled by proposer.","Use block letters where applicable.","Original documents may be required for verification."],"title":"DOG HEALTH COVER PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"1. Your Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"2. Present address with PIN code","options":[],"required":null,"pdf_field":""},{"help":"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 start date of policy","type":"date","label":"3. Policy Period (The policy will start on/after premium receipt date) From:","options":[],"required":null,"pdf_field":""},{"help":"Enter end date of policy (one year from start)","type":"date","label":"To:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"4. How many pet dogs do you have?","options":[],"required":null,"pdf_field":""},{"help":"Central KYC number if available","type":"text","label":"5. CKYC Number (if available)","options":[],"required":false,"pdf_field":""},{"help":"Provide existing insurer name if any","type":"text","label":"6. In case, you have any existing insurance for your dogs? If yes, then please share the details. Name of the Insurance company:","options":[],"required":false,"pdf_field":""},{"help":"Provide policy number if insured with GCI","type":"text","label":"In case of GCI please policy provide policy number :","options":[],"required":false,"pdf_field":""},{"help":"Provide claim amount for last 3 years","type":"amount","label":"In case of other Insurer please provide the following; Claim Amount (for the last 3 years)  :","options":[],"required":false,"pdf_field":""},{"help":"Reason for claim in last 3 years","type":"text","label":"Reason of Claim :","options":[],"required":false,"pdf_field":""},{"help":"Fill columns: Name of Pet Dog(s), Sex(M/F), Age (YY/MM), Breed, Weight of the pet dog when it is 15-18 months old, Identification features/marks","type":"table","label":"7. Please share the following details for all your pet dogs. Name of Pet Dog(s)","options":[],"required":true,"pdf_field":""},{"help":"Provide registration or micro-chip number if available for discount eligibility","type":"text","label":"8. Registration No. of Municipal Corporation/ deemed local Government authority/ Kennel club of India certificate or Tagging/Micro-chip No. (optional)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured and Coverage Options","fields":[{"help":"Enter sum insured amount for Surgery and Hospitalization Cover","type":"amount","label":"9. Sum Insured Base Covers Coverage Description Sum Insured (in Rs.) I Surgery and Hospitalization Cover","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No for higher co-pay option","type":"choice","label":"II OPD Cover- up to 20% of the Sum Insured of “Coverage I” or maximum amount of INR 10,000/- Do you want to opt for higher co-pay of 20%?    Yes/No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No to opt for Terminal Illness Cover","type":"choice","label":"Optional Covers S.No Cover Cover Opted Sum Insured (in Rs.) 1 Terminal Illness Cover Yes/No Same as Coverage I","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No to opt for Lost and Stolen Cover","type":"choice","label":"2 Lost and Stolen Cover Yes/No 25% of the Sum Insured of “Coverage I”","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No to opt for Long Term Care Cover","type":"choice","label":"3 Long Term Care Cover Yes/No Same as Coverage I or Max Rs.50,000/-","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No to opt for Funeral Cost Cover","type":"choice","label":"4 Funeral Cost Cover Yes/No Rs.5,000/-","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No to opt for Veterinary on Call; if Yes, select number of visits and co-pay options","type":"choice","label":"5 Veterinary on Call (Home Visits) Yes/No If opted, pls select no. of visits 5 visits/10 visits Do you want to opt for higher co-pay of 20%? Yes/No If opted, pls select amount per visit Rs.1,000/ Rs. 2,000/-","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No to opt for Emergency Pet Minding Cover; if Yes, select number of days","type":"choice","label":"6 Emergency Pet Minding Cover Yes/No (If opted, pls select for how many days?) 5days/10 days (Per Day limit up to Rs.1,500/- max)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No to opt for Third Party Liability Cover; if Yes, specify sum insured","type":"choice","label":"7 Third Party Liability Cover Yes/No If opted, pls specify the Sum Insured (up to maximum of Rs.10,00,000/-)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"10. Do you use your Dog (s) for Commercial Purpose?  Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"11. Is/Are your pet Dog(s) healthy? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"For each vaccine, indicate Yes or No; specify other vaccines if any","type":"table","label":"12. Is your Pet Dog (s) vaccinated? Name of Vaccine Is your dog vaccinated? (Yes/No) Rabies Distemper Hepatitis Adeno Virus Leptospirosis Parainfluenza Corona Parvovirus Others, please specify","options":[],"required":null,"pdf_field":""},{"help":"Provide details if any pre-existing conditions","type":"text","label":"13. Does Your Pet Dog(s) suffer from any pre-existing diseases/conditions? Yes/No, If yes, then please share details","options":[],"required":null,"pdf_field":""},{"help":"Optional additional information","type":"text","label":"14. Do you want to share any other information that is important for the policy?","options":[],"required":false,"pdf_field":""},{"help":"Tick all applicable categories","type":"checkbox","label":"15. I am (please tick all that are applicable) High Net Worth Individual/s, Non-Residential Indian/s, Politically Exposed Person, Non-Governmental Organisation, Non-Profit Organisation","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 NGO/NPO","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":"16. If you are Differently Abled, please tick on the checkbox to provide confirmation. Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"Percentage of Impairment:","options":[],"required":false,"pdf_field":""},{"help":"Unique Disability ID number","type":"text","label":"UDID Number:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Specify payment mode","type":"text","label":"Mode of Payment","options":[],"required":null,"pdf_field":""},{"help":"Provide payment details","type":"text","label":"Payment Details","options":[],"required":null,"pdf_field":""},{"help":"Enter amount paid","type":"amount","label":"Amount in (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Enter payment date","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":null,"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"},{"title":"Bank Details for Refund or Claim","fields":[{"help":"Name on bank account for refunds/claims","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder):","options":[],"required":null,"pdf_field":""},{"help":"Bank name and branch","type":"text","label":"Bank Name & Branch:","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Bank Account Number:","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFS Code:","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Nominee's full name","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Nominee's date of birth","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"Relationship to proposer","type":"text","label":"Relationship with the proposer:","options":[],"required":null,"pdf_field":""},{"help":"Nominee's mobile number","type":"phone","label":"Mobile Number:","options":[],"required":null,"pdf_field":""},{"help":"Nominee's email address","type":"email","label":"E-Mail ID:","options":[],"required":false,"pdf_field":""},{"help":"Nominee's present address","type":"text","label":"Address of Nominee: Present address:","options":[],"required":null,"pdf_field":""},{"help":"Nominee's permanent address or same as present","type":"text","label":"Permanent address: ((if left blank, will be construed as being same as Present Address)):","options":[],"required":false,"pdf_field":""},{"help":"Nominee's bank account holder name","type":"text","label":"Bank Account Details of Nominee: Name of Account holder:","options":[],"required":null,"pdf_field":""},{"help":"Nominee's bank name and branch","type":"text","label":"Bank Name & Branch:","options":[],"required":null,"pdf_field":""},{"help":"Nominee's bank account number","type":"text","label":"Bank Account Number:","options":[],"required":null,"pdf_field":""},{"help":"Nominee's bank IFSC code","type":"text","label":"IFS Code:","options":[],"required":null,"pdf_field":""},{"help":"Details of authorized person if nominee is minor","type":"text","label":"Authorized person details (in case nominee is a minor):","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"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 the form; stamp if juridical person","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":"Dog Health Cover insurance policies","attachments":["Dog’s health evaluation report (if required)","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.","The insurer adheres to anti-financial crime practices and may require assistance to address these.","Premiums are paid from legitimate sources; insurer may verify source and reject or terminate policy if otherwise.","Consent to receive communications electronically and for processing personal data as per privacy policy.","Consent to insurer accessing CKYC records for verification and updates.","Policyholder agrees to insurer's right to reject or terminate contract if named in sanctions list.","KYC records are current and proposer will inform insurer of any changes.","Option to receive physical copy of policy document by ticking a box; otherwise digital copy will be sent."],"dropped_labels":1},"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/2775-dog-health-cover-proposal-form"}