{"id":2791,"title":"ELEPHANT INSURANCE PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/elephant-insurance/proposal-forms/elephant-insurance-proposal-form.pdf","sha256":"df17e81043f07635165d37ff72018dd8f45d949a6892f32f46c477b5dff54d91","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer to apply for Elephant Insurance by providing details about themselves and the animals to be insured.","notes":["Fill all questions in full; attach separate signed and dated sheet if space is insufficient and identify question number.","Cover commences only after acceptance and receipt of premium.","Use original documents and certificates as required.","If permanent address is left blank, it will be construed as same as present address.","If nominee is a minor, provide authorized person details.","The form includes an office use only section for intermediary details and declarations.","The insurer follows anti-money laundering and anti-financial crime practices.","Physical policy copy will be sent only if requested; otherwise electronic copy will be provided."],"title":"ELEPHANT INSURANCE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter the start and end dates of the insurance period","type":"date","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of the proposer","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter full present address including state, pin code, telephone and mobile numbers","type":"text","label":"Address of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter permanent address or 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 address where animals are stabled if different from proposer address","type":"text","label":"Animal Stabling Address (If Different)","options":[],"required":false,"pdf_field":""},{"help":"Enter occupation and period from and to dates","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"Provide details if animals are hypothecated","type":"text","label":"Hypothecation, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Animal Details","fields":[{"help":"Fill details for each animal including tag number, sex (M/F), age in years, breed, color, trunk size, tail switch, distinguishing features, right/left ear, and market value in Rs.","type":"table","label":"Give the following particulars in full, of each of the animals proposed for insurance. Type of Animal, Sex, Age, Breed, Description of the Animal (Tag No., Market Value/S.I., Colour, Trunk Size, Tail Switch, Distinguishing Features, Rt/Lt Ear)","options":[],"required":true,"pdf_field":""},{"help":"Enter Central KYC 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. Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If differently abled, specify type of impairment","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":"If differently abled, provide UDID number","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""},{"help":"Describe the intended use of the animals","type":"text","label":"State for what purpose the animals will be used","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Is/are the animals in the stable sound and healthy and free from vice? Yes / No","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Whether own Veterinary Services available or dependant on Government Veterinary Services? Yes / No","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Loss and Insurance History","fields":[{"help":"Provide details of animal losses in last 3 years","type":"table","label":"Have you lost any animal/s during the last three years? If so state particulars. Year, Cause of Loss, Number of animals lost","options":[],"required":false,"pdf_field":""},{"help":"Provide previous insurance and claim details for last 3 years","type":"table","label":"Previous Insurance and Claims experience (for the last three years): Year, Policy No., Name of Insurer, Claim Amount, Whether claim settled in full or in part or outstanding or repudiated","options":[],"required":false,"pdf_field":""},{"help":"Specify number and type of other animals owned","type":"text","label":"How many other animals do you own and of what type?","options":[],"required":false,"pdf_field":""},{"help":"Provide insurer details if other animals are insured","type":"text","label":"Are they insured and if so with which insurer?","options":[],"required":false,"pdf_field":""},{"help":"Explain why other animals are not insured","type":"text","label":"If not why are they not proposed for insurance now?","options":[],"required":false,"pdf_field":""},{"help":"Provide previous insurer details for other animals","type":"text","label":"Were they insured previously and if so where?","options":[],"required":false,"pdf_field":""},{"help":"Provide name of company if animals are or were insured","type":"text","label":"Are any of the animals now proposed for insurance or have any other animals belonging to you been previously insured? If so, state name of Company","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Ownership and Financing Details","fields":[{"help":"Provide owner details if not the proposer","type":"text","label":"Are you the owner of the animal? If not state name and address of owner and also nature of your interest in the animal","options":[],"required":true,"pdf_field":""},{"help":"Provide financing institution details and loan amount if applicable","type":"text","label":"Is any bank or other financing institution interested in the animal, if so, state (i) name and address of the bank (ii) Amount of loan outstanding","options":[],"required":false,"pdf_field":""},{"help":"Provide government scheme details if applicable","type":"text","label":"Is / are the animal/s proposed for insurance covered by any Govt. scheme? If so, state (i) Address of Govt. Agency Implementing the scheme (ii) Amount of subsidy obtained from Implementing Govt. agency","options":[],"required":false,"pdf_field":""},{"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":"Payment Details","fields":[{"help":"Specify mode of payment","type":"choice","label":"Mode of Payment","options":[],"required":true,"pdf_field":""},{"help":"Provide payment details such as transaction number","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Enter premium amount paid","type":"amount","label":"Amount in (₹)","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 100,000 or more","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":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":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Enter nominee's full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Enter 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":"Enter nominee's mobile number","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's email address","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's present address","type":"text","label":"Address of Nominee","options":[],"required":true,"pdf_field":""},{"help":"Enter permanent address or leave blank if 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":"Provide bank account holder name for nominee","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":true,"pdf_field":""},{"help":"Provide bank name and branch for nominee","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Provide bank account number for nominee","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Provide IFSC code for nominee","type":"text","label":"IFS Code","options":[],"required":true,"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":"Declarations and Consent","fields":[{"help":"Sign the form; affix stamp if proposer is a juridical person","type":"signature","label":"Signature of the Proposer(s) (Affix stamp, where proposer is a juridical person)","options":[],"required":true,"pdf_field":""},{"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":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Elephant Insurance","attachments":["A Certificate given by a qualified Veterinary Surgeon must accompany this proposal","Annexure with GSTIN details if more than one GSTIN","Request for authorization form to receive Claim/Refund payments through NEFT if premium paid is more than Rs 10000/-"],"declarations":["All statements and information provided in this proposal are complete and accurate with no material information withheld.","If misrepresentation or suppression of material facts is found, the policy may be voided and premium forfeited.","The proposer agrees to assist the insurer with records and information to address anti-financial crime practices.","Premiums are paid from legitimate sources and the insurer may verify source of funds and reject or terminate policy if found otherwise.","Consent is given to receive policy communications electronically and for processing of personal data as per privacy policy.","Consent is given for insurer to access CKYC records for verification and communication.","The insurer reserves the right to reject or terminate the contract if the 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":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/2791-elephant-insurance-proposal-form"}