{"id":2113,"title":"E-TRAVEL PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/travel-insurance/e-travel/E-travel-proposal-form.pdf","sha256":"8f1777f2f273b39d77cba895895b0b576f7a4fbc391bf31e56f8f381f4975713","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals proposing to purchase the E Travel Value insurance policy. The proposer must fill it out to provide personal and travel details for insurance coverage.","notes":["Please answer all questions in BLOCK letters.","If insufficient space, attach a separate sheet.","Read declaration wordings carefully before signing.","Nominee for self must be one of specified relations or specify if 'Others'.","This form is required for proposing E Travel Value insurance policy."],"title":"E-TRAVEL 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":false,"pdf_field":""},{"help":"Enter valid 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 occupation","type":"text","label":"Occupation : _______________________________","options":[],"required":true,"pdf_field":""},{"help":"Enter travel departure date","type":"date","label":"Departure Date","options":[],"required":true,"pdf_field":""},{"help":"Enter travel arrival date","type":"date","label":"Arrival Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Persons to be insured","fields":[{"help":"Provide Sr. No, Name, Date of Birth, Gender, Passport No., Nominee for each insured person","type":"table","label":"Family Members","options":[],"required":true,"pdf_field":""},{"help":"Specify nominee relation or specify if 'Others'","type":"text","label":"*Nominee for self has to be one of the below mentioned relations. \"Father, Mother, Son, Daughter, Spouse, Financier, Employer & Others\" If Nominee is \"Others\" please specify --------------------------------------.","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"","type":"yes-no","label":"Partnership Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Limited Liability/Partnership Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide DARPAN registration if applicable","type":"yes-no","label":"NGO/NPO- Provide DARPAN Portal Registration, if applicable","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Company","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Trust","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Society","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Section 8 Company","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Proprietorship Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify other constitution if applicable","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""},{"help":"Provide DARPAN portal registration details if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Enter amount paid by cash or cheque","type":"amount","label":"Cash / Cheque Amount","options":[],"required":true,"pdf_field":""},{"help":"Enter cheque number if payment by cheque","type":"text","label":"Cheque No.","options":[],"required":false,"pdf_field":""},{"help":"Enter cheque date if payment by cheque","type":"date","label":"Cheque Dt.","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name if payment by cheque","type":"text","label":"Bank/Name","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":"Declarations 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","type":"date","label":"Date :","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations – Physical Proposal Form","fields":[{"help":"PEP means Politically Exposed Persons as defined","type":"yes-no","label":"Are you or any of the proposal applicants a PEP* or a close relative of PEP*? If yes, please share the details","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Consent for KYC verification","type":"yes-no","label":"I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through CERSAI records or National Securities Depository Limited Portal for the purpose of undertaking KYC verification.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Declaration of legal source of premium payment","type":"yes-no","label":"I/we hereby declare and confirm that the premium has been paid out of legally acquired sources of income and the subsequent premiums if any, will continue to be paid out of legally declared and assessed source of income.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Consent to share personal information","type":"yes-no","label":"I/We hereby give voluntary consent to Bajaj General/Company to share my/our personal information and data provided in this proposal for its group companies or any other person in connection with the Insurance Policy or otherwise, including for providing products and services of group companies that may be of interest to me/us, to be used in accordance with their respective privacy policies and subject to appropriate measures being in place to safeguard my/our personal information.","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"E Travel Value Policy","attachments":[],"declarations":["The proposer must disclose all relevant facts affecting policy issuance or terms.","The company’s liability starts only after proposal acceptance and full premium payment.","Premium must be paid from legally acquired sources.","Consent is given for KYC verification through specified portals.","Consent may be given to share personal data with group companies.","No rebates or inducements are allowed as per Insurance Act, 1938 Section 41."],"dropped_labels":0},"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/2113-e-travel-proposal-form"}