{"id":2786,"title":"ELECTRIC VEHICLE BATTERY - EXTENDED WARRANTY PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/electric-vehicle-battery-extended-warranty/proposal-forms/electric-vehicle-battery-extended-warranty-proposal-form.pdf","sha256":"556fa21c68647849ac9b1bb102d8a81248da9f5c40e50edc6890e3508a73fe13","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer (vehicle owner) to apply for an extended warranty on the electric vehicle battery. The proposer fills it to provide personal, vehicle, warranty, payment, and nominee details.","notes":["Answer all questions; attach separate signed and dated sheet if more space is needed referencing question number.","Battery must have minimum 80% health as per mandatory Battery State of Health Check before extended warranty starts.","Evidence of battery health check-up must be produced before start of extended warranty period as communicated.","Premium payment from legitimate sources is mandatory as per Prevention of Money Laundering Act, 2002.","Use the request for authorization form attached to receive claim/refund payments directly via NEFT if premium is more than Rs.10,000/-.","The insurer reserves the right to reject proposal or terminate contract if proposer or associated persons are on any blacklist.","If permanent address is left blank, it will be construed as same as present address.","Physical copy of policy document will be sent only if requested; otherwise electronic copy will be provided."],"title":"ELECTRIC VEHICLE BATTERY - EXTENDED WARRANTY PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Details of Proposer","fields":[{"help":"","type":"text","label":"Name Of Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Present Address of the Proposer","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":"Provide email and mobile number","type":"text","label":"Contact details (email and mobile number)","options":[],"required":null,"pdf_field":""},{"help":"Provide CKYC number if available","type":"text","label":"CKYC No. (If available)","options":[],"required":false,"pdf_field":""},{"help":"Specify the policy period","type":"text","label":"Policy Period","options":[],"required":null,"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":null,"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":null,"pdf_field":""},{"help":"If Yes to Differently Abled, specify type","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes to Differently Abled, specify percentage","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes to Differently Abled, provide UDID number","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of OEM Warranty","fields":[{"help":"","type":"text","label":"What kind of existing warranties are in place?","options":[],"required":null,"pdf_field":""},{"help":"Specify the OEM warranty period","type":"text","label":"OEM Warranty Period?","options":[],"required":null,"pdf_field":""},{"help":"Specify warranty limits","type":"text","label":"Warranty Limits","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Vehicle","fields":[{"help":"","type":"text","label":"Original Equipment Manufacturer (OEM)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Vehicle Make and Model","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Battery Pack Serial Number","options":[],"required":null,"pdf_field":""},{"help":"Year of Manufacture or age","type":"text","label":"Age of the Vehicle / YOM","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Vehicle Registration Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Vehicle Identification Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Invoice Number","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of invoice","options":[],"required":null,"pdf_field":""},{"help":"Provide battery specifications","type":"text","label":"Battery Type & Specifications (Voltage, Battery Capacity and Charging Time etc.)","options":[],"required":null,"pdf_field":""},{"help":"Specify sum insured amount","type":"amount","label":"Sum Insured of the Battery","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Other Information","fields":[{"help":"Attach original warranty booklet","type":"attachment","label":"Original Warranty Booklet","options":[],"required":true,"pdf_field":""},{"help":"Provide any additional relevant information","type":"text","label":"Please provide any information, which you think, might be relevant to the proposed Extended Warranty policy.","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 in rupees","type":"amount","label":"Amount in (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YY","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":null,"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":""},{"help":"Provide bank account holder name","type":"text","label":"Bank details of proposer for refund or claim purpose: Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":null,"pdf_field":""},{"help":"Provide bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":null,"pdf_field":""},{"help":"Provide bank account number","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"Provide 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":"Specify relationship","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":null,"pdf_field":""},{"help":"Nominee's present address","type":"text","label":"Address of Nominee: Present address","options":[],"required":null,"pdf_field":""},{"help":"Leave blank if same as present 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'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 IFSC code","type":"text","label":"IFS Code","options":[],"required":null,"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"},{"title":"Declaration of 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 here; affix 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":"Electric Vehicle Battery - Extended Warranty","attachments":["Original Warranty Booklet","Request for authorization form to receive claim/refund payments if premium amount 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 relevant information withheld.","Misrepresentation or suppression of material facts may render the policy void and premium forfeited.","The proposer agrees to assist the insurer with records and information 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 as per privacy policy.","Consent for insurer to access CKYC records for verification and communication.","Policy may be rejected or terminated if proposer or associated persons are named in any recognized sanctions list.","KYC records are current and proposer will inform insurer of any changes."],"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/2786-electric-vehicle-battery-extended-warranty-proposal-form"}