{"id":2134,"title":"MOTOR TRADE INTERNAL RISKS","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/motor-insurance/Proposal-Form-Motor-Trade-Internal-Risk-Policy.pdf","sha256":"00c77919c99df582f19315458d907469901f5cdd5b0404b4d49cc842c26d20f0","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for insurance coverage under the Motor Trade Internal Risks policy, to be filled by the proposer (applicant for insurance).","notes":["Attach original plan of premises with measurements and details as specified.","PAN card is mandatory.","Use the form to provide complete and accurate information to avoid policy issues.","Bank details are mandatory for refund/claim payments via electronic transfer.","The proposal form must be witnessed by someone other than the advisor/employee of the company.","If premium is paid by cheque, attach a cancelled cheque leaf of the bank account.","Nominee for self (primary insured) must be a close family relation as listed.","The insurer may require additional information for underwriting purposes.","The proposer should keep the company informed of any changes in KYC or contact details."],"title":"MOTOR TRADE INTERNAL RISKS","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details and Premises Information","fields":[{"help":"","type":"text","label":"Proposer's full name","options":[],"required":null,"pdf_field":""},{"help":"Enter your PAN card number","type":"text","label":"PAN CARD (mandatory)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Attach a plan with measurements and details as described","type":"text","label":"Particulars of premises to be insured: (Attach plan showing measurement and situation and number of entrances and exits, trap-doors, inspection pits or other openings in floor or pavement. Show also situation of any plant, machinery or petrol pumps.)","options":[],"required":null,"pdf_field":""},{"help":"Location of the premises","type":"text","label":"Situation","options":[],"required":null,"pdf_field":""},{"help":"Date when the premises was constructed","type":"date","label":"Date of construction","options":[],"required":null,"pdf_field":""},{"help":"Area in square feet or meters","type":"number","label":"Superficial area of the premises i.e. whole of the land and buildings occupied by the Proposer for the purposes of his Motor trade business.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If premises used for any purpose other than as a showroom, garage or workshop state such other use.","options":[],"required":null,"pdf_field":""},{"help":"Describe adjoining car park area and size","type":"text","label":"Do you wish cover for any adjoining area outside your premises which is used as a car park? If so give brief description and state its superficial area.","options":[],"required":null,"pdf_field":""},{"help":"Total annual employee compensation","type":"amount","label":"State total estimated annual wages, salaries and other earnings paid to employees.","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History and Claims","fields":[{"help":"Name of insurer if applicable","type":"text","label":"Are you or have you ever been insured against Liability to the Public Risks of any kind including Motor vehicle Road Risk? If so state name of the Company or Underwriter.","options":[],"required":null,"pdf_field":""},{"help":"Answer Yes or No for each question","type":"yes-no","label":"Has any Company or Underwriter ever – a) Declined your proposal? b) Required you to carry the first portion of any loss? c) Required an increased premium or imposed special conditions? d) Refused to renew your Policy? e) Cancelled your Policy?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of claims and accidents","type":"text","label":"Has any Company or Underwriter ever – Total cost of settled claims, Outstanding Claims Year, Total No. of Accidents","options":[],"required":null,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Has any Company or Underwriter ever – a) Damage and Liability to Public Risks (i.e. Package policy) or b) Liability only Policy (excluding damage to vehicle)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Select the constitution type and provide DARPAN details if applicable","type":"choice","label":"Constitution Details","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO - Provide DARPAN Portal Registration, if applicable","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":null,"pdf_field":""},{"help":"Provide DARPAN Portal Registration details if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Document Preference","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Do you want a physical copy of this policy document? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Insured","fields":[{"help":"Sign and date the declaration","type":"signature","label":"Declaration by Insured","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":""}],"filled_by":"proposer"},{"title":"Vernacular Declaration","fields":[{"help":"Proposer's signature or thumb impression","type":"signature","label":"Signature/Thumb impression of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Agent or intermediary signs here","type":"signature","label":"Name & Signature of agent/intermediary","options":[],"required":true,"pdf_field":""}],"filled_by":"agent or intermediary"},{"title":"Nomination Details","fields":[{"help":"","type":"text","label":"Name of the Nominee","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Age of the Nominee","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship of the Nominee","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Appointee (If nominee is minor)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Appointee to the Nominee","options":[],"required":null,"pdf_field":""},{"help":"Select one relation","type":"choice","label":"Nominee for Self (Primary Insured) has to be one of the mentioned relations - Father, Mother, Son, Daughter, Spouse, Other","options":["Father","Mother","Son","Daughter","Spouse","Other"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Assignment Details","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Do you want to assign the policy? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide assignee details if applicable","type":"text","label":"Please provide details: Name of the Assignee (Bank / Financier)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account and Bank Details","fields":[{"help":"Provide e-IA number if available","type":"text","label":"Electronic-Insurance Account: Please provide e-IA No. to deposit your insurance policy.","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you want to open e-IA account: Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide mobile number","type":"phone","label":"Bank Details Contact detail *: Mobile No:","options":[],"required":null,"pdf_field":""},{"help":"Provide email address","type":"email","label":"Email Address:","options":[],"required":null,"pdf_field":""},{"help":"Name as registered with bank","type":"text","label":"Name as per Bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name Of Bank","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Type of bank account","type":"text","label":"Account Type","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Existing Customer Details","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Are you an existing customer of BGIL? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide existing policy or PID number","type":"text","label":"If Yes. Please provide PID No:/ Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Confirm no change in KYC details","type":"checkbox","label":"I hereby confirm that, there is no change in my existing KYC details that are available from my previous/existing policy.","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Disability Declaration and Refund Authorization","fields":[{"help":"Consent for refund to bank account","type":"checkbox","label":"I/We hereby authorize Bajaj General Insurance Limited (“the Company”) to refund any amount related to my policy and/or claim directly credited to my aforesaid Bank Account and also agree to inform if there is any change in the above contact or bank details, for ensuring smooth policy servicing","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Certification by Representative and Agent Declaration","fields":[{"help":"Name of person certifying the proposal form","type":"text","label":"Full name of the representative","options":[],"required":true,"pdf_field":""},{"help":"Relationship to proposer","type":"text","label":"Relationship with the Proposer","options":[],"required":true,"pdf_field":""},{"help":"City of residence of representative","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Representative signs here","type":"signature","label":"Signature of the representative","options":[],"required":true,"pdf_field":""},{"help":"Proposer signs here","type":"signature","label":"Signature/Thumb impression of the Proposer/Primary Insured","options":[],"required":true,"pdf_field":""},{"help":"Agent license number","type":"text","label":"License No. (Intermediary/Corporate Agent/Broker/Relationship Officer)","options":[],"required":true,"pdf_field":""},{"help":"Agent code","type":"text","label":"Name of the specified Person and code","options":[],"required":true,"pdf_field":""},{"help":"Agent signs here","type":"signature","label":"Signature of Agent","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":""}],"filled_by":"representative and agent"},{"title":"Politically Exposed Persons (PEP) Declaration and Consent","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Are you or any of the proposal applicants a PEP* or a close relative of PEP*? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if Yes","type":"text","label":"If yes, please share the details","options":[],"required":null,"pdf_field":""},{"help":"Consent for KYC verification","type":"checkbox","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":[],"required":null,"pdf_field":""},{"help":"Declaration of legitimate source of funds","type":"checkbox","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":[],"required":null,"pdf_field":""},{"help":"Consent for sharing personal data","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 (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Motor Trade Internal Risks insurance proposals","attachments":["Plan showing measurement and situation and number of entrances and exits, trap-doors, inspection pits or other openings in floor or pavement","Cancelled cheque leaf of the bank account if premium is paid by cheque"],"declarations":["Statements made in this Proposal Form are true to the best of the proposer's knowledge and belief and form the basis of the contract.","Any additions or alterations after submission must be conveyed to the insurer immediately.","The proposer agrees to receive Certificate of Insurance and Policy Schedule only and access policy terms online.","The insurer may share/verify information with rating agencies, third parties or service providers for underwriting/servicing.","Premiums paid will be from bonafide sources and not from proceeds of crime.","The proposer is not a Politically Exposed Person (PEP) or close relative unless declared.","Consent is given for KYC verification through specified portals.","Consent is given for sharing personal information with group companies for services and products.","Prohibition of rebates as per Insurance Act applies.","Commencement of risk cover is subject to receipt of premium by the insurer."],"dropped_labels":2},"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/2134-motor-trade-internal-risks"}