{"id":2826,"title":"AGRICULTURAL PUMP SET INSURANCE PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/rural-insurance/agricultural-pump-set-insurance/proposal-forms/agricultural-pump-set-insurance-retail-proposal-form.pdf","sha256":"638a6c607b529035956c14bdcf7f23fcc7ea91e2e218191994ca4320a68daf6a","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or entities to apply for Agricultural Pump Set Insurance by providing details about the proposer, the pump set, previous insurance, and payment information.","notes":["Insurance contract requires utmost good faith; disclose all material facts.","Fill all questions in full; attach separate sheet if needed.","Cover starts only after acceptance and receipt of premium.","Use replacement value of pump set for sum insured.","If premium is above Rs 1 lakh, PAN is mandatory.","For premium above Rs 10,000, fill authorization form for NEFT payments.","Physical policy copy available on request; otherwise electronic copy will be sent.","Section 41 of Insurance Act prohibits rebates; penalty applies for violations."],"title":"AGRICULTURAL PUMP SET INSURANCE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"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":"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":"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":"Enter start and end date of policy period","type":"date","label":"Policy Period From to","options":[],"required":true,"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":"number","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":""}],"filled_by":"proposer"},{"title":"Risk Details","fields":[{"help":"","type":"choice","label":"Description Of Pump Set","options":["Centrifugal","Submersible"],"required":true,"pdf_field":""},{"help":"List each pump set with these details and sum insured","type":"table","label":"Sr. no Number, Make, Year of Manufacture, Electrical or Diesel, Solar, Capacity, Sum Insured in (Rs.)","options":[],"required":true,"pdf_field":""},{"help":"Sum of all pump sets' insured values","type":"amount","label":"Total Sum Insured","options":[],"required":true,"pdf_field":""},{"help":"List optional covers with sum insured: Sabotage and Terrorism Cover Endorsement (Material Damage Only), Earthquake, Storm, Cyclone, Typhoon, Tempest, Hurricane, Tornado, Flood And Inundation","type":"table","label":"Optional Covers","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Is the Pump Set in working condition?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Is the Pump set solely used for Irrigational Purposes?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Address or location of the risk","type":"text","label":"Risk Location","options":[],"required":true,"pdf_field":""},{"help":"Provide details of ownership or financial interest","type":"text","label":"List Insurable Interest, including Financial Institution, with details of ownership/interest","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Previous Insurer and Claim Details","fields":[{"help":"List 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 such as transaction number or cheque number","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":"","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"","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":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":"","type":"signature","label":"Proposer’s Signature","options":[],"required":true,"pdf_field":""},{"help":"Place where form is signed","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"},{"title":"For 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":"Agricultural Pump Set Insurance","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.","Misrepresentation or suppression of material facts may render the policy void and premium forfeited.","Policyholder and related persons will assist the insurer with anti-financial crime practices.","Premium is paid from legitimate sources and insurer may verify source of funds and reject policy if otherwise.","Consent to receive policy and service communications electronically and for processing personal data.","Consent to insurer accessing CKYC records for verification and communication.","Agreement to abide by insurer's Privacy Policy.","Insurer may reject proposal or terminate contract if proposer or associated persons are on sanctions lists.","KYC records are current and proposer will inform insurer of any changes."],"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/2826-agricultural-pump-set-insurance-proposal-form"}