{"id":2779,"title":"PET HEALTH PAWLICY PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/lifestyle-insurance/pet-health-pawlicy/proposal-forms/pet-health-pawlicy-proposal-form.pdf","sha256":"5f20e9d71add69f8abc80109beee848fa75ef10ffc5d292a255c66ca3b200f96","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer (pet owner) to apply for pet health insurance for their dogs with Generali Central Insurance Co. Ltd.","notes":["Insurance contract is based on utmost good faith; disclose all material facts and do not suppress any.","If additional space is needed, attach a separate signed and dated sheet referencing the question number.","Cover commences no earlier than acceptance date and premium receipt.","If more than one dog, insurance must be taken for each dog; policy does not allow selecting specific dogs.","Micro-chip number eligibility gives discount.","For premium above Rs.10,000, fill authorization form for NEFT payments.","Physical copy of policy available on request; otherwise digital copy will be sent via email/phone link.","Use original bills and documents as required for claims (implied from context).","Section 41 of Insurance Act prohibits rebates; violation punishable with fine up to ten lakh rupees."],"title":"PET HEALTH PAWLICY PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Your Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Present address with 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":""}],"filled_by":"proposer"},{"title":"Policy Period and Pet Details","fields":[{"help":"Enter the start date of the policy","type":"date","label":"Policy Period (The policy will start on/after premium receipt date) From:","options":[],"required":true,"pdf_field":""},{"help":"Enter the end date of the policy (one year from start)","type":"date","label":"To:","options":[],"required":true,"pdf_field":""},{"help":"Enter the total number of pet dogs you own","type":"number","label":"How many pet dogs do you have?","options":[],"required":true,"pdf_field":""},{"help":"Enter your Central KYC number if you have one","type":"text","label":"CKYC 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":"choice","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":"Provide details of existing insurance if any","type":"text","label":"In case, you have any existing insurance for your dogs? If yes, then please share the details.","options":[],"required":false,"pdf_field":""},{"help":"Name of existing insurer","type":"text","label":"Name of the Insurance company","options":[],"required":false,"pdf_field":""},{"help":"Provide policy number if insured with GCICL","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":"Provide details for each dog in the table","type":"table","label":"Please share the following details for all your pet dogs. 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","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Pet Registration and Sum Insured","fields":[{"help":"Provide registration or microchip number; microchip number gives discount","type":"text","label":"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":""},{"help":"Specify if breed is Indian and details if yes","type":"text","label":"Indian Breed: No / Yes (Breed details if ‘Yes’)","options":["No","Yes"],"required":false,"pdf_field":""},{"help":"Select Yes or No and specify percentage if Yes","type":"choice","label":"Do you want to opt for higher co-pay of 20%/30%?","options":["No","Yes"],"required":false,"pdf_field":""},{"help":"Select amount per visit","type":"choice","label":"Please select amount per visit: Rs.1,000/ Rs. 2,000/-","options":["Rs.1,000","Rs.2,000"],"required":false,"pdf_field":""},{"help":"Select Yes or No and specify percentage if Yes","type":"choice","label":"Do you want to opt for higher co-pay of 20%/30%? No / Yes","options":["No","Yes"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Pet Usage and Health Details","fields":[{"help":"Select Yes or No","type":"choice","label":"Do you use your Dog(s) for Commercial Purpose?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is/Are your pet Dog(s) healthy?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No for each vaccine","type":"yes-no","label":"Is your Pet Dog(s) vaccinated?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Does Your Pet Dog(s) suffer from any preexisting diseases/conditions? Yes/No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of preexisting conditions if any","type":"text","label":"If yes, then please share details","options":[],"required":false,"pdf_field":""},{"help":"Provide any additional relevant information","type":"text","label":"Do you want to share any other information that is important for the policy?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"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 date of payment","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Provide PAN if premium is 1 lakh or more","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"},{"title":"Bank and Nominee Details","fields":[{"help":"Provide bank account holder name for refunds/claims","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":true,"pdf_field":""},{"help":"Provide bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Provide bank account number","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Provide IFSC code","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's name","type":"text","label":"Nominee Details: Name","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's date of birth","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship to proposer","type":"text","label":"Relationship with the proposer","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's mobile number","type":"phone","label":"Mobile Number","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's email if available","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"Provide nominee's present address","type":"text","label":"Address of Nominee: Present address","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's permanent address if different","type":"text","label":"Permanent address (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"Provide nominee's bank account holder name","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's bank account number","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's 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":"Declaration by Proposer","fields":[{"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":""},{"help":"Sign the form; affix stamp if applicable","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":"Pet health insurance proposal for dogs","attachments":["Dog’s health evaluation report (if required)","Request for authorization form to receive claim/refund payments if premium is more than 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 with relevant records.","Premiums are paid from legitimate sources and insurer may verify source of funds and reject policy if otherwise.","Consent to receive policy and service communications electronically and for processing personal data.","Consent to insurer accessing CKYC records for verification and receiving related communications.","Agreement to abide by insurer's privacy policy and acceptance of insurer's right to reject or terminate policy if sanctions list conditions apply.","KYC records are current and proposer will inform insurer of any changes."],"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/2779-pet-health-pawlicy-proposal-form"}