{"id":2182,"title":"PROPOSAL FORM PREMIUM PERSONAL GUARD POLICY","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/digital-pf/Premium-Personal-Guard-Proposal-Form-Final.pdf","sha256":"df2a0e9f2b156344f59e8179e4aced8ba07a4ef076995bdc1ad28c7f03af3a4c","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for the Premium Personal Guard insurance policy to be filled by the proposer seeking insurance coverage.","notes":["Answer all questions in BLOCK letters.","The liability of the company starts only after acceptance of the proposal and payment of premium.","Nominee for self must be one of the specified relations; if 'Others', specify relationship and reason.","For family members other than self, 100% nomination must be to the proposer.","Use original and accurate documents for KYC and identity proof.","If the proposer or insured has disability, attach the government-issued disability certificate.","If the proposal form is filled in vernacular language, intermediary must sign confirming explanation.","Policy copy will be sent digitally by default; tick box if physical copy is desired.","Keep policy contact and bank details updated for faster service.","Submission of proposal or payment does not oblige the company to issue a policy."],"title":"PROPOSAL FORM PREMIUM PERSONAL GUARD POLICY","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter your full name in block letters","type":"text","label":"Full Name: Title; First Name; Middle Name; Surname","options":[],"required":true,"pdf_field":"Full Name Title, First Name, Middle Name, Surname"},{"help":"","type":"choice","label":"Are you an existing Bajaj General Customer","options":["Yes","No"],"required":true,"pdf_field":"G1"},{"help":"If existing customer, provide policy number","type":"text","label":"The Policy No.","options":[],"required":false,"pdf_field":"The Policy No OG"},{"help":"If existing customer, provide PID number","type":"text","label":"Existing Customer (PID) No.","options":[],"required":false,"pdf_field":"Existing Customer PID No"},{"help":"","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":false,"pdf_field":"G2"},{"help":"Provide employee code if applicable","type":"text","label":"Bajaj Employee Code, if Proposer is Bajaj General/Bajaj Life Employee","options":[],"required":false,"pdf_field":"3 Bajaj Employee Code if Proposer is Bajaj GeneralBajaj Life Employee"},{"help":"","type":"choice","label":"Gender","options":["Male","Female","Other"],"required":true,"pdf_field":"G3"},{"help":"Enter in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":"5 Date of Birth"},{"help":"Enter your PAN number","type":"text","label":"Pan No.","options":[],"required":true,"pdf_field":"6 Pan No"},{"help":"Enter your Aadhaar number","type":"text","label":"Aadhar ID","options":[],"required":true,"pdf_field":"7 Aadhar ID"},{"help":"","type":"choice","label":"Marital Status","options":["Married","Single","Divorced","Widowed"],"required":true,"pdf_field":"G4"},{"help":"Enter number of sons","type":"number","label":"No. of Children’s: Sons","options":[],"required":false,"pdf_field":"fill_15"},{"help":"","type":"choice","label":"Occupation","options":["Business","Salaried","Professional","Student","Housewife","Retired","Others"],"required":true,"pdf_field":"G5"},{"help":"","type":"choice","label":"Are you or any of your family members registered under the Ayushmaan Bharat Yojana","options":["Yes","No"],"required":true,"pdf_field":"G6"},{"help":"Enter your permanent house number","type":"text","label":"Permanent /Residential Address: House 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