{"id":2126,"title":"EMERGENCY HOTEL ACCOMMODATION FOR FAMILY MEMBER 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-extension-for-insured-and-family-member/Proposal_Form_EHE.pdf","sha256":"e8b0747e90f8d7b6e23ed77a94d1c0cc84f408a2a657a2051c6bc71427b865a5","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer to apply for emergency hotel accommodation insurance coverage for a family member during overseas travel. The proposer fills this form.","notes":["Please answer all questions in BLOCK letters.","Use separate sheet if space is insufficient.","Policy will come into force only after full receipt of premium.","Read declaration wordings carefully before signing.","Certified explanation of the proposal form is required if not filled by the proposer.","Keep policy contact and bank details updated for faster service.","No rebate of commission or premium is allowed as per Insurance Act, 1938 Section 41."],"title":"EMERGENCY HOTEL ACCOMMODATION FOR FAMILY MEMBER PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Name of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address In India for Communication :","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid phone number","type":"phone","label":"Phone No:","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"E-mail:","options":[],"required":null,"pdf_field":""},{"help":"Format DD-MM-YYYY","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Enter passport number","type":"text","label":"Passport No:","options":[],"required":null,"pdf_field":""},{"help":"List all countries of travel","type":"text","label":"Country/Countries of Travel :","options":[],"required":null,"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":"Provide DARPAN registration details if applicable","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":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Travel and Insurance Details","fields":[{"help":"Format DD-MM-YYYY","type":"date","label":"Period of Travel : Departure Date","options":[],"required":null,"pdf_field":""},{"help":"Format DD-MM-YYYY","type":"date","label":"Arrival Date","options":[],"required":null,"pdf_field":""},{"help":"Select one sum insured option","type":"choice","label":"Sum Insured Options : ( Please Select any one of the below Options)","options":["USD 1000","USD 2000","USD 3000","USD 4000"],"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":"Enter cheque number if payment by cheque","type":"text","label":"Cheque No.","options":[],"required":null,"pdf_field":""},{"help":"Date of cheque, format DD-MM-YYYY","type":"date","label":"Cheque Dt.","options":[],"required":null,"pdf_field":""},{"help":"Name of bank","type":"text","label":"Bank/Name","options":[],"required":null,"pdf_field":""},{"help":"Name of bank branch","type":"text","label":"Branch Name :","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature :","options":[],"required":true,"pdf_field":""},{"help":"Date of signature, format DD-MM-YYYY","type":"date","label":"Date :","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"PEP means Politically Exposed Persons","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"},{"title":"Applicant's Signature","fields":[{"help":"Sign here","type":"signature","label":"APPLICANT'S 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"}],"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":["The proposer must disclose all facts relevant to all persons proposed to be insured that may affect the insurer's decision or terms.","The liability of the company does not commence until the proposal is accepted and premium is paid.","The proposer declares that the information given is true and complete to the best of their knowledge and consents to medical and insurance information verification.","The proposer agrees to notify any change in occupation or health after submission but before acceptance.","The proposer consents to sharing information for underwriting and claims settlement purposes.","The premium has been paid from legally acquired sources and future premiums will be similarly paid.","Consent is given for KYC verification through specified portals.","Consent is given for sharing personal information 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/2126-emergency-hotel-accommodation-for-family-member-proposal-form"}