{"id":2117,"title":"PRAVASI BHARATIYA BIMA YOJANA POLICY (PROPOSAL FORM)","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/travel-insurance/Pravasi-bharatiya-Bima-Yojana/Pravasi-bharatiya-Bima-Yojana-pf.pdf","sha256":"9b8bd629dd9477868fbede71125c40ecce74add5ebfa196087beb6785b3291ff","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for the Pravasi Bharatiya Bima Yojana travel insurance policy, to be filled by the proposer seeking insurance coverage.","notes":["Please answer all questions in BLOCK letters.","If there is insufficient space, attach a separate sheet.","The policy will not be issued unless premium is received in full and realized.","Use original documents and provide accurate information to avoid policy avoidance.","Keep policy contact details updated for faster service processing.","Declaration must be signed by the proposer or authorized person.","Section 41 of Insurance Act prohibits rebates as inducements for insurance."],"title":"PRAVASI BHARATIYA BIMA YOJANA POLICY (PROPOSAL FORM)","submit":{"to":"Bajaj General Insurance Limited","how":"","address":"Bajaj Insurance House, Airport Road, Yerawada, Pune - 411 006"},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter full name in BLOCK letters","type":"text","label":"1. Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"2. Address","options":[],"required":true,"pdf_field":""},{"help":"Enter contact phone number","type":"phone","label":"3. Phone No:","options":[],"required":true,"pdf_field":""},{"help":"Enter email address","type":"email","label":"4. E-mail :","options":[],"required":false,"pdf_field":""},{"help":"Enter departure and arrival dates in DD/MM/YYYY format","type":"date","label":"5. Departure Date Arrival Date","options":[],"required":true,"pdf_field":""},{"help":"Enter passport number","type":"text","label":"6. Passport Number","options":[],"required":true,"pdf_field":""},{"help":"Enter PAN number if available","type":"text","label":"7. PAN No","options":[],"required":false,"pdf_field":""},{"help":"Enter Aadhar or other unique ID number","type":"text","label":"8. UID/Unique ID/Aadhar Card","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Select the constitution type and provide DARPAN Portal Registration if applicable","type":"choice","label":"Constitution Details","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":null,"pdf_field":""},{"help":"Provide DARPAN Portal Registration details if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Period and Payment Details","fields":[{"help":"Enter policy start and end dates in DD/MM/YYYY format","type":"date","label":"9. Proposed Policy Period From _ _/_ _/_ _ _ _ to _ _/_ _/_ _ _ _","options":[],"required":true,"pdf_field":""},{"help":"Select policy tenure","type":"choice","label":"10. Policy Tenure","options":["2 Years","3 Years"],"required":true,"pdf_field":""},{"help":"Enter payment amount","type":"amount","label":"Payment Details 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 and branch if payment by cheque","type":"text","label":"Bank/Name Branch","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration & Warranty","fields":[{"help":"Enter name of proposer signing declaration","type":"text","label":"Name :","options":[],"required":true,"pdf_field":""},{"help":"Sign the declaration","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":"Politically Exposed Persons details if applicable","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 form with 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":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Pravasi Bharatiya Bima Yojana travel insurance policies","attachments":["Attach a separate sheet if there is insufficient space to provide information as requested or otherwise"],"declarations":["The proposer must disclose all facts relevant to persons proposed to be insured that may affect policy issuance or premium.","The policy liability starts only after full premium receipt and acceptance of the proposal by the company.","The proposer declares that all information provided is true and complete to the best of their knowledge.","The proposer consents to the company seeking medical and insurance information for underwriting and claims settlement.","The proposer authorizes sharing of proposal and medical information with government and regulatory authorities.","The proposer must notify any change in occupation or health after submission but before risk acceptance.","The proposer consents to KYC verification through CERSAI or National Securities Depository Limited Portal.","The proposer declares premium is paid from legally acquired sources and future premiums will be similarly paid.","The proposer consents to sharing personal data with group companies for insurance and related services."],"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/2117-pravasi-bharatiya-bima-yojana-policy-proposal-form"}