{"id":2133,"title":"Bajaj General Pet Insurance Policy Proposal Form","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/pet-insurance/Pet-Insurance-Proposal-Form-Final-Digital.pdf","sha256":"93572d1c8fb98b472f332f9c1f6fccefad53e92ffe1d6a586272c04acfae3335","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer (policyholder) to apply for pet insurance coverage with Bajaj General Insurance Limited. It collects details about the proposer, the pets to be insured, and the coverage options desired.","notes":["Answer all questions fully and accurately; provide additional sheets if needed.","Liability of the company starts only after acceptance of proposal and payment of premium.","Policy period for all covers must be identical.","Use recent medical reports if available (not older than 30 days).","If hospitalization cover is chosen, specify per day limit.","If proposer is a company or firm, provide full incorporated or partnership names as applicable.","Declarations must be signed and dated by proposer or authorized person.","No rebates or inducements are allowed as per Insurance Act 1938 Section 41."],"title":"Bajaj General Pet Insurance Policy Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details and Pet Information","fields":[{"help":"Enter your full name as proposer","type":"text","label":"Name of the Proposer (in full)","options":[],"required":true,"pdf_field":"Name of the Proposer in full"},{"help":"Provide your PAN, TAN, GST or AADHAR number","type":"text","label":"PAN / TAN / GST / AADHAR Number","options":[],"required":true,"pdf_field":"PAN  TAN  GST  AADHAR Number"},{"help":"Enter your full communication address","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":"Address for Communication"},{"help":"Provide your contact telephone number","type":"phone","label":"Telephone Number","options":[],"required":true,"pdf_field":"Telephone Number"},{"help":"Select Yes if you are an employee, else No","type":"yes-no","label":"Are you an Employee of BGIL/ Group Companies of BGIL","options":["Yes","No"],"required":false,"pdf_field":"Are you an Employee of BAGIC Group Companies of BAGIC"},{"help":"If employee, provide your employee code","type":"text","label":"Emp. Code","options":[],"required":false,"pdf_field":"Emp Code"},{"help":"List any other active Bajaj General Insurance policies you hold","type":"text","label":"Kindly provide details of any other active policy of Bajaj General Insurance Limited held by you","options":[],"required":false,"pdf_field":"Kindly provide details of any other active policy of Bajaj Allianz General Insurance Co Ltd held by you"},{"help":"Fill details for each pet: Name, Dog/Cat, Sex (M/F), Age (Years), Breed, Micro Chip/RFID/Tag Number, Unique Identification Description, Policy Tenure (select one: Up to 365 Days, 1 Year, 2 Year, 3 Year)","type":"table","label":"Give the following particulars in full, of the pet(s) proposed for insurance","options":[],"required":true,"pdf_field":"Name of PetsRow1.0"},{"help":"Select Yes if any pet is used commercially, else No","type":"yes-no","label":"Is any of the pet proposed to be covered under the policy used for Commercial purpose","options":["Yes","No"],"required":true,"pdf_field":"Is any of the pet proposed to be covered under the policy used for Commercial purpose"},{"help":"Provide details if any pet is used commercially","type":"text","label":"If yes please provide details","options":[],"required":false,"pdf_field":"If yes please provide details"}],"filled_by":"proposer"},{"title":"Coverage Options","fields":[{"help":"Select Yes or No for each cover and specify sum insured and co-pay where applicable","type":"table","label":"Please mention the Sections you want to opt for and specify what Sum Insured option you want for the cover","options":["Surgery Expenses Cover (Yes/No)","Hospitalisation Cover (Yes/No) with Co-Pay options 10%, 20%, 30%","Cover for Hip Dysplasia under Section 1 and 2 (Yes/No)","Mortality Benefit Cover (Yes/No) with options for death due to Kidney Failure and Accidental Death","Terminal Diseases Cover (Yes/No)","Long Term Care Cover (Yes/No)","OPD Cover (Yes/No) with Co-Pay options 10%, 20%, 30%","Third Party Liability Cover (Yes/No) with Co-Pay options 10%, 20%, 30%","Theft/Lost/Straying Cover (Yes/No)"],"required":true,"pdf_field":"Please Select YesNoHospitalisation Cover"},{"help":"Specify per day limit if hospitalization cover is chosen","type":"text","label":"Note Wherever Hospitalization cover is opted kindly specify Per Day Limit opted","options":[],"required":false,"pdf_field":"Note Wherever Hospitalization cover is opted kindly specify Per Day Limit opted"},{"help":"Select Yes if pet is pedigree, else No","type":"yes-no","label":"Is the pet of Pedigree lineage?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"List vaccination schedule for your pet(s)","type":"text","label":"Please provide Schedule of the vaccinations provided to your Pet(s)","options":[],"required":false,"pdf_field":"Please provide Schedule of the vaccinations provided to your Pets"},{"help":"Provide past disease or condition details for your pet(s)","type":"text","label":"Give details of diseases/ conditions Pet(s) suffered in past","options":[],"required":false,"pdf_field":"11 Give details of diseases conditions Pets suffered in past"},{"help":"Select Yes if pet is spayed/castrated, else No","type":"yes-no","label":"Is your Pet(s) spayed or castrated?","options":["Yes","No"],"required":false,"pdf_field":"12 Is your Pets spayed or castrated"},{"help":"Provide reasons if pet is spayed or castrated","type":"text","label":"If yes, please state the reasons","options":[],"required":false,"pdf_field":""},{"help":"Select Yes if you have a recent fitness certificate or medical report","type":"yes-no","label":"Fitness certificate/ complete medical report not older than 30 days available?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide year, cause of loss, and number of animals lost for each incident","type":"table","label":"Have you lost any animal/s during the last three years? If so state particulars","options":[],"required":false,"pdf_field":"YearRow1"},{"help":"Provide insurance and claims experience for last three years","type":"table","label":"Previous Pet(s) Insurance and Claims experience (for the last three years)","options":[],"required":false,"pdf_field":"Year 1"},{"help":"Provide any other relevant information","type":"text","label":"Any other information material to the risk or the terms upon which cover might be offered","options":[],"required":false,"pdf_field":"17 Any other information material to the risk or the terms upon which cover might be offered"}],"filled_by":"proposer"},{"title":"Group Cover Details (if applicable)","fields":[{"help":"Full incorporated name if Pvt Ltd company or full name of partnership or proprietorship","type":"text","label":"Name of the Proposer (in full)","options":[],"required":true,"pdf_field":"Name of the Proposer in full_2"},{"help":"Provide PAN, TAN, GST or AADHAR number","type":"text","label":"PAN / TAN / GST / AADHAR Number","options":[],"required":true,"pdf_field":"PAN  TAN  GST  AADHAR Number_2"},{"help":"Provide full communication address","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":"Address for Communication_2"},{"help":"Provide contact telephone number","type":"phone","label":"Telephone Number","options":[],"required":true,"pdf_field":"Telephone Number_2"},{"help":"Describe the group or association covered","type":"text","label":"Please mention detail of the Group/ Association/ Institution/ Corporate Body whose members are being covered under the Policy","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is the group being formed with the sole purpose of obtaining Insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter initial number of persons covered","type":"number","label":"Please mention the total number of persons to be covered initially","options":[],"required":true,"pdf_field":""},{"help":"Fill pet details as per coverage description in part I","type":"table","label":"Give the following particulars in full, of the pet(s) proposed for insurance","options":[],"required":true,"pdf_field":""},{"help":"Provide any other relevant information","type":"text","label":"Any other information material to the risk or the terms upon which cover might be offered","options":[],"required":false,"pdf_field":"12 Any other information material to the risk or the terms upon which cover might be offered"}],"filled_by":"proposer"},{"title":"Declarations and Consents","fields":[{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":"Date"},{"help":"Sign the form","type":"signature","label":"Signature (on behalf of the Proposer)","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":"Place"}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Pet insurance policies offered by Bajaj General Insurance Limited","attachments":["Fitness certificate/ complete medical report not older than 30 days (if available)","Schedule of vaccinations provided to your Pet(s)"],"declarations":["The information provided is true, accurate and complete.","Policy is void if any untrue or incorrect statement or non-disclosure is made.","Policy issuance is subject to realization of premium payment.","Consent is given to share personal information with group companies for products and services.","AML declarations and consents regarding PEP status, identity verification, and premium source are agreed."],"dropped_labels":11},"pdf_fields":[{"name":"Name of the Proposer in full","page":1,"type":"text","label":"Name of the Proposer (in full"},{"name":"undefined","page":1,"type":"text","label":"undefined"},{"name":"undefined_2","page":1,"type":"text","label":"undefined"},{"name":"PAN  TAN  GST  AADHAR Number","page":1,"type":"text","label":"PAN / TAN / GST / AADHAR Number"},{"name":"Address for Communication","page":1,"type":"text","label":"Address for Communication"},{"name":"undefined_3","page":1,"type":"text","label":"undefined"},{"name":"State","page":1,"type":"text","label":"State"},{"name":"E mail ID","page":1,"type":"text","label":"E mail ID"},{"name":"undefined_4","page":1,"type":"text","label":"undefined"},{"name":"undefined_5","page":1,"type":"text","label":"undefined"},{"name":"Pin Code","page":1,"type":"text","label":"Pin Code"},{"name":"undefined_6","page":1,"type":"text","label":"undefined"},{"name":"Telephone Number","page":1,"type":"text","label":"Telephone Number"},{"name":"Are you an Employee of BAGIC Group Companies of BAGIC","page":1,"type":"text","label":"Are you an Employee of BAGIC/ Group Companies of BAGIC"},{"name":"Emp Code","page":1,"type":"text","label":"Emp. Code"},{"name":"Kindly provide details of any other active policy of Bajaj Allianz General Insurance Co Ltd held by you","page":1,"type":"text","label":"Kindly provide details of any other active policy of Bajaj Allianz General Insurance Co. Ltd. held by you"},{"name":"Name of PetsRow1.0","page":1,"type":"text","label":"Name of Pet(s)_Row_1"},{"name":"Dog CatRow1.0","page":1,"type":"text","label":"Dog/ Cat_Row_1"},{"name":"Sex MFRow1.0","page":1,"type":"text","label":"Sex (M/F)_Row_1"},{"name":"Age YearsRow1.0","page":1,"type":"text","label":"Age (Years)_Row_1"},{"name":"BreedRow1.0","page":1,"type":"text","label":"Breed_Row_1"},{"name":"Micro Chip RFID Tag NumberRow1.0","page":1,"type":"text","label":"Micro Chip/ RFID/ Tag Number_Row_1"},{"name":"Unique Identification DescriptionRow1.0","page":1,"type":"text","label":"Unique Identification Description_Row_1"},{"name":"Up to 365 DaysRow1.0","page":1,"type":"text","label":"Up to 365 Days_Row_1"},{"name":"1 YearRow1.0","page":1,"type":"text","label":"1 Year_Row_1"},{"name":"2 YearRow1.0","page":1,"type":"text","label":"2 Year_Row_1"},{"name":"3 YearRow1.0","page":1,"type":"text","label":"3 Year_Row_1"},{"name":"Name of PetsRow1.1","page":3,"type":"text","label":"Name of Pet(s)_Row_1"},{"name":"Dog CatRow1.1","page":3,"type":"text","label":"Dog/ Cat_Row_1"},{"name":"Sex MFRow1.1","page":3,"type":"text","label":"Sex (M/F)_Row_1"},{"name":"Age YearsRow1.1","page":3,"type":"text","label":"Age (Years)_Row_1"},{"name":"BreedRow1.1","page":3,"type":"text","label":"Breed_Row_1"},{"name":"Micro Chip RFID Tag NumberRow1.1","page":3,"type":"text","label":"Micro Chip/ RFID/ Tag Number_Row_1"},{"name":"Unique Identification DescriptionRow1.1","page":3,"type":"text","label":"Unique Identification Description_Row_1"},{"name":"Up to 365 DaysRow1.1","page":3,"type":"text","label":"Up to 365 Days_Row_1"},{"name":"1 YearRow1.1","page":3,"type":"text","label":"1 Year_Row_1"},{"name":"2 YearRow1.1","page":3,"type":"text","label":"2 Year_Row_1"},{"name":"3 YearRow1.1","page":3,"type":"text","label":"3 Year_Row_1"},{"name":"Name of PetsRow1.2","page":3,"type":"text","label":"Name of Pet(s)_Row_1"},{"name":"Dog CatRow1.2","page":3,"type":"text","label":"Dog/ 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opted"},{"name":"Group1.24","page":4,"type":"radiobutton","options":["Choice1","Choice1","Choice1"]},{"name":"Group1.24","page":4,"type":"radiobutton","options":["Choice1","Choice1","Choice1"]},{"name":"Group1.24","page":4,"type":"radiobutton","options":["Choice1","Choice1","Choice1"]},{"name":"undefined_10","page":4,"type":"text","label":"undefined"},{"name":"Please provide Schedule of the vaccinations provided to your Pets","page":4,"type":"text","label":"Please provide Schedule of the vaccinations provided to your Pet(s"},{"name":"undefined_11","page":4,"type":"text","label":"undefined"},{"name":"11 Give details of diseases conditions Pets suffered in past","page":4,"type":"text","label":"11. 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Any other information material to the risk or the terms upon which cover might be offered"},{"name":"Note Kindly proceed to declaration part provided at the end of the Proposal Form","page":5,"type":"text","label":"Note: Kindly proceed to declaration part provided at the end of the Proposal Form"},{"name":"End of part I","page":5,"type":"text","label":"End of part I"},{"name":"Name of the Proposer in full_2","page":5,"type":"text","label":"Name of the Proposer (in full"},{"name":"undefined_14","page":5,"type":"text","label":"undefined"},{"name":"Note If proposer if a PvtLtd company then please mention the full incorporated name of this Company If","page":5,"type":"text","label":"Note: If proposer if a Pvt/Ltd company, then please mention the full incorporated name of this Company. 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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. 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