{"id":2129,"title":"REPLACEMENT AND REARRANGEMENT OF STAFF PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/travel-insurance/replacement-and-rearrangement-of-staff/Proposal_Form_RAR.pdf","sha256":"afd0d5f5cb3860d435fee5ea4aa72fd5df50d265b054e8da719dbfbf197c02b0","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for insurance coverage related to replacement and rearrangement of staff, to be filled by the proposer seeking insurance.","notes":["Please answer all questions in BLOCK letters.","Use separate sheet if space is insufficient.","Read declaration carefully before signing.","Keep policy contact and bank details updated for faster service.","Contact details for updates: Caringly yours App, WhatsApp, Call Center, SMS, Email, website, agent or branch."],"title":"REPLACEMENT AND REARRANGEMENT OF STAFF PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address In India for Communication :","options":[],"required":true,"pdf_field":""},{"help":"Enter a valid phone number","type":"phone","label":"Phone No:","options":[],"required":true,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"E-mail:","options":[],"required":true,"pdf_field":""},{"help":"Format DD-MM-YYYY","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Enter passport number","type":"text","label":"Passport No:","options":[],"required":true,"pdf_field":""},{"help":"List all countries of travel","type":"text","label":"Country/Countries of Travel :","options":[],"required":true,"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":"If yes, provide DARPAN registration details","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":false,"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":true,"pdf_field":""},{"help":"Format DD-MM-YYYY","type":"date","label":"Arrival Date","options":[],"required":true,"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":true,"pdf_field":""},{"help":"If payment by cheque, enter cheque number","type":"text","label":"Cheque No.","options":[],"required":false,"pdf_field":""},{"help":"Date of cheque, format 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 & Signature","fields":[{"help":"Sign here","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 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":true,"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":true,"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":true,"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":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"","attachments":["If there is insufficient space for you to provide information, please attach a separate sheet."],"declarations":["The statements and particulars given are true and complete to the best of the proposer's knowledge.","The proposer is authorized to propose on behalf of all persons to be insured.","The policy will come into force only after full receipt of the premium.","The proposer will notify any change in occupation or health after submission but before risk acceptance.","The company may seek medical and insurance information for underwriting and claim settlement.","The company may share proposal information with government or regulatory authorities.","The proposer consents to KYC verification through specified portals.","The premium has been paid from legally acquired sources.","The proposer consents to sharing personal information with group companies for services and products."],"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/2129-replacement-and-rearrangement-of-staff-proposal-form"}