{"id":2805,"title":"PACK & PROTECT PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/pack-protect/proposal-forms/pack-and-protect-proposal-form.pdf","sha256":"29a32ebe968630c3951d3ad1c5f078e5bb854b943b8aca17de6bc0e07f546a6e","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for Pack & Protect insurance coverage for luggage and personal effects.","notes":["Insurance is a contract of utmost good faith requiring full disclosure of all material facts.","Read the prospectus/key features document/policy wordings before completing the form.","Answer all questions; if additional space is needed, attach a separate signed and dated sheet referencing the question number.","Cover commences only after acceptance and receipt of premium.","Use full block letters for the name of the proposer.","If permanent address is left blank, it will be construed as same as present address.","The insured includes legally wedded spouse, dependent children, and dependent parents.","The company reserves the right to reject the proposal or terminate the contract if the proposer or associated persons are named in any recognized blacklist.","For premium above Rs.10,000, fill the authorization form to receive payments via NEFT.","The proposer may opt to receive a physical copy of the policy by ticking the box; otherwise, policy will be sent electronically.","Section 41 of Insurance Act, 1938 prohibits rebates as inducements for insurance."],"title":"PACK & PROTECT PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Information","fields":[{"help":"","type":"text","label":"Name of the Proposer (in full block letters)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Present Address of Proposer (Complete 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":""},{"help":"","type":"text","label":"Business/Occupation /Profession of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter start and end date of insurance coverage","type":"date","label":"Period of Insurance From:                   To:","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":"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. ☐Yes  ☐No","options":["Yes","No"],"required":false,"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, provide UDID number","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Details","fields":[{"help":"Select coverage type","type":"checkbox","label":"Coverage","options":["1(a){Suitcases/trunks/bags/backpack (or similar luggage carriers)}","1 (a) + 1(b) Contents - ‘Articles and / or personal effects of the Insured (other than property of the Business).’"],"required":true,"pdf_field":""},{"help":"List each luggage item with make and sum insured","type":"table","label":"Description of Carrier/Luggage to be covered (Please read following instructions before filling the details) - Sr. No. Description of the Luggage (Suitcase/Trunk/ Bag) Make Sum Insured (in Rs.)","options":[],"required":true,"pdf_field":""},{"help":"List contents and sum insured if coverage includes contents","type":"table","label":"Contents (if opted for) Sum Insured (in Rs.)","options":[],"required":false,"pdf_field":""},{"help":"Select geographical coverage","type":"choice","label":"Geographical Limit (shall be India, unless specifically extended for worldwide coverage)","options":["India","Worldwide"],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Is your carrier/luggage up to 6 months old? Yes/No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide manufacturer name and invoice date if luggage is up to 6 months old","type":"text","label":"If Yes, please share details of the invoice. (Name of Manufacturer, Date of Invoice)","options":[],"required":false,"pdf_field":""},{"help":"Provide details if currently insured","type":"text","label":"Is the property currently insured under similar kind of insurance product? If so, please state a) Name of the Insurance Company b) Policy No. c) Sum Insured d) Period","options":[],"required":false,"pdf_field":""},{"help":"List past losses with date, details, amount, and insurer","type":"table","label":"Have you suffered any loss relating to the Luggage in the past 3 Years? If so, give full details thereof. (irrespective of whether insured or not) Date of occurrence of loss Details of loss Amount of loss (in Rs.) Name of the Insurance Company","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No for each question","type":"yes-no","label":"Has any company in respect of Luggage insurance: a) Declined your proposal? b) Cancelled or refused to renew your policy? c) Accepted your proposal on special terms & conditions?","options":[],"required":false,"pdf_field":""},{"help":"Provide any other relevant information","type":"text","label":"Is there any other material information relevant to the acceptance of this proposal which must be known by the Company?","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 details such as cheque number or transaction reference","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Enter premium amount paid","type":"amount","label":"Amount in (Rs.)","options":[],"required":true,"pdf_field":""},{"help":"Enter payment date","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(s) if applicable","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":"Nominee full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Nominee 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 mobile number","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Nominee email address","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"Nominee present address","type":"text","label":"Address of Nominee: Present address","options":[],"required":true,"pdf_field":""},{"help":"Nominee 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":"Nominee bank account holder name","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":true,"pdf_field":""},{"help":"Nominee bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Nominee bank account number","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Nominee IFSC code","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 Signatures","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","type":"signature","label":"Signature of the Proposer(s) (Affix stamp, where proposer is a juridical person)","options":[],"required":true,"pdf_field":""},{"help":"Agent name","type":"text","label":"Name of Insurance agent/POSP/Specified person of the Corporate agent/authorised person of the Broker/IMF","options":[],"required":true,"pdf_field":""},{"help":"Agent code or license number","type":"text","label":"Agency Code/licence No","options":[],"required":true,"pdf_field":""},{"help":"Date of agent declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of agent declaration","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and insurance agent"}],"deadlines":["If we do not accept the proposal, we will inform you within 15 days from the date of receipt of this proposal and refund any payment received from you without interest."],"applies_to":"Pack & Protect insurance policy","attachments":["If additional space is needed, attach a separate signed and dated sheet, and reference the relevant question number.","If more than one GSTIN, kindly attach an annexure with details.","Request for authorization form attached with this proposal form to receive claim/refund payments if any, directly into your bank account through NEFT if the premium amount is more than Rs.10,000/-"],"declarations":["All statements and information provided in this proposal are complete and accurate with no relevant information withheld.","If misrepresentation or suppression of material facts is found, the policy may be 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 not from crime proceeds; insurer may verify source of funds and reject or terminate policy if otherwise.","Consent to receive policy and service communications electronically and for insurer to process personal data for the policy.","Consent to insurer accessing CKYC records for verification and receiving information via SMS/email.","Agreement to abide by the insurer's Privacy Policy.","Insurer reserves the right to reject or terminate the policy if proposer or associated persons are named in any recognized sanctions list."],"dropped_labels":8},"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/2805-pack-and-protect-proposal-form"}