{"id":2125,"title":"EMERGENCY HOTEL EXTENSION FOR INSURED AND FAMILY MEMBERS PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/travel-insurance/emergency-hotel-accomodation-for-family-member/Proposal_Form_EH.pdf","sha256":"277b230a5bf429bcbf88e157f3666bf9df043e9cdd7c4eba0be431614fcba790","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for emergency hotel accommodation insurance coverage for themselves and their family members under a Bajaj General Insurance policy covering overseas travel.","notes":["Please answer all questions in BLOCK letters.","Use original documents and provide complete and accurate information.","Read declaration wordings carefully before signing the proposal form.","Keep your policy updated with contact and bank details for faster service.","For assistance, contact Bajaj General Insurance via phone, email, app, or website."],"title":"EMERGENCY HOTEL EXTENSION FOR INSURED AND FAMILY MEMBERS PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"1. Name of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"2. Address In India for Communication :","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"3. Phone No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"4. E-mail:","options":[],"required":null,"pdf_field":""},{"help":"Use DD-MM-YYYY format","type":"date","label":"5. Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"6. Passport No:","options":[],"required":null,"pdf_field":""},{"help":"List all countries to be visited","type":"text","label":"7. Country/Countries of Travel :","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 registration details if NGO/NPO","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Travel and Insurance Details","fields":[{"help":"Use DD-MM-YYYY format","type":"date","label":"8. Period of Travel : Departure Date","options":[],"required":null,"pdf_field":""},{"help":"Use DD-MM-YYYY format","type":"date","label":"Arrival Date","options":[],"required":null,"pdf_field":""},{"help":"Select one sum insured option","type":"choice","label":"9. Sum Insured Options : ( Please Select any one of the below Options)","options":["USD 500","USD 1000","USD 1500","USD 2000"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Enter amount paid","type":"amount","label":"Cash / Cheque Amount","options":[],"required":null,"pdf_field":""},{"help":"If payment by cheque, provide cheque number","type":"text","label":"Cheque No.","options":[],"required":false,"pdf_field":""},{"help":"Date of cheque (DD-MM-YYYY)","type":"date","label":"Cheque Dt.","options":[],"required":false,"pdf_field":""},{"help":"Name of bank on cheque","type":"text","label":"Bank/Name","options":[],"required":false,"pdf_field":""},{"help":"Branch of bank","type":"text","label":"Branch Name :","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Signature","fields":[{"help":"Sign to confirm declaration","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date (DD/MM/YY)","options":[],"required":true,"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*? If yes, please share the details","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","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":null,"pdf_field":""},{"help":"","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":null,"pdf_field":""},{"help":"","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":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"This Rider can be taken in Conjunction with any Bajaj General Insurance Policy Covering Overseas Travel.","attachments":["If there is insufficient space for you to provide information whether as requested or otherwise, please attach a separate sheet."],"declarations":["You must disclose all facts relevant to all persons proposed to be insured that may affect the insurer's decision or terms.","The insurer's liability starts only after acceptance of the proposal and receipt of premium.","The proposal is subject to policy terms and conditions and underwriting policy.","You must notify any change in occupation or health after proposal submission but before risk acceptance.","You consent to the insurer seeking medical and insurance information for underwriting and claim settlement.","You authorize sharing of proposal information with government or regulatory authorities.","You declare that the premium is paid from legally acquired sources.","You consent to KYC verification through specified portals.","You consent to sharing personal data with group companies for insurance-related purposes."],"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/2125-emergency-hotel-extension-for-insured-and-family-members-proposal-form"}