Group Disability Insurance Scheme Claim Form (GDISCF)

Group Disability Insurance Scheme Claim Form (GDISCF)
ƒºKt¡ "Û¡³t¡à [¤³à šøA¡¿ ƒà[¤ ó¡³¢ ([\[l¡"àÒü&Î[Î&ó¡)
Policy Details š[º[ι [¤¤¹o
Name of Scheme
šøA¡ì¿¹ >à³
Name of Master Policyholder
³àС๠š[º[Î ‹à¹ìA¡¹ >à³
Master Policy Number
Member Policy Number
³àС๠š[º[ι >´¬¹
΃ìθ¹ š[º[Î >´¬¹
Member Details ΃ìθ¹ [¤¤¹o
Name of Member
΃ìθ¹ >à³
S/D/W of
Occupation
\ã[¤A¡à
[št¡à/Ѭà³ã¹ >à³
Date of Birth
Residence Address
\@µ t¡à[¹J
¤àÎÑ‚àì>¹ [k¡A¡à>à
Membership cum Scheme Details ΃θt¡à t¡=à šøA¡ì¿¹ [¤¤¹o
For Employer - Employee Scheme
[>ìÚàKA¡t¡¢à-A¡³¢W¡à¹ã šøA¡ì¿¹ \>¸
Date of Joining to Employer
[>ìÚàKA¡t¡¢à¹ ÎìU A¡àì\ ì™àKƒàì>¹ t¡à[¹J
Employee code
Grade
A¡³¢W¡à¹ã¹ ìA¡àl¡
ëNøl¡
For Non Employer – Employee Scheme
"[>ì™àv¡û¡à-A¡³¢W¡à¹ã šøA¡ì¿¹ \>¸
Nature of Association between Member & Group -
΃θ * ƒìº¹ ³ì‹¸ δšìA¢¡¹ ‹¹o
Loan / Deposit No
– ˜¡o / "à³à>t¡ >}-
Membership No.
΃θt¡à >´¬¹
Client ID –
NøàÒA¡ "àÒü[l¡Unit Name
Òül¡ü[>ìi¡¹ >à³
Loan / Deposit Amount ˜¡o /
"à³à>ìt¡¹ "=¢¹à[Ź š[¹³ào
State Name
¹àì\¸¹ >à³
Loan / Deposit Tenor
˜¡o / "à³à>ìt¡¹ ë³Úàƒ
Member Effective Name
΃θt¡à A¡à™¢A¡¹ Ò*Ú๠t¡à[¹J
Claims/GDISCF/Ver1.1/01stDec12
Group Disability Insurance Scheme Claim Form (GDISCF)
ƒºKt¡ "Û¡³t¡à [¤³à šøA¡¿ ƒà[¤ ó¡³¢ ([\[l¡"àÒü&Î[Î&ó¡)
Claims Details ƒà[¤¹ [¤¤¹o
Claim On –
™à¹ \>¸ ƒà[¤ A¡¹à ÒìZá-
Primary Members
Spouse
šøà=[³A¡ ΃θ
Date of occurrence of Disability
Ѭà³ã/Ñ|ã
Sum Assured Claimed
"Û¡³t¡à Qi¡à¹ t¡à[¹J
Exact Nature of Disability
ƒà[¤Aõ¡t¡ "àÅ«à[Ît¡ "=¢¹à[Å
"Û¡³t¡à¹ ™=à=¢ ‹¹o
Exact Cause of Disability
"Û¡³t¡à¹ ™=à=¢ A¡à¹o
Please specify is cause of disability is Medical
"Û¡³t¡à [W¡[A¡;Îà \[>t¡ A¡à¹ìo Qìi¡ =àA¡ìº ">åNøÒ A¡ì¹ l¡üìÀJ A¡¹ç¡>Date of Admission
Date of Discharge
®¡[t¡¢ Ò*Ú๠t¡à[¹J
[l¡ÎW¡à\¢ Ò*Ú๠t¡à[¹J
Name of Hospital
Name of Illness Diagnosed
ÒàΚàt¡à캹 >à³
Å>àv¡û¡ A¡¹à ì¹àìK¹ >à³
Duration of illness diagnosed during hospitalization
ÒàΚàt¡àìº =àA¡àA¡àºã> Å>àv¡û¡ A¡¹à ì¹àìK¹ Ñ‚à[Úâ«
Antecedent Cause of Disability (If Any)
Duration of any antecedent cause
ìA¡à> šè¤¢¤t¡¢ã A¡à¹o =àA¡ìº t¡à¹ Ñ‚à[Úâ«
"Û¡³t¡à¹ šè¤¢¤t¡¢ã A¡à¹o (™[ƒ =àìA¡)
Please specify is cause of disability is Accident"Û¡³t¡à¹ A¡à¹o ƒåQ¢i¡>à Òìº ">åNøÒ A¡ì¹ l¡üìÀJ A¡¹ç¡>Date of Accident
Place of Accident
ƒåQ¢i¡>๠t¡à[¹J
ƒåQ¢i¡>๠тà>
Cause of Accident
ƒåQ¢i¡>๠A¡à¹o
Is Member able to resume current occupation or continue with same occupation or any other in future?
΃θ [A¡ ¤t¡¢³à> \ã[¤A¡àÚ "à¤à¹ ì™àKƒà> A¡¹ìt¡ šàì¹ “=¤à ®¡[¤È¸ìt¡ &Òü &A¡Òü \ã[¤A¡àÚ ¤à ">¸ ìA¡à> \ã[¤A¡àÚ ¤Òຠ=àA¡ìt¡ šà¹ì¤?
Yes
Ò¸òà
NO
>à
Last date of Service with Current Employer (For Employee-Employee Group Only)
¤t¡¢³à> [>ìÚàKA¡t¡¢à¹ ÎìU W¡àA¡[¹ìt¡ ¤Òຠ=àA¡à¹ ëÅÈ t¡à[¹J (ìA¡¤º³ày [>ìÚàKA¡t¡¢à-A¡³¢W¡à¹ã ƒìº¹ \>¸)
Benefit Payment Method Îå[¤‹à¹ "=¢ šøƒà> A¡¹à¹ š‡ý¡[t¡
Title (Claimant) under which, the Claim has been submitted (Please tick the appropriate Option)-
ë™ [Åì¹à>àì³¹ (ƒà[¤ƒà¹) "‹ãì> ƒà[¤ ƒà[Jº A¡¹à ÒìÚìáú (">åNøÒ A¡ì¹ >ãìW¡ Î[k¡A¡ "šÅ>[i¡ìt¡ [i¡A¡ [W¡Òû¡ [ƒ>)
Master Policyholder
³àС๠š[º[Î ‹à¹A¡
Insured Member
[¤³àAõ¡t¡ ΃θ
Please tick the desired option, if no option is exercised then refund would be processed through Cheque
">åNøÒ A¡ì¹ šáì@ƒ¹ [¤A¡ì¿ [i¡A¡ [W¡Òû¡ [ƒ>, ìA¡à> [¤A¡¿ [>¤à¢W¡> >à A¡¹à Òìº "=¢ ëW¡ëA¡¹ ³à‹¸ì³ šøt¡¸š¢o A¡¹à Òì¤
NEFT
&>Òü&ó¡[i¡
CHEQUE
ìW¡A¡
IFSC Code
Account Number
"àÒü&ó¡&Î[Î ìA¡àl¡
"¸àA¡àl¡ü@i¡ >´¬¹
Name of Claimant (As mentioned in the Bank Record)
ƒà[¤ƒàì¹¹ >à³ (¤¸à}ìA¡¹ ë¹A¡ìl¢¡ 뙳> l¡üìÀJ A¡¹à "àìá)
Bank Name
¤¸à}ìA¡¹ >à³
NEFT Stands for "National Electronic Fund Transfer”. In case you opt for NEFT payout facility, Please fill in the NEFT mandate
enclosed completely and get the same duly verified by your bank and submit it along with one cancelled cheque / copy of pass
book. If any information is missing in NEFT form, Payment will be made by Cheque.
&>Òü&ó¡[i¡-¹ "=¢ Òº ‘‘>¸àÅ>ຠÒüìºCö¡[>A¡ ó¡à“¡ i¡öàXó¡à¹ú‘‘ "àš[> ™[ƒ &>Òü&ó¡[i¡ ëš"àl¡üi¡ Îå[¤‹à [>¤¢àW¡> A¡ì¹> t¡àÒìº ">åNøÒ A¡ì¹ Î}™åv¡û¡ &>Òü&ó¡[i¡ ³¸àì“¡i¡[i¡ δšèo¢ ®¡àì
¤šè¹o A¡¹ç¡> &¤} ëÎ[i¡ "àš>๠¤¸à}A¡ ‡à¹à ™=à™= ®¡àì¤ šøt¡¸à[Út¡ A¡¹ç¡> &¤} &A¡[i¡ ¤à[t¡º A¡¹à ëW¡A¡ /šàΤÒüìÚ¹ A¡[š¹ ÎìU \³à [ƒ>ú ™[ƒ &>Òü&ó¡[i¡ ó¡ì³¢ ìA¡à> t¡=¸
"δšèo¢ =àìA¡ t¡àÒìº ëW¡ìA¡¹ ³à‹¸ì³ "=¢ šøƒà> A¡¹à Òì¤ú
Claims/GDISCF/Ver1.1/01stDec12
Group Disability Insurance Scheme Claim Form (GDISCF)
ƒºKt¡ "Û¡³t¡à [¤³à šøA¡¿ ƒà[¤ ó¡³¢ ([\[l¡"àÒü&Î[Î&ó¡)
Master Policy’s Holder (Holders’)Declaration And Authority to Pay Claim
³àС๠š[º[Î ‹à¹ìA¡¹ ìQàÈoà &¤} ƒà[¤¹ "=¢ šøƒà> A¡¹à¹ ">å³[t¡
I/We the undersigned on ________________________________,in my / our capacity as____________________(designation)____________________of ______________________and duly authorized to make this declaration in connection with claim
under captioned Policy No________________; That Member whose disability gave to this Claim has infact suffered with disability on ______________and was a legitimate Member of the Scheme. That the information and submissions as furnished herein
above are true. I/We have concealed nothing material or relevant to the matter and further that Aviva Life Insurance Company
India Ltd. (Company) shall not be held liable for any error or omission on our part in this regard. That in event that any portion (s) of the information or submissions made herein are found to be incorrect, misleading, the Company reserves the right
to not to admit this Claim and recover all benefits that may have been paid by the Company relying on the submissions herein
made by us. I/we hereby assure the Company that in such an event, I/We shall forthwith, on receipt of a written request from
the Company, refund all such benefits. That on admission of claim, payment of the benefit due thereupon in favor of us/Insured Member shall represent full and final discharge of Company’s liability in respect of the Member under Scheme.
"à[³ / "à³¹à [>ì³¥ ѬàÛ¡¹ šøƒà>A¡à¹ã _________ t¡à[¹ìJ _______________&¹ __________________(šƒ) _____________Û¡³t¡à
¤ìº l¡üšì¹àv¡û¡ š[º[Î >}. _______________________&¹ "‹ãì> A¡¹à ƒà[¤¹ ÎìU δš[A¢¡t¡ &Òü ìQàÈoà A¡¹à¹ \>¸ ™=à™= ¹ê¡ìš ">åì³à[ƒt¡ : ë™ ë™ Îƒëθ¹
"Û¡³t¡à¹ \>¸ &Òü ƒà[¤ A¡¹à ÒìÚìá [t¡[> Ît¡¸Òü ______________ t¡à[¹ìJ "Û¡³ ÒìÚìá> &¤} l¡ü[> šøA¡ì¿¹ &A¡\> í¤‹ ΃θú ë™ &Jàì> l¡üšì¹ šøƒv¡ ÎA¡º t¡=¸
&¤} l¡üšÑ‚àš> γèÒ Ît¡¸ú ë™ "à[³/ "à³¹à &Òü Qi¡>๠ÎìU δšA¢™åv¡û¡ &¤} P¡¹ç¡â«šèo¢ ëA¡à> t¡=¸ ëKàš> A¡[¹[> &¤} &áàØl¡à* &Òü ¤¸àšàì¹ "à³¹à ™[ƒ ëA¡à> t¡=¸ ëKàš> ¤à ¤àƒ
[ƒìÚ =à[A¡ t¡àÒìº ìÎÒü \>¸ "[®¡®¡à ºàÒüó¡ Òü>[Î*ì¹X ëA¡à´šà[> Òü[“¡Úà [º[³ìi¡l¡ (ëA¡à´šà[> ) ƒàÚã =àA¡ì¤ >à¡ú ë™ ™[ƒ \à>à ™àÚ ë™ &Jàì> šøƒv¡ ìA¡à> t¡=¸ "=¤à l¡üšÑ‚àšì>¹
ìA¡à> "}Å (γèÒ) "Ît¡¸ "=¤à [¤°à[”zA¡¹ t¡àÒìº ƒà[¤ "ѬãA¡à¹ A¡¹à¹ &¤} "à³¹à &Jàì> ë™ l¡üšÑ‚àš> A¡ì¹[á t¡à¹ l¡üš¹ [>®¢¡¹ A¡ì¹ &[i¡ ìA¡à> Îå[¤‹à šøƒà> A¡ì¹ =àA¡ìº ëÎÒü
γÑz šå>¹ç¡‡ý¡à¹ A¡¹à¹ δšèo¢ "[‹A¡à¹ "[®¡®¡à Î}¹Û¡o A¡ì¹ú "à[³/ "à³¹à &t¡‡à¹à ëA¡à´šà[>ìA¡ "àÅ«àÎ šøƒà> A¡¹[á ë™ &Òü ëÛ¡ëy "à³¹à ëA¡à´šà[>¹ ë=ìA¡ [º[Jt¡ ">åì¹à‹
ëšìº šøƒv¡ ÎA¡º "=¢ šøt¡¸š¢o A¡¹ì¤à¡ú ë™ ƒà[¤ KõÒãt¡ Ò*Úà, ëÎ[i¡¹ \>¸ "à³à샹 /[¤³àAõ¡t¡ ΃ìθ¹ šìÛ¡ šøìƒÚ Îå[¤‹à γèÒ &Òü šøA¡ì¿¹ "”zK¢At¡ ΃ìθ¹ šø[t¡ ƒà[Úâ« ë=ìA¡
δšèo¢ &¤} Wè¡Øl¡à”z ¹ê¡ìš ëA¡à´šà[>¹ ƒàÚ³å[v¡û¡ `¡àš> A¡¹ì¤ú
Name of Authorized
Signatory
Date
t¡à[¹J
">åì³à[ƒt¡ ѬàÛ¡¹A¡à¹ã¹ >à³
Signature of Authorized
Signatory ">åì³à[ƒt¡
Place
Ñ‚à>
ѬàÛ¡¹A¡à¹ã¹ ѬàÛ¡¹
Rubber Stamp of
Master
Policyholder
³àС๠š[º[Î ‹à¹ìA¡¹ ¹¤à¹
С¸à´š
Insured Member Authority For Obtaining the Information
t¡=¸ Î}NøìÒ¹ \>¸ [¤³àAõ¡t¡ ΃ìθ¹ ">åì³àƒ>
I_____________________________________________(Insured Member) consent to M/s Aviva Life Insurance Company India Ltd,
and/or its representative to obtain all employment/medical/hospital records/police records/other records (including photocopies)/information pertaining to the treatment/occupation of mine which I might have acquired whether before or after the
Joining the respective Scheme. I hereby declare that above statements are true in all respects and if any information is found
untrue, all monies paid in the scheme shall be forfeited. I agree on authorization made by Life Assured in Membership Form
towards the remittance of claim payment to Master Policyholder.
"à[³ __________________________ ([¤³àAõ¡t¡ ΃θ) &t¡‡à¹à "[®¡®¡à ºàÒüó¡ Òü>[Î*ì¹X ìA¡à´šà[> Òü[“¡Úà [º[³ìi¡l¡ &¤} / "=¤à &¹ šø[t¡[>[‹ìA¡ ™à
¤t¡ãÚ A¡³¢ [>ìÚàK/ [W¡[A¡;Îà/ ÒàΚàt¡à캹 ë¹A¡l¢¡/šå[ºÅ ë¹A¡l¢¡ ">¸à>¸ ë¹A¡l¢¡ (ó¡ìi¡àA¡[š ÎÒ) "à³à¹ [W¡[A¡;Îà Î}yû¡à”z/\ã[¤A¡à ™à "à[³ ìA¡à´šà[> š[º[Î šøƒà> A¡¹à¹ "àìK ¤à
šì¹ NøÒo A¡ì¹[á ëÎÒü Î}yû¡à”z t¡=¸ šøàœ¡ A¡¹à¹ ">å³[t¡ [ƒ[Zá¡ú "à[³ &t¡‡à¹à ëQàÈoà A¡¹[á ë™ l¡üšì¹ šøƒà> A¡¹à ÎA¡º t¡=¸ Τà¢}ìÅ Ît¡¸ &¤} ™[ƒ ëA¡à> t¡=¸ "Ît¡¸ ¤ìº
\à>à ™àÚ t¡àÒìº &Òü šøA¡ì¿¹ \>¸ šøƒv¡ ÎA¡º "=¢ ¤àì\Úàœ¡ A¡¹à Ò줡ú "à[³ \ã¤> [¤³àAõ¡t¡ ¤¸[v¡û¡ ΃θt¡à ó¡ì³¢ ³àС๠š[º[Î ‹à¹A¡ìA¡ ƒà[¤¹ “=¢ šøƒà> A¡¹à¹ \>¸ ë™
">åì³àƒ> šøƒà> A¡ì¹ìá> t¡à¹ \>¸ δ¶[t¡ šøƒà> A¡¹[á¡ú
Date
Signature or thumb impression of Member
΃ìθ¹ ѬàÛ¡¹ "=¤à ¤õ‡ý¡àUåìË¡¹ áàš
t¡à[¹J
Place
Ñ‚à>
Claims/GDISCF/Ver1.1/01stDec12
Group Disability Insurance Scheme Claim Form (GDISCF)
ƒºKt¡ "Û¡³t¡à [¤³à šøA¡¿ ƒà[¤ ó¡³¢ ([\[l¡"àÒü&Î[Î&ó¡)
Address To Which Cheque And Confirm tion Of Payment Should Be Sent
ëW¡A¡ &¤} "=¢ šøƒàì>¹ [>[ÆW¡t¡A¡¹o ë™ [k¡A¡à>àÚ šàk¡àì>à Òì¤
Name of Contact Person
ì™àKàì™àìK¹ ¤¸[v¡û¡¹ >à³
Designation
Postal Address
šƒ
[W¡[k¡ šàk¡àì>๠[k¡A¡à>à
City
ÅÒ¹
Pin No
[š> >}
Standard Claims Checklist & Instruction С¸à“¡àl¢¡ ƒà[¤¹ ëW¡A¡[ºÐ¡ &¤} [>샢Åऺã
Please attach following documents to this Claim Form -
">åNøÒ A¡ì¹ &Òü ƒà[¤ ó¡ì³¢¹ ÎìU [>³¥[º[Jt¡ >[=P¡[º Î}™åv¡û¡ A¡¹ç¡> -
1) Covering Letter issued by Master Policyholder as an intimation of Claim (Preferable)
1) ƒà[¤¹ [¤`¡[œ¡ ¹ê¡ìš ³àС๠š[º[Î ‹à¹A¡ ‡à¹à šøƒv¡ A¡®¡à[¹} ëºi¡à¹ (A¡à³¸)
2) Evidence of occurrence & type of disability- (Please furnish following documents)corporation
2) Qi¡à¹ šø³ào &¤} "Û¡³t¡à¹ ‹¹o- (">åNøÒ A¡ì¹ [>³¥[º[Jt¡ >[= šøƒà> A¡¹ç¡>) A¡ìšà¢ì¹Å>
• Doctor’s Certificate stating that Life Assured has been suffering from PTD for continuous and uninterrupted period of Six Months.
• \ã¤> [¤³àAõ¡t¡ áÚ ³àìι \>¸ "[¤¹t¡ &¤} [>¹¤[ZáÄ ®¡àì¤ [š[i¡[l¡ ‡à¹à "àyû¡à”z Ò*Ú๠[W¡[A;¡ÎìA¡¹ Å}Îàšy
• Police FIR Report/Inquest Report, Newspaper clipping (If any).
• šå[ºìŹ &ó¡"àÒü"๠[¹ìšài¡¢ /t¡ƒ”z [¹ìšài¡¢, Î}¤àƒšìy¹ [Aá[š} (™[ƒ =àìA¡)ú
• All relevant Medical Records related to establishment, diagnosis & treatment of PTD.
• [š[i¡[l¡ Qi¡à, ì¹àK [>o¢Ú &¤} [W¡[A;¡Îà Î}yû¡à”z ÎA¡º δš[A¢¡t¡ [W¡[A¡;Î๠ë¹A¡l¢¡ú
• Termination letter from current employer (Mandatory and only for Employer-Employee Group).
• ¤t¡¢³à> [>ìÚàKA¡t¡¢à ‡à¹à šøƒv¡ W¡àA¡[¹ ë=ìA¡ ¤¹JàÑz A¡¹à¹ šy (¤à‹¸t¡à³èºA¡ &¤} ëA¡¤º³ày [>ìÚàKA¡t¡¢à-A¡³¢W¡à¹ã ƒìº¹ \>¸)ú
3) Certificate of Insurance (COI) (For Non Employer-Employee Group)
3) Îà[i¡¢[ó¡ìA¡i¡ "ó¡ Òü>[Î*ì¹X ([Î*"àÒü) ("[>ì™àv¡û¡à-A¡³¢W¡à¹ã ƒìº¹ \>¸)
4) Pay slip of Last Month of Service / Full & Final Settlement Sheet (For Employer-Employee Group only).
4) W¡àA¡[¹¹ ëÅÈ ³àìι ëš [ÑÚ /δšèo¢ &¤} Wè¡Øl¡à”z [>Íš[v¡ šy (ìA¡¤º³ày [>ìÚàKA¡t¡¢à-A¡³¢W¡à¹ã ƒìº¹ \>¸)ú
5) Copy of Age Proof of Insured Member (For Non-Employer-Employee Group only)
5) [¤³àAõ¡t¡ ΃ìθ¹ ¤Úìι šø³àošy ("[>ì™àv¡û¡à-A¡³¢W¡à¹ã ƒìº¹ \>¸)
6) Membership Form (Wherever Applicable & if same has not been submitted on Member Effective Date)
6) ΃θt¡à ó¡³¢ (ì™Jàì> šøì™à\¸ &¤} ™[ƒ ëÎ[i¡ ΃θt¡à A¡à™¢A¡¹ Ò*Ú๠t¡à[¹ìJ \³à ëƒ*Úà >à ÒìÚ =àìA¡)
Note‰Ê¡¤¸-
1) All fields are mandatory to be filled up,
1) ÎA¡º ëÛ¡y šèo¢ A¡¹à ¤à‹¸t¡à³èºA¡,
2) The above-mentioned documents are standard & indicative and additional info may be called for where necessary.
2) l¡üšì¹àv¡û¡ >[=šyP¡[º [>Ú³à>åK * [>샢ÅA¡ &¤} šøìÚà\> ">åÎàì¹ "t¡[¹v¡û¡ t¡=¸ W¡à*Úà Òìt¡ šàì¹ú
3) All documents should be self attested & counter signed by the Master Policyholder with Original seen & verified
3) γÑz >[=šy Ѭ-šøt¡¸[Út¡ &¤} ³àС๠š[º[Î ‹à¹A¡ ‡à¹à "àκ >[= ƒÅ¢> * šø[t¡šàƒ> ÎÒ šø[t¡ ѬàÛ¡[¹t¡ Òìt¡ Òì¤
4) English Translation for Vernacular Documents (Preferable)
4) "àe¡[ºA¡ ®¡àÈàÚ ëºJà >[=šìy¹ Òü}¹à[\ ">å¤àƒ (A¡à³¸)
A Joint Venture between Dabur Invest Corp. & Aviva International Holdings Limited
Aviva Life Insurance Company India Ltd
Head Office: Aviva Tower, Sector Road, Opp. DLF Golf Course, DLF Ph- V, Sector 43, Gurgaon-122003. Haryana India.
Registered Office: 2nd Floor, Prakashdeep Building, 7 Tolstoy Marg, New Delhi-110001. India
l¡à¤¹ Òü>쮡С A¡š¢ &¤} "[®¡®¡à Òü@i¡à¹>¸àÅ>ຠëÒà[Á¡}Î [º[³ìi¡ìl¡¹ &A¡[i¡ ì™ï= l¡ü샸àK
"[®¡®¡à ºàÒüó¡ Òü>[Î*ì¹X ìA¡à´šà[> Òü[“¡Úà [º[³ìi¡l¡
ëÒl "[ó¡Î: "[®¡®¡à i¡à*Úà¹, ëÎC¡¹ ì¹àl¡, [l¡&º&ó¡ Kºó¡ ìA¡àì΢¹ [¤š¹ãìt¡, [l¡&º&ó¡ ëó¡\ V, ëÎC¡¹ 43, P¡¹Kòà*-122003ú Ò[¹Úà>à Òü[“¡Úàú
[>¤[Þê¡t¡ A¡à™¢àºÚ: 2Ú t¡º, šøA¡àŃ㚠[¤[Á¡}, 7 t¡ºÑzÚ ³àK¢, [>l¡ü [ƒ[À-110001ú Òü[“¡Úà
Tel/ ëi¡[ºìó¡à>:+91 (0) 124 270 9000 Fax/ ó¡¸àG: +91 (0) 124 257 1210.
www.avivaindia.com Email/ Òü쳺 :[email protected]