{"id":2820,"title":"TEA CROP 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/tea-crop-insurance/proposal-forms/tea-crop-insurance-retail-proposal-form.pdf","sha256":"ad5b36926c6c89ec2e7725fa17644343dd6f3be8117d52ac3aa2568866fbb290","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer (tea estate owner or manager) to apply for tea crop insurance coverage with Generali Central Insurance Company Limited.","notes":["Insurance is a contract of utmost good faith requiring full disclosure of material facts.","Read the prospectus/key features/policy wordings before completing the form.","Answer all questions; use additional signed sheets if needed.","Cover starts only after acceptance and receipt of premium.","If permanent address is left blank, it will be considered same as present address.","For CIF sales, sum insured should not exceed CIF value plus 10%.","Prompt date is the date by which buyer must take delivery at auction centres.","Use original documents and provide accurate bank details for refunds or claims.","Physical copy of policy document can be requested by ticking the box; otherwise digital copy will be sent.","Section 41 of Insurance Act prohibits rebates on commission or premium."],"title":"TEA CROP INSURANCE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"1. NAME","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"PRESENT ADDRESS OF THE PROPOSER","options":[],"required":null,"pdf_field":""},{"help":"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":"Central KYC Registry number if available","type":"text","label":"CKYC No. (if available)","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Contact Details","options":[],"required":null,"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":null,"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.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If differently abled, specify type","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":"Unique Disability ID if applicable","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Particulars of Tea Estate Proposed for Insurance","fields":[{"help":"","type":"text","label":"2. PARTICULARS OF TEA ESTATE PROPOSED FOR INSURANCE a. Name of the Tea Estate","options":[],"required":null,"pdf_field":""},{"help":"Include full address and state","type":"text","label":"b. Location and Address (including name of the State)","options":[],"required":null,"pdf_field":""},{"help":"Area in hectares","type":"number","label":"c. Total Crop area in Hectares (excluding Nursery Crop Area)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Particulars of Production","fields":[{"help":"Enter production in Kgs for 3 years: Year 1, Year 2, Year 3","type":"table","label":"3. PARTICULARS OF PRODUCTION a. Made Tea produced during the last 3 years excluding the expiring year","options":[],"required":null,"pdf_field":""},{"help":"Estimate quantity in Kgs (Green leaf converted into Made Tea at ratio 4:1)","type":"number","label":"b. Estimated quantity of Made Tea during the period ............. to ...........","options":[],"required":null,"pdf_field":""},{"help":"Quantity in Kgs","type":"number","label":"(i) Made Tea from own produce","options":[],"required":null,"pdf_field":""},{"help":"Quantity in Kgs","type":"number","label":"(ii) Made Tea from tea leaf purchased from other Garden(s)","options":[],"required":null,"pdf_field":""},{"help":"Sum of (i) and (ii) in Kgs","type":"number","label":"Total","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Disposal Particulars of Made Tea and Storage Cover Requirements","fields":[{"help":"Estimated quantity in Kgs","type":"number","label":"TEA TO BE SENT TO DESTINATIONS OTHER THAN AUCTION CENTRES - Transits upto 80 Kms. from the Garden (1)","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Transits beyond 80 Kms. upto 300 Kms. from the Garden (2) - Estimated Quantity","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Transits beyond 300 Kms. upto 750 Kms. from the Garden (3) - Estimated Quantity","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Basis of Valuation of Made Tea","fields":[{"help":"Select one option A, B, or C; D is for Tea Waste valuation","type":"choice","label":"5. BASIS OF VALUATION OF MADE TEA: Rs. per kg.","options":["A. OPTION I - Inland (Agreed Value), Overseas (Provisional Value)","B. OPTION II - 1. Inland & Overseas (Agreed Value other than C. I. F. Sales), 2. C. I. F. Sales (Provisional Value)","C. OPTION III - Inland & Overseas (Provisional Value)","D. ----------- Tea Waste (Agreed Value)"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Tea Details","fields":[{"help":"Quantity in Kgs","type":"number","label":"6. ESTIMATED QUANTITY OF TEA DESPATCHED THROUGH CONTAINERS","options":[],"required":null,"pdf_field":""},{"help":"Value in Rs.","type":"amount","label":"7. STATE MAXIMUM VALUE OF ANYONE SENDING PER ANY ONE CONVEYANCE","options":[],"required":null,"pdf_field":""},{"help":"Quantity in Kgs","type":"number","label":"8. PROPOSED QUANTITY OF GREEN LEAF TO BE SENT TO NEIGHBOURING TEA ESTATE FOR MANUFACTURE a) One Way","options":[],"required":null,"pdf_field":""},{"help":"Quantity in Kgs","type":"number","label":"b) Both Ways","options":[],"required":null,"pdf_field":""},{"help":"Quantity in Kgs","type":"number","label":"9. IS COVER REQUIRED FOR TEA LYING IN THE ESTATE BEYOND 15% OF THE ESTIMATED ANNUAL CROP? Surplus Quantity","options":[],"required":null,"pdf_field":""},{"help":"Number of months cover is required","type":"number","label":"Period (Months)","options":[],"required":null,"pdf_field":""},{"help":"List disposal particulars and quantity in Kgs for up to 5 entries","type":"table","label":"10. IS COVER REQUIRED FOR TEA HELD BACK RELATING TO THE PREVIOUS PERIOD? IF SO, SPECIFY QUANTITY AND DISPOSAL PARTICULARS OF THE SAME","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"11. IS COVER REQUIRED AGAINST a) Strikes, Riots & Civil Commotion","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"b) War & SRCC (for Overseas shipments)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"12. IS STORAGE EXTENSION OF 15 DAYS FROM THE DATE OF 'PROMPT' * REQUIRED (For auctions within India only)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History","fields":[{"help":"Provide details for 3 years","type":"table","label":"13. INSURANCE DETAILS OF THE GARDEN FOR THE 3 YEARS IMMEDIATELY PRECEDING THE EXPIRING YEAR: Period of Insurance, Insurer's Name with Full Address, Premium (Excluding War & SRCC Premium), Claims (Excluding War & SRCC Claim) Paid, Outstanding, Total","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"14. IN THE PAST, HAS ANY INSURER DECLINED TO ACCEPT OR RENEW AND/OR CANCELLED AND/OR IMPOSED ANY SPECIAL RESTRICTIVE CONDITIONS FOR SIMILAR INSURANCES? : Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if answered Yes above","type":"text","label":"IF SO, PLEASE GIVE DETAILS","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Specify payment mode","type":"choice","label":"Mode of Payment","options":[],"required":null,"pdf_field":""},{"help":"Provide payment reference/details","type":"text","label":"Payment Details","options":[],"required":null,"pdf_field":""},{"help":"Amount paid","type":"amount","label":"Amount in (Rs.)","options":[],"required":null,"pdf_field":""},{"help":"Date format DD/MM/YY","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":null,"pdf_field":""},{"help":"Permanent Account Number if applicable","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":""},{"help":"","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":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"Indian Financial System Code","type":"text","label":"IFS Code","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Nominee's full name","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Nominee's date of birth","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E-Mail ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of Nominee: Present address","options":[],"required":null,"pdf_field":""},{"help":"Leave blank if same as present address","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":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"Indian Financial System Code","type":"text","label":"IFS Code","options":[],"required":null,"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":"Declaration of Proposer","fields":[{"help":"Sign and date the form","type":"signature","label":"Signature of the Proposer(s) (Affix stamp, where proposer is a juridical person)","options":[],"required":true,"pdf_field":""},{"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":""}],"filled_by":"proposer"},{"title":"Intermediary Use Only","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":"Tea Crop Insurance","attachments":["If additional space is needed, attach a separate signed and dated sheet referencing the relevant question number","If more than one GSTIN, attach an annexure with details","Request for authorization form to receive claim/refund payments directly into bank account through NEFT if premium amount is more than Rs.10,000/-"],"declarations":["All statements and information provided are complete and accurate with no material facts withheld.","Misrepresentation or suppression of material facts may render the policy 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 insurer may verify source of funds and reject or terminate policy if found otherwise.","Consent to receive policy and service communications electronically and for processing of personal data as per privacy policy.","Consent to insurer accessing CKYC records for verification and receiving related information.","Agreement to abide by the insurer's Privacy Policy.","Insurer reserves the right to reject or terminate insurance if proposer or associated persons are named in sanctions lists.","KYC records are current and proposer will inform insurer of any changes."],"dropped_labels":13},"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/2820-tea-crop-insurance-proposal-form"}