{"id":2776,"title":"DOG SURAKSHA 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-suraksha/proposal-forms/dog-suraksha-proposal-form.pdf","sha256":"0d40a8f881578c6b893a0ebe8ba9a4e65670a1cfcb21c4af1ff6ccfe7179ac45","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer to apply for insurance coverage for their dog(s) under the Dog Suraksha policy.","notes":["Read the prospectus/key features document/policy wordings before completing the form.","Answer all questions fully; attach separate signed and dated sheet if needed.","Cover starts only after acceptance and receipt of premium.","Use original documents and certificates as required.","If permanent address is left blank, it will be considered same as present address.","Fill request for authorization form to receive claim/refund payments directly via NEFT if premium paid is more than Rs 10,000.","Section 41 of Insurance Act prohibits rebates; penalties apply for violations.","The form includes sections for office use and intermediary declarations which are not to be filled by the proposer."],"title":"DOG SURAKSHA PROPOSAL FORM","submit":{"to":"Generali Central Insurance Company Limited","how":"","address":"Registered Office: Unit No. 801 & 802, 8th Floor, Tower C, Embassy Park, LBS Marg, Vikhroli (West), Mumbai – 400083\nEmail ID: GCIcare@generalicentral.com\nToll-free Phone: 1800 220 233 / 1860 500 3333 / 022 6783 7800"},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Present Address of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin code","options":[],"required":true,"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":"State","options":[],"required":false,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Telephone no.","options":[],"required":false,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile No","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Occupation","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":"Start date of insurance coverage","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Animal Details","fields":[{"help":"Specify the type of dog","type":"text","label":"Type of Animal","options":[],"required":true,"pdf_field":""},{"help":"Breed of the dog","type":"text","label":"Breed","options":[],"required":true,"pdf_field":""},{"help":"Estimated market value in Indian Rupees","type":"amount","label":"Market Value Rs.","options":[],"required":true,"pdf_field":""},{"help":"Attach two clear photos of the dog","type":"photo","label":"Please attach two clear Photographs of the proposed Dog","options":[],"required":true,"pdf_field":""},{"help":"Provide registration number if applicable","type":"text","label":"Kennel Club Registration No., If any","options":[],"required":false,"pdf_field":""},{"help":"State the purpose of keeping the dog","type":"text","label":"Purpose for which the dog is domesticated","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Is/are the dog’s house sound, healthy and free from vice? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe any defects or ailments if answer above is No","type":"text","label":"If no, then give full particulars of defects and ailments, if any","options":[],"required":false,"pdf_field":""},{"help":"Attach veterinary health certificate","type":"attachment","label":"Please provide a certificate of good health issued by a qualified veterinary practitioner for each dog proposed for insurance","options":[],"required":true,"pdf_field":""},{"help":"Provide vaccination details","type":"text","label":"Vaccination Particulars","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Have you lost any dog/s during the last three years? Yes No","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History and Other Information","fields":[{"help":"Provide any other relevant information","type":"text","label":"Any other information material to the risk or the terms upon which cover might be offered","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Declarations and Status","fields":[{"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. Yes No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify 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":true,"pdf_field":""},{"help":"Provide payment reference or details","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Amount paid in Indian Rupees","type":"amount","label":"Amount in (₹)","options":[],"required":true,"pdf_field":""},{"help":"Date when payment was made","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Permanent Account Number for tax purposes","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":""}],"filled_by":"proposer"},{"title":"Bank Details for Refund or Claim Purpose","fields":[{"help":"Name as per bank records","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":true,"pdf_field":""},{"help":"Full bank branch name","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Account number for refunds or claims","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Indian Financial System Code","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Nominee's full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Nominee's 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's mobile number","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Nominee's email address","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"Nominee's current address","type":"text","label":"Address of Nominee - Present address","options":[],"required":true,"pdf_field":""},{"help":"Nominee's 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":"Name as per nominee's bank account","type":"text","label":"Bank Account Details of Nominee - Name of Account holder","options":[],"required":true,"pdf_field":""},{"help":"Nominee's bank branch","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Nominee's bank account number","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Nominee's bank IFSC code","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""},{"help":"Provide 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":"Declarations and Consent","fields":[{"help":"Sign the form","type":"signature","label":"Proposer’s Signature","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Intermediary Declaration","fields":[{"help":"Full 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":"Dog insurance under the Dog Suraksha policy","attachments":["Certificate given by a qualified Veterinary Doctor","Two clear Photographs of the proposed Dog","Certificate of good health issued by a qualified veterinary practitioner for each dog proposed for insurance","Request for authorization form to receive Claim/Refund payments if premium paid is more than Rs 10000/-"],"declarations":["All statements and information provided are complete and accurate and form the basis of the insurance contract.","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 must be paid from legitimate sources; insurer may verify source of funds and reject policy if not compliant.","Consent to receive communications electronically and for processing of personal data as per privacy policy.","Consent to insurer accessing CKYC records for verification and updates.","KYC records are current and proposer will inform insurer of any changes.","The insurer may reject proposal or terminate contract if proposer or associated persons are named in any blacklist or sanctions list."],"dropped_labels":10},"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/2776-dog-suraksha-proposal-form"}