{"id":2810,"title":"POULTRY 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/poultry-insurance/proposal-forms/poultry-insurance-proposal-form.pdf","sha256":"93cbcbcd3480dec07f1f5c5b2259f70858bc608561851be136de7fc286f636ac","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or entities proposing to insure their poultry farm and birds. The proposer fills it to provide details about the farm, birds, and insurance requirements.","notes":["Read the prospectus/key features/policy wordings before completing the form.","Answer all questions fully; attach separate signed and dated sheet if needed referencing question number.","Cover starts only after acceptance and premium receipt.","Pin code is compulsory for addresses.","Attach certificate of good health from qualified veterinary practitioner for each batch of birds.","Use original documents where required.","For premium above Rs 1 Lac, PAN is required.","For premium above Rs 10,000, fill authorization form for NEFT payments.","The form includes a section for office use only which should not be filled by proposer.","The proposer may opt to receive a physical copy of the policy by ticking the box.","No rebates or inducements are allowed as per Section 41 of Insurance Act, 1938."],"title":"POULTRY INSURANCE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer and Farm Details","fields":[{"help":"","type":"text","label":"Name of Proposer:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name of Poultry Farm:","options":[],"required":true,"pdf_field":""},{"help":"Include pin code","type":"text","label":"Present Address: (Pin code compulsory)","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":"Include pin code","type":"text","label":"Farm Address: (Pin code compulsory)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"CKYC number (if available)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposer Status and Bird Details","fields":[{"help":"","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":"","type":"text","label":"If you are an NGO/NPO, please provide Niti Ayog – Darpan Portal Registration Number:","options":[],"required":false,"pdf_field":""},{"help":"If Yes, provide details below","type":"choice","label":"If you are Differently Abled, please tick on the checkbox to provide confirmation.","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Only if Differently Abled is Yes","type":"text","label":"(i) Type of Impairment:","options":[],"required":false,"pdf_field":""},{"help":"Only if Differently Abled is Yes","type":"number","label":"(ii) Percentage of Impairment:","options":[],"required":false,"pdf_field":""},{"help":"Only if Differently Abled is Yes","type":"text","label":"(iii) UDID Number:","options":[],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Type of Birds:","options":["Layers","Broilers","Hatchery"],"required":true,"pdf_field":""},{"help":"Provide year or full date","type":"date","label":"When was the farm established?","options":[],"required":true,"pdf_field":""},{"help":"Columns: Unit, Date of Hatch of birds, Date of Purchase, No of birds purchased as per delivery challan, Total no of birds in the unit at proposal, Breed strain, Age in weeks at proposal, Source of purchase, Expected date disposal","type":"table","label":"Give the following particulars in full, of each unit/ batch of birds proposed for insurance.","options":[],"required":true,"pdf_field":""},{"help":"Attach certificate of good health","type":"yes-no","label":"Are the birds in the farm sound and healthy and free from vice? (Please provide a certificate of good health issued by a qualified veterinary practitioner for each batch proposed for insurance).","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Farm Housing and Equipment","fields":[{"help":"Specify system for each house type","type":"text","label":"What is the system of Housing of the Birds? In brooding House: Deep Litter/cage system In grower House: Deep Litter/cage system In layer House: Deep Litter/cage system","options":[],"required":true,"pdf_field":""},{"help":"","type":"number","label":"Equipment Used: No. of Feeders:","options":[],"required":true,"pdf_field":""},{"help":"","type":"number","label":"No. of Drinkers:","options":[],"required":true,"pdf_field":""},{"help":"","type":"number","label":"No. of Brooders:","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Veterinary and Staff Details","fields":[{"help":"","type":"yes-no","label":"Is a qualified Veterinary doctor employed to look after the farm?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Only if veterinary doctor employed","type":"text","label":"If yes, please give his: Name:","options":[],"required":false,"pdf_field":""},{"help":"Only if veterinary doctor employed","type":"text","label":"Qualification:","options":[],"required":false,"pdf_field":""},{"help":"Only if veterinary doctor employed","type":"text","label":"Regd. No, if any","options":[],"required":false,"pdf_field":""},{"help":"Only if veterinary doctor employed","type":"yes-no","label":"Is he residing at the farm 24 hours","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Only if no veterinary doctor employed","type":"text","label":"If qualified Veterinary doctor is not employed then whose services are availed?","options":[],"required":false,"pdf_field":""},{"help":"Name of technical staff","type":"text","label":"Details of other persons residing at the farm premises Technical Name:","options":[],"required":false,"pdf_field":""},{"help":"Qualification of technical staff","type":"text","label":"Qualification:","options":[],"required":false,"pdf_field":""},{"help":"Role of technical staff","type":"text","label":"Job Description:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Farm Maintenance and Experience","fields":[{"help":"","type":"yes-no","label":"Are the diagnostic equipment/agents maintained at the farm?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you stock essential medicines at the farm?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Do you manufacture your own feed or get it from the market?","options":["Manufacture own feed","Get from market"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the owner/partner experienced in poultry farming or has undergone any training?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if yes","type":"text","label":"Has there been any epidemic outbreak during last 3 years? If so, give details:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Previous Insurance and Claims Experience","fields":[{"help":"Columns: Year, Policy No., Name of Insurer, Claim Amount, Whether claim settled in full or in part or outstanding or repudiated","type":"table","label":"Previous Poultry Insurance and Claims experience (for the last three years)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance Period and Financing Details","fields":[{"help":"Number of weeks","type":"number","label":"For what period is insurance required? For_____ Weeks","options":[],"required":true,"pdf_field":""},{"help":"Start date of insurance","type":"date","label":"With Effect From:","options":[],"required":true,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Is any bank or other financing institution interested in the birds, If so, state (i) name and address of the bank / Financing Institution (ii) Amount of loan outstanding.","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Are the birds proposed for insurance covered by Government sponsored scheme? If so, state (i) Name and Address of sponsoring agency (ii) Amount of subsidy obtained from the agency.","options":[],"required":false,"pdf_field":""},{"help":"","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":"Declarations and Signature","fields":[{"help":"","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""},{"help":"","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":"Payment Details","fields":[{"help":"Specify payment mode","type":"text","label":"Mode of Payment","options":[],"required":true,"pdf_field":""},{"help":"Provide payment reference/details","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Premium amount paid","type":"amount","label":"Amount in (₹)","options":[],"required":true,"pdf_field":""},{"help":"Date payment was made","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Provide PAN if applicable","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 Details for Refund or Claim","fields":[{"help":"","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder):","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch:","options":[],"required":true,"pdf_field":""},{"help":"Provide full 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 DOB","type":"date","label":"Date of Birth:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the proposer:","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Mobile Number:","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"E-Mail ID:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address of Nominee: Present address:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Permanent address: ((if left blank, will be construed as being same as Present Address))","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Details of Nominee: Name of Account holder:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"IFS Code:","options":[],"required":true,"pdf_field":""},{"help":"Provide 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":"Intermediary Declaration","fields":[{"help":"","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":"","type":"text","label":"Intermediary’s Code:","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Intermediary’s Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary"}],"deadlines":[],"applies_to":"Poultry insurance","attachments":["A Certificate given by a qualified Veterinary Practitioner must accompany this proposal","If more than one GSTIN, kindly attach an annexure with details","Request for authorization form to receive Claim/Refund payments if premium paid is more than Rs 10000/-"],"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 ab initio and premium forfeited.","The insurer adheres to anti-financial crime practices and may require assistance with relevant records.","Premium must be paid from legitimate sources; insurer may verify source and reject or terminate policy if not compliant.","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.","The insurer reserves the right to reject proposal or terminate contract if proposer or associated persons are named in sanctions lists."],"dropped_labels":2},"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/2810-poultry-insurance-proposal-form"}