{"id":2812,"title":"SARV PRACHAL BIMA KAVACH PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/sarva-prachal-bima-kavach/proposal-forms/sarv-prachal-bima-kavach-proposal-form.pdf","sha256":"fb389806049a5cfa4b670b2a7241a2b3d89feed255e255ea72ed2bca7ff1af11","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for the Sarv Prachal Bima Kavach insurance policy from Generali Central Insurance Company Limited.","notes":["Insurance is a contract of utmost good faith requiring full disclosure of material facts.","Cover starts only after acceptance and receipt of premium.","Use separate sheet if space is insufficient and identify question number.","Original bills or documents are not mentioned; follow instructions as per form.","No rebate or inducement is allowed as per Section 41 of Insurance Act, 1938.","Policy documents will be sent electronically by default as part of Go Green initiative."],"title":"SARV PRACHAL BIMA KAVACH 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; Email ID: gcicare@generalicentral.com"},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Present Address of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Permanent Address of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Business of the Proposal","options":[],"required":true,"pdf_field":""},{"help":"If not available, download the form from the website and submit along with this proposal form","type":"text","label":"CKYC No (if available)","options":[],"required":false,"pdf_field":""},{"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":"","type":"choice","label":"If you are Differently Abled, please tick on the checkbox to provide confirmation","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If Differently Abled is Yes","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Differently Abled is Yes","type":"text","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Differently Abled is Yes","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Contact No.","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"Email Id","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Proposer’s Nationality","options":[],"required":true,"pdf_field":""},{"help":"Start date of policy","type":"date","label":"Policy Period: From","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details","fields":[{"help":"","type":"text","label":"Risk Location","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"Total Sum Insured","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No for each parameter","type":"checkbox","label":"Risk Parameters for which coverage is sought","options":["Rainfall","Temperature","Humidity","Fog","Air Quality Index","Wind Velocity","Sunshine","Hailstorm","Cloud Burst","Normalized difference vegetation index (NDVI)","Normalized difference water index (NDWI)","Land surface water index (LSWI)","Soil Moisture Content Index","Soil Adjusted Vegetation Index (SAVI)","Microwave Backscatter","Fraction of absorbed photosynthetically active radiation (FAPAR)","Drought Index","Tsunami","Earthquake","Hurricanes","Tornadoes/Cyclones","Wildfires","Volcanic Eruptions","Blizzards","Hailstorms","Mudslides","Floods","Index Plus Cover"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Previous Insurer and Claim Details","fields":[{"help":"Provide details of previous insurance policies and claims","type":"table","label":"Product Name, Policy Number, Name of Insurer, Policy Period, Premium Paid (₹), No. of claims, Claim Amount (₹)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Any other information please specify","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Has any company Declined/Cancelled/ Refused to renew/ Accept on special terms in the past? If Yes, please give the details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"","type":"text","label":"Mode of Payment","options":[],"required":true,"pdf_field":""},{"help":"Details of payment transaction","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"","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":"Permanent Account Number for payments above Rs 1,00,000","type":"text","label":"PAN (If premium is 1 Lac and Above.)","options":[],"required":false,"pdf_field":""},{"help":"Goods and Services Tax Identification Number","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":"","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":"","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Indian Financial System Code","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Nominee's full name","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":"","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":"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":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"IFS Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Authorized person details (in case nominee is a minor)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations","fields":[{"help":"Sign to confirm all declarations","type":"signature","label":"Proposer’s Signature","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Sarv Prachal Bima Kavach insurance policy","attachments":["Separate signed and dated sheet if insufficient space to answer any question","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 10,000"],"declarations":["All statements and information provided are complete and accurate with no material facts withheld.","If misrepresentation or suppression of material facts is found, the policy may be void and premium forfeited.","Policyholder and related persons will assist GCICL with records and information to address anti-financial crime practices.","Premium is paid from legitimate sources and not from crime proceeds; GCICL may verify and reject policy if otherwise.","Consent to receive policy and service communications electronically and for GCICL to process personal data as per privacy policy.","Consent to GCICL accessing CKYC records for verification and updates.","KYC records are current and valid and proposer will inform GCICL of any changes."],"dropped_labels":4},"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/2812-sarv-prachal-bima-kavach-proposal-form"}