{"id":2821,"title":"WARRANTY 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/warranty-insurance/proposal-forms/warranty-insurance-retail-proposal-form.pdf","sha256":"001057abbcfae7d82567709e91d86c3bf7f24fb67e0e741e280a5f5d68ad97c7","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or entities proposing to purchase warranty insurance from Generali Central Insurance Co. Ltd. The proposer fills it to provide details about themselves, the products, and the warranty coverage requested.","notes":["Read the prospectus/key features document/policy wordings before completing the form.","Answer all questions fully; attach separate signed and dated sheet if needed referencing question number.","Cover commences only after acceptance and receipt of premium.","Use original bills and documents as required.","Fill request for authorization form for NEFT payments if premium exceeds Rs 10,000.","The form includes a Go Green initiative offering digital policy documents; tick box if physical copy is desired.","Section 41 of Insurance Act prohibits rebates as inducements for insurance.","The form includes an Anti Money Laundering notice requiring cooperation with relevant checks."],"title":"WARRANTY INSURANCE 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":"Client Details","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Present Address of the proposer","options":[],"required":null,"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":"Contact Person","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Designation","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Direct line","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Fax number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Central KYC Registry number if available","type":"text","label":"CKYC Number (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":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":"If Differently Abled, provide Unique Disability ID","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""},{"help":"Start date of policy","type":"date","label":"Policy Period: From","options":[],"required":null,"pdf_field":""},{"help":"End date of policy","type":"date","label":"To midnight of","options":[],"required":null,"pdf_field":""},{"help":"Select one client type","type":"choice","label":"Client Type","options":["Manufacturer","Dealer","Service Provider","Retail Customer"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Product Details","fields":[{"help":"List product names","type":"text","label":"Name of the products","options":[],"required":null,"pdf_field":""},{"help":"Quantity of each product","type":"number","label":"Quantity","options":[],"required":null,"pdf_field":""},{"help":"Contact mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Specify existing warranty period","type":"text","label":"Inbuilt Warranty period","options":[],"required":null,"pdf_field":""},{"help":"Current financial year volume","type":"number","label":"Current Fin Yr volume","options":[],"required":null,"pdf_field":""},{"help":"Projected volume","type":"number","label":"Project Volume","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Cover Details","fields":[{"help":"Select warranty period cover required","type":"choice","label":"Warranty Period Cover required","options":["12 months","18 Months","24 months"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Whether you have insured the same property with any other Insurance Company with the same type of Coverage","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if insured elsewhere","type":"text","label":"If yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Whether Insurance was declined by any other Company or imposed any Special Condition?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if declined or special conditions imposed","type":"text","label":"If yes, please provide the details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Details","fields":[{"help":"Specify payment mode","type":"text","label":"Mode of Payment","options":[],"required":null,"pdf_field":""},{"help":"Provide payment details","type":"text","label":"Payment Details","options":[],"required":null,"pdf_field":""},{"help":"Enter premium amount in rupees","type":"amount","label":"Amount in (₹)","options":[],"required":null,"pdf_field":""},{"help":"Date payment was made","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":null,"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) or attach annexure","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","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":null,"pdf_field":""},{"help":"Bank and branch name","type":"text","label":"Bank Name & Branch","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC 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":"Relationship to proposer","type":"text","label":"Relationship with the proposer","options":[],"required":null,"pdf_field":""},{"help":"Nominee's mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Nominee's email address","type":"email","label":"E-Mail ID","options":[],"required":null,"pdf_field":""},{"help":"Nominee's present address","type":"text","label":"Address of Nominee: Present address","options":[],"required":null,"pdf_field":""},{"help":"Nominee's 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":"Name on nominee's bank account","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":null,"pdf_field":""},{"help":"Nominee's bank and branch","type":"text","label":"Bank Name & Branch","options":[],"required":null,"pdf_field":""},{"help":"Nominee's bank account number","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"Nominee's bank IFSC code","type":"text","label":"IFS Code","options":[],"required":null,"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":"Declaration by 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":"For Intermediary Use Only","fields":[{"help":"Name of intermediary","type":"text","label":"Name of Insurance Agent/POSP/Specified Person of the Corporate Agent/Authorized Person of the Broker/IMF","options":[],"required":null,"pdf_field":""},{"help":"Code of intermediary","type":"text","label":"Intermediary’s Code","options":[],"required":null,"pdf_field":""},{"help":"Signature of intermediary","type":"signature","label":"Intermediary’s Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"intermediary"}],"deadlines":[],"applies_to":"Warranty Insurance","attachments":["Original Manufacturer’s Warranty Wordings","Listing of Goods to be included in the proposed Warranty Insurance","Details of additional costs to proposed Warranty insurance (e.g. Tax, Import cost, restrictions etc.)","Original Warranty Booklet","Request for authorization form to receive Claim/Refund payments if premium paid is more than Rs 10000/-"],"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 proposer agrees to assist the insurer with anti-financial crime practices including anti-money laundering.","Premiums are paid from legitimate sources and the insurer may verify source of funds and reject or terminate policy if otherwise.","Consent to receive policy communications electronically and for processing of personal data as per privacy policy.","Consent to insurer accessing CKYC records for verification and communication.","Agreement to abide by the insurer's Privacy Policy.","Insurer reserves the right to reject or terminate the contract if proposer or associated persons are named in sanctions lists."],"dropped_labels":1},"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/2821-warranty-insurance-proposal-form"}