{"id":2809,"title":"PLATE GLASS INSURANCE POLICY PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/plate-glass-policy/proposal-forms/plate-glass-insurance-policy-retail-proposal-form.pdf","sha256":"3de75649ed55e73957f9e8269435a5325e61fde7dc80c9f8391b33e1fc2b0950","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for a Plate Glass Insurance Policy with Generali Central Insurance Co. Ltd. The proposer fills it to provide details about the insured premises, plate glass particulars, previous insurance, and nominee information.","notes":["Read the prospectus/key features document/policy wordings before completing the form.","Insurance is a contract of utmost good faith; disclose all material facts and do not suppress any.","Fill all questions in full; attach separate signed and dated sheet if space is insufficient.","Cover starts only after acceptance and receipt of premium.","Use block letters where applicable.","Original bills and documents may be required for claims (implied from context).","The insurer reserves the right to reject proposals or terminate contracts if proposer or associated persons are on any blacklist or sanctions list.","Physical copy of policy document available on request; otherwise digital copy will be sent."],"title":"PLATE GLASS INSURANCE POLICY PROPOSAL FORM","submit":{"to":"Generali Central Insurance Company Limited","how":"","address":"Registered Office: Unit No. 801 & 802, 8th Floor, Tower C, Embassy 247 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 and Insured Location Details","fields":[{"help":"Enter the start and end dates of the insurance coverage period.","type":"text","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Full name of the person or entity applying for insurance.","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Full address where the insured plate glass is located.","type":"text","label":"Address of the Insured Location","options":[],"required":true,"pdf_field":""},{"help":"State of the insured location.","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Postal code of the insured location.","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Telephone number of the insured location.","type":"phone","label":"Telephone No.","options":[],"required":false,"pdf_field":""},{"help":"Mobile number of the proposer or insured location.","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"Permanent address if different from insured location address.","type":"text","label":"Permanent Address of the Insured(if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"State of the permanent address.","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Postal code of the permanent address.","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Telephone number of the permanent address.","type":"phone","label":"Telephone No.","options":[],"required":false,"pdf_field":""},{"help":"Mobile number of the permanent address.","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"Select the nature of your business or specify if others.","type":"choice","label":"Nature of Business or Trade","options":["Trader","Manufacturer","Others (Please specify)"],"required":true,"pdf_field":""},{"help":"Select whether you own or rent the premises.","type":"choice","label":"Basis of occupation of the premises","options":["Proprietor","Tenant"],"required":true,"pdf_field":""},{"help":"Provide Central KYC number if available.","type":"text","label":"CKYC (if available)","options":[],"required":false,"pdf_field":""},{"help":"Select 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":"Specify type of impairment if applicable.","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Specify percentage of impairment if applicable.","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Provide Unique Disability ID if applicable.","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Particulars of Plate Glass to be insured","fields":[{"help":"Describe the position of each glass pane.","type":"text","label":"Position of each square of pane of glass","options":[],"required":true,"pdf_field":""},{"help":"Describe the type of glass.","type":"text","label":"Description of glass - State whether plain, plate or plain sheet, silvered embossed, stained bent or ornamental etc","options":[],"required":true,"pdf_field":""},{"help":"Declared value of each glass pane in Indian Rupees.","type":"amount","label":"Value (Rs)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"General Questions","fields":[{"help":"Tick Yes or No.","type":"yes-no","label":"Are the premises situated at the corner of a street or exposed to any special risk?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Describe the special risk if applicable.","type":"text","label":"If ‘Yes’, please give brief description","options":[],"required":false,"pdf_field":""},{"help":"Select the floor or specify if other.","type":"choice","label":"On which floor are the insured premises situated?","options":["Cellar","Ground Floor/ First floor","Other (specify)"],"required":true,"pdf_field":""},{"help":"Tick Yes or No.","type":"yes-no","label":"Is there any plate glass in the insured premises that is not included in the schedule?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Describe the additional plate glass if any.","type":"text","label":"If ‘Yes’, please give brief description","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No.","type":"yes-no","label":"Is there at present any broken or damaged plate glass?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Describe broken or damaged glass details.","type":"text","label":"If ‘Yes’, please describe its position and size","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Previous Insurance / Previous damages","fields":[{"help":"Tick Yes or No.","type":"yes-no","label":"Has any insurance company in respect of plate glass insurance ever declined your proposal?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Tick Yes or No.","type":"yes-no","label":"Has the risk been previously insured?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Previous policy number.","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Period covered by previous insurance.","type":"text","label":"Period of Insurance","options":[],"required":false,"pdf_field":""},{"help":"Rate charged by previous insurer.","type":"text","label":"Rate charged","options":[],"required":false,"pdf_field":""},{"help":"Details of any special terms.","type":"text","label":"Any special terms & conditions imposed","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No.","type":"yes-no","label":"Do you have other insurance policies currently (Fire etc.)?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Name of other insurance company.","type":"text","label":"If Yes, please mention the insurance company","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No.","type":"yes-no","label":"Do you need cover against riot, strike, terrorist activities on the payment of additional premium?","options":["YES","NO"],"required":true,"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 reference or details.","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Enter premium 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":"Provide PAN if premium is 100,000 INR 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":""}],"filled_by":"proposer"},{"title":"Bank details of proposer for refund or claim purpose","fields":[{"help":"Name on bank account for refunds or claims.","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":true,"pdf_field":""},{"help":"Bank name and branch details.","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Bank account number.","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code.","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Full name of the nominee.","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 of nominee 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 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":"Name on 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 name and 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":"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 Signature","fields":[{"help":"Date of signing the proposal.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place where the proposal is signed.","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign the form; stamp if proposer is a company.","type":"signature","label":"Signature of the Proposer(s) (Affix stamp, where proposer is a juridical person)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"For Intermediary Use Only","fields":[{"help":"Name of intermediary who explained the product.","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 the intermediary.","type":"text","label":"Intermediary’s Code","options":[],"required":true,"pdf_field":""},{"help":"Signature of the intermediary.","type":"signature","label":"Intermediary’s Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary"}],"deadlines":[],"applies_to":"Plate Glass Insurance Policy","attachments":["Separate signed and dated sheet if insufficient space to answer any question","Annexure with details if more than one GSTIN","Request for authorization form to receive Claim/Refund payments if premium paid is more than Rs 10,000/-"],"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 are paid from legitimate sources and insurer may verify source of funds and reject policy if otherwise.","Consent is given to receive communications electronically and for processing of personal data as per privacy policy.","KYC records are current and valid and proposer will inform insurer of any changes."],"dropped_labels":6},"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/2809-plate-glass-insurance-policy-proposal-form"}