{"id":2112,"title":"TRAVEL PRIME PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/travel-insurance/travel-prime-holiday/travel-prime-holiday-pf.pdf","sha256":"f5b26f558223315f479413ea3595387d613d1d6bad5ad6e74a06b10db2370203","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or groups proposing to purchase the Travel Prime Holiday insurance policy from Bajaj General Insurance. The proposer fills it to provide personal, travel, and health information for underwriting the insurance policy.","notes":["Answer all questions in BLOCK letters.","Use separate sheet if space is insufficient.","Nominee for self must be one of: Father, Mother, Son, Daughter, Spouse, Financier, Employer, or Others (specify).","Read declaration carefully before signing.","Certified explanation required if form is not filled by proposer.","Keep policy contact details updated via app, WhatsApp, call center, email, website, agent or branch."],"title":"TRAVEL PRIME PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter full name in BLOCK letters","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Enter contact phone number","type":"phone","label":"Phone No:","options":[],"required":true,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E-mail :","options":[],"required":false,"pdf_field":""},{"help":"Enter date of birth in DD-MM-YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Enter passport number","type":"text","label":"Passport No :","options":[],"required":true,"pdf_field":""},{"help":"Enter current occupation","type":"text","label":"Occupation :","options":[],"required":true,"pdf_field":""},{"help":"Enter departure date in DD-MM-YYYY format","type":"date","label":"Departure Date","options":[],"required":true,"pdf_field":""},{"help":"Enter arrival date in DD-MM-YYYY format","type":"date","label":"Arrival Date","options":[],"required":true,"pdf_field":""},{"help":"Select the geographical coverage for travel","type":"choice","label":"Geographical Location","options":["Worldwide Including USA/Canada","Worldwide Excluding USA/Canada","Asia Excluding Japan"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"","type":"yes-no","label":"Partnership Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Limited Liability/Partnership Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes, provide DARPAN registration details","type":"yes-no","label":"NGO/NPO- Provide DARPAN Portal Registration, if applicable","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Company","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Trust","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Society","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Section 8 Company","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Proprietorship Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify other constitution if applicable","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Family Doctor Details","fields":[{"help":"Enter family doctor's name","type":"text","label":"Name","options":[],"required":false,"pdf_field":""},{"help":"Enter doctor's qualification","type":"text","label":"Qualification","options":[],"required":false,"pdf_field":""},{"help":"Enter registration number","type":"text","label":"Reg No","options":[],"required":false,"pdf_field":""},{"help":"Enter doctor's mobile number","type":"phone","label":"Mobile No","options":[],"required":false,"pdf_field":""},{"help":"Enter doctor's address","type":"text","label":"Address","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Plan Selection","fields":[{"help":"Select the appropriate plan and sum insured","type":"choice","label":"Choose Plans","options":["Travel Prime Individual Plans: Silver (50000 USD), Gold (200000 USD), Platinum (500000 USD), Super Platinum (750000 USD), Maximum (1000000 USD)","Travel Prime Age Plans: Silver (50000 USD), Gold (200000 USD), Platinum (500000 USD), Super Platinum (750000 USD), Maximum (1000000 USD)","Travel Prime Super Age Plan: 50000 USD","Travel Prime Corporate Plans: Corporate Lite (250000 USD), Corporate Maximum (1000000 USD), Corporate Age Plus (200000 USD), Corporate Plus (500000 USD), Corporate Age Lite (50000 USD)","Travel Prime Holiday Plans & Travel Prime Asia Plans: Asia Flair (15000 USD), Asia Supreme (25000 USD)","Travel Prime Family Plan: Standard (50000 USD), Silver (100000 USD)","Travel Prime Student Plans: Standard (50000 USD), Platinum (300000 USD), Maximum (1000000 USD), Silver (100000 USD), Super Gold (500000 USD), Gold (200000 USD), Super Platinum (750000 USD)"],"required":true,"pdf_field":""},{"help":"Check if opting for pre-policy health check-up","type":"checkbox","label":"With Pre Policy Health Check Up","options":["With Pre Policy Health Check Up"],"required":false,"pdf_field":""},{"help":"Check if not opting for pre-policy health check-up","type":"checkbox","label":"Without Pre Policy Health Check Up","options":["Without Pre Policy Health Check Up"],"required":false,"pdf_field":""},{"help":"Check if journey is within 30 days","type":"checkbox","label":"Journey within 30 Days","options":["Journey within 30 Days"],"required":false,"pdf_field":""},{"help":"Check if journey is after 30 days","type":"checkbox","label":"Journey after 30 Days","options":["Journey after 30 Days"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Information","fields":[{"help":"Fill student name, date of birth, school overseas, address, course, duration, semesters, tuition fees, financing details, medical examination, and any other relevant information","type":"text","label":"Additional information to be completed by the student (Only for Travel Prime Student plan)","options":[],"required":false,"pdf_field":""},{"help":"Provide number of passengers and number of travel days; attach annexure with passenger details including name, gender, DOB, passport no, address, medical history, family doctor details, and payment details","type":"text","label":"Additional information to be completed for Travel Prime Holiday","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Enter amount paid","type":"amount","label":"Cash / Cheque Amount","options":[],"required":true,"pdf_field":""},{"help":"Enter bank name if payment by cheque","type":"text","label":"Bank/Name","options":[],"required":false,"pdf_field":""},{"help":"Enter cheque number if applicable","type":"text","label":"Cheque No.","options":[],"required":false,"pdf_field":""},{"help":"Enter cheque date if applicable","type":"date","label":"Cheque Dt.","options":[],"required":false,"pdf_field":""},{"help":"Enter bank branch if payment by cheque","type":"text","label":"Branch","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Signature","fields":[{"help":"Enter name of proposer signing","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing (DD/MM/YY)","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations – Physical Proposal Form","fields":[{"help":"Politically Exposed Persons details if Yes","type":"yes-no","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Travel Prime Holiday Policy (Group)","attachments":["Separate sheet if insufficient space for information","Annexure stating details of passengers for Travel Prime Holiday plan"],"declarations":["The information provided is true and complete to the best of the proposer's knowledge.","The proposer is authorized to propose on behalf of all persons insured.","The policy will come into force only after full receipt of premium.","The proposer will notify any change in occupation or health before risk acceptance.","Consent to company seeking medical and insurance information for underwriting and claims.","Consent to share proposal and medical records with government or regulatory authorities.","Agreement to the company's Privacy Policy as amended from time to time.","Premiums are paid from legally acquired sources.","Consent to share personal information with group companies for services and products.","Policy contact and bank details must be kept updated for faster service."],"dropped_labels":8},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"email","value":"careforyou@bajajgeneral.com","label":"Customer Service Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"in a new tab\nBajaj General Insurance Limited\nTollfree: For sales :\n1800-209-0144\nFor service :\n1800-209-5858\nEmail id:\ncareforyou@bajajgeneral.com\nFor senior citizens:\nseniorcitizen@bajajgeneral.com\nFor senior citizens:\n1800-209-5858\nFax no:\n020-30512246\nRegistered","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-209-5858","label":"Service Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"Careers\nBecome\n                                An Agent\nAwards\nUpdate KYC\nMY ABHA\nBuy Policy:\n1800-209-0144\n| Service:\n1800-209-5858\nService Chat:\n+91 75074 25858\nInsure\nHealth Insurance\nIndividual Health Insurance\nFamily Health Insurance\nInternational","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-209-0144","label":"Sales Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"nsurance\nSupport\nAbout Us\nCareers\nBecome\n                                An Agent\nAwards\nUpdate KYC\nMY ABHA\nBuy Policy:\n1800-209-0144\n| Service:\n1800-209-5858\nService Chat:\n+91 75074 25858\nInsure\nHealth Insurance\nIndividual Health Insurance\nFamily Healt","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-209-5858","label":"Customer Service Toll Free Number","level":1,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"ted servicing team to help you meet your service needs.\nCustomer Service - We're Here to Help\nDial our Toll Free Number\n1800-209-5858\nEmail us on\ncareforyou@bajajgeneral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Cha","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"ggro@bajajgeneral.com","label":"Grievance Redressal Officer Email Mr. Jerome Vincent","level":2,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"fied with the response given to you by our team, you may write to our Grievance Redressal Officer Mr. Jerome Vincent at\nggro@bajajgeneral.com\nLevel 3\nHead Customer Service\nif you are still not satisfied with the solutions provided, or have some feedback for us,","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-209-7073","label":"Toll free No. Intermediary","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"Here to Help\nDial our Toll Free Number\n1800-209-5858\nEmail us on\ncareforyou@bajajgeneral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Chatbot\nConnect with us on WhatsApp +91 7507425858\nFor Support\nBajaj General App\nPle","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"whatsapp","value":"+91 7507425858","label":"BOING WhatsApp Chatbot","level":null,"hours":"24x7","applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"ral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Chatbot\nConnect with us on WhatsApp +91 7507425858\nFor Support\nBajaj General App\nPlease scan and download\nMissed Call Facility\nMissed Call - 80809 45060 Short code - SMS","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/bajaj-general-insurance/2112-travel-prime-proposal-form"}