{"id":2121,"title":"TRAVEL ACE (INTERNATIONAL) : 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-Ace/Travel-Ace-PF.pdf","sha256":"b3082bb4b49718baac29f6ccf500ee1f1e3823ffb0ac0110d9be0d25e0be3811","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for Travel ACE (International) insurance coverage, to be filled by the proposer seeking travel insurance.","notes":["Answer all questions in BLOCK letters.","Liability of the company starts only after proposal acceptance and premium payment.","Provide all information fully and accurately.","Use original documents where required.","For student plans, some covers and information are applicable only to students.","Choose only one of 'All risk trip Cancellation' or 'Trip and Event Cancellation' cover.","Keep policy contact and bank details updated for faster service.","Signatures/thumb impressions are mandatory where indicated.","If proposal form is filled by someone else, certification of explanation and understanding is required."],"title":"TRAVEL ACE (INTERNATIONAL) : PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details and Travel Information","fields":[{"help":"Write your full name in BLOCK letters","type":"text","label":"Name of the Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"Write your full address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter your area's postal code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter your contact phone number","type":"phone","label":"Phone No:","options":[],"required":true,"pdf_field":""},{"help":"Enter your email address","type":"email","label":"Email:","options":[],"required":true,"pdf_field":""},{"help":"Enter date of departure (DD/MM/YYYY)","type":"date","label":"Departure Date","options":[],"required":true,"pdf_field":""},{"help":"Enter date of arrival (DD/MM/YYYY)","type":"date","label":"Arrival Date","options":[],"required":true,"pdf_field":""},{"help":"Provide if applicable","type":"text","label":"Bajaj Employee Code, if Proposer is Life/General Employee:","options":[],"required":false,"pdf_field":""},{"help":"Select one option","type":"choice","label":"Geographical Location:","options":["Worldwide Including USA/Canada","Worldwide Excluding USA/Canada"],"required":true,"pdf_field":""},{"help":"Specify the plan type","type":"text","label":"Plan Opted Individual/Student/ Annual Multi-trip Policy","options":[],"required":true,"pdf_field":""},{"help":"Select maximum trip duration if annual multi-trip plan chosen","type":"choice","label":"In case of annual multitrip plan please provide maximum trip duration -","options":["30 days","60 days","90 days","120 days","180 days"],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If you have any other policy for coverage of International Journey i.e Health/ PA/ Travel etc (if yes please provide details)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Cover Options and Sum Insured","fields":[{"help":"Tick if you wish to opt cover; specify sum insured opted; columns: Tick if wish to opt Cover, Cover, Sum Insured Opted","type":"table","label":"Choose desired cover and Sum Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Select applicable constitution type","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 if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Details of Persons to be Insured","fields":[{"help":"","type":"yes-no","label":"Waiver of Sub-limits","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Columns: Sr. No, Name of Insured/ Family member, Date of Birth, Gender, Passport No., Medical Declaration (if any), Nominee","type":"table","label":"Details of Persons to be insured : Kindly give the details of passengers in below table.","options":[],"required":true,"pdf_field":""},{"help":"Columns: Questions, Insured 1, Insured 2, Insured 3, Insured 4; questions include alcohol/smoke/tobacco use, recreational drug use","type":"table","label":"Detailed Medical History Questions","options":[],"required":false,"pdf_field":""},{"help":"Provide student name, DOB, school overseas name and address, course details, tuition fees, financing details, medical examination info","type":"text","label":"Additional information to be completed by the student (Only for Student plan)","options":[],"required":false,"pdf_field":""},{"help":"Provide payment mode and details","type":"text","label":"Payment Details: Cash / Cheque Amount Cheque No. Cheque Date Bank/Name Branch","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign or provide thumb impression","type":"signature","label":"Signature/ Thumb Impression of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Required if proposal form filled by someone else","type":"signature","label":"Signature (On behalf of Proposer)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations – Physical Proposal Form","fields":[{"help":"PEP means Politically Exposed Person","type":"yes-no","label":"Are you or any of the proposal applicants a PEP* or a close relative of PEP*?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If yes, please share the details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"International travel insurance policies including individual, student, and annual multi-trip plans","attachments":["Documents supporting medical declarations if any","Proof of identity/address for KYC verification if required","Payment proof (cash/cheque/DD/credit card/debit card details)"],"declarations":["The proposer declares all information provided is true and complete to the best of their knowledge.","The policy will commence only after acceptance of the proposal and receipt of premium by the company.","The proposer agrees to notify any change in occupation or health before risk acceptance.","The company may seek medical and insurance information from relevant sources for underwriting and claims.","The proposer consents to sharing proposal and medical information with reinsurers and regulatory authorities.","No rebates or inducements are allowed as per Insurance Act 1938 Section 41.","Consent is given for KYC verification through specified portals.","Premiums are declared to be paid from legally acquired sources.","Consent is given to share personal data with group companies for insurance products and services."],"dropped_labels":5},"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/2121-travel-ace-international-proposal-form"}