{"id":2435,"title":"HOUSEHOLDERS INSURANCE POLICY PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/home-insurance/house-holders-package-policy/householders_pf.pdf","sha256":"dd86ed5f805779bd59253a9bb3ba64b90c256bde5a55746a5045948cb2d52aed","pages":12,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) to apply for householders insurance coverage for their home and contents. The proposer fills it to provide personal, property, and coverage details to the insurer.","notes":["Answer all questions fully and accurately to avoid claim rejection or policy avoidance.","Attach separate sheets if space is insufficient for any answer.","Use block letters where applicable.","Original bills and valuation certificates may be required for claims.","Policy does not commence until proposal acceptance and premium payment.","Keep policy contact and bank details updated for faster service.","Electronic equipment older than 10 years are not covered.","Sum insured for personal accident cover should be restricted as per instructions.","For long term policies, period shall not exceed 10 years."],"title":"HOUSEHOLDERS INSURANCE POLICY PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter your full name as proposer","type":"text","label":"Name of the Proposer ( in full)","options":[],"required":true,"pdf_field":""},{"help":"Enter your full postal address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Provide your contact details including phone and email","type":"text","label":"Communication Details","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Enter nominee's full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's date of birth in dd/mm/yyyy format","type":"date","label":"DOB (dd/mm/yyyy)","options":[],"required":true,"pdf_field":""},{"help":"Select nominee relation; for 'Others' specify relation and reason","type":"choice","label":"Nominee*","options":["Father","Mother","Son","Daughter","Spouse","Others"],"required":true,"pdf_field":""},{"help":"Provide appointee details if nominee is a minor","type":"text","label":"Appointee (If nominee is minor)","options":[],"required":false,"pdf_field":""},{"help":"Explain relation and reason if nominee is 'Others'","type":"text","label":"If Nominee is \"Others\" please specify the relation and reason for such nomination","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details","fields":[{"help":"Enter name as per bank records","type":"text","label":"Name as pr Bank","options":[],"required":true,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name Of Bank","options":[],"required":true,"pdf_field":""},{"help":"Enter your bank account number","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"Enter bank IFSC code","type":"text","label":"IFSCCode","options":[],"required":true,"pdf_field":""},{"help":"Tick to accept payment through this bank account","type":"checkbox","label":"* I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["accept"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic-Insurance Account","fields":[{"help":"Select applicable family member for e-Insurance Account","type":"choice","label":"Electronic-Insurance Account: Father Mother Son Daughter Spouse","options":["Father","Mother","Son","Daughter","Spouse"],"required":false,"pdf_field":""},{"help":"Enter IFSC code for e-Insurance Account","type":"text","label":"IFSCCode","options":[],"required":false,"pdf_field":""},{"help":"Provide e-Insurance Account number if available","type":"text","label":"Please provide e-lA No. to deposite your insurance policy.","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you want to open e-lA account:","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Existing Customer Details","fields":[{"help":"Select Yes or No","type":"choice","label":"Are you an exisiting customer of BGI L?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide your existing customer PID number","type":"text","label":"If Yes. Please provide PID No:","options":[],"required":false,"pdf_field":""},{"help":"Provide your existing policy number","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Tick to 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":["confirm"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Occupation","fields":[{"help":"Enter your occupation","type":"text","label":"Occupation","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Proposed","fields":[{"help":"Specify the coverage details you want","type":"text","label":"Coverage Proposed","options":[],"required":true,"pdf_field":""},{"help":"Enter your age","type":"number","label":"Age","options":[],"required":true,"pdf_field":""},{"help":"Specify relation if applicable","type":"text","label":"Relation","options":[],"required":false,"pdf_field":""},{"help":"Specify other details if applicable","type":"text","label":"Others","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Partnership Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Limited Liability/Partnership Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"NGO/NPO","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide DARPAN registration details if applicable","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Company","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Trust","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Society","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Section 8 Company","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Proprietorship Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify other constitution if applicable","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Period of Insurance","fields":[{"help":"Enter policy start date","type":"date","label":"From","options":[],"required":true,"pdf_field":""},{"help":"Enter policy end date","type":"date","label":"To","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"PAN No","fields":[{"help":"Provide PAN number if premium is Rs.1,00,000 or more","type":"text","label":"PAN No","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Fire & Allied Perils Cover Details","fields":[{"help":"Describe valuables insured under fire section; attach separate sheet if needed","type":"text","label":"Description of all valuables in the insured premises excluding jewellery and electronic equipment","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Would you wish to avail cover on first loss basis? (Cover is for 40% of the total value at risk)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Jewellery and/or Precious Stones All Risks Cover","fields":[{"help":"List jewellery items with description and value; valuation certificate required for items over Rs.5000","type":"table","label":"Description of all Jewellery and/or Precious Stones to insure along with their value","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Would you wish to avail cover on first loss basis? (Cover is for 40% of the total value at risk)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Breakdown of Domestic Appliances","fields":[{"help":"List domestic appliances with details; attach separate sheet if needed","type":"table","label":"Description with Sr No, Year of manufacture, Reinstatement value","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Equipment","fields":[{"help":"List electronic equipment including TV, VCR etc.; equipment older than 10 years not covered","type":"table","label":"Description with Sr No., Year of manufacture, Reinstatement value","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Pedal Cycles","fields":[{"help":"Provide details of pedal cycles to insure","type":"table","label":"Name of the manufacturer, Year of production, Frame No., Value including accessories (Rs)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Personal Accident Cover","fields":[{"help":"Provide details for each family member opting for personal accident cover","type":"table","label":"Name of the Person, Date of birth, Occupation, Relationship with proposer, Details of existing infirmity or disability","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No for additional covers","type":"choice","label":"Do you wish to opt for the following additional covers: Hospital Confinement Allowance, Public Liability/Workmen's Compensation","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify limit of indemnity for public liability","type":"amount","label":"Limit of indemnity required for public liability (max Rs.5,00,000)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration of Assignment","fields":[{"help":"Provide details of assignee for claim amount","type":"text","label":"In case of death of the Insured person, the payable amount shall be assigned to Name, Date of Birth, Relation to the Proposer","options":[],"required":false,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Proposers Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Warranty","fields":[{"help":"Agree to the declaration and warranty","type":"checkbox","label":"I/We hereby declare and warrant that the above statements are true and complete in all respects...","options":["agree"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Annexure - Standard Fire and Special Perils Cover","fields":[{"help":"Enter proposer name","type":"text","label":"Name of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter proposer address","type":"text","label":"Address of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Provide email address","type":"email","label":"Email","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Covers Opted","fields":[{"help":"Select Yes or No","type":"choice","label":"Is there any policy in place for the same property?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide existing policy details if any","type":"text","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Select the cover type required","type":"choice","label":"Cover/s required","options":["Home Building & Home Contents","Home Building Only","Home Contents Only"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Location of Home Building","fields":[{"help":"Provide full address including pin code","type":"text","label":"Location of Home Building - full postal address with Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter pin code","type":"text","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Select building type","type":"choice","label":"Is it in a multi-storey building or is it a standalone house?","options":["Multi-storey","Standalone"],"required":true,"pdf_field":""},{"help":"Provide floor number if applicable","type":"number","label":"In case of multi-storey building, please provide the floor number of Your house","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is there a basement to Your house?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Home Building","fields":[{"help":"Enter carpet area in square meters","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":true,"pdf_field":""},{"help":"Enter prevailing construction cost rate","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date","options":[],"required":true,"pdf_field":""},{"help":"Select age category","type":"choice","label":"Age of Home Building","options":["Less than 5 years","5-10 years","10-20 years","Above 20 years"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Home Contents","fields":[{"help":"Provide sum insured for basement contents","type":"amount","label":"In case of Basement, If there are contents in it, please provide the sum insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"In-Built Cover (Loss of Rent & Rent for Alternative Accommodation)","fields":[{"help":"Tick if you want Loss of Rent cover","type":"checkbox","label":"Cover for (Please Tick) Loss of Rent","options":["Loss of Rent"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Covers","fields":[{"help":"Select Yes or No","type":"choice","label":"Do You require 'Personal Accident Cover' for Yourself and Your spouse?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide spouse name and age if opting for cover","type":"text","label":"If Yes, Name & age of Your spouse","options":[],"required":false,"pdf_field":""},{"help":"Provide your age","type":"number","label":"Your age","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do You require 'Cover for Valuable Contents on Agreed Value Basis (under Home Contents cover)'?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach list of valuable items and sum insured","type":"attachment","label":"If Yes, please attach list of items and Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Indicate if valuation certificate is attached","type":"choice","label":"Valuation certificate attached? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Claims Details","fields":[{"help":"Provide date of any loss in last 3 years","type":"date","label":"Date of Loss","options":[],"required":false,"pdf_field":""},{"help":"Describe cause of loss","type":"text","label":"Cause of Loss","options":[],"required":false,"pdf_field":""},{"help":"Enter claimed amount","type":"amount","label":"Claimed Amount","options":[],"required":false,"pdf_field":""},{"help":"Enter settled amount or note if claim is outstanding","type":"amount","label":"Settled Amount/please specify if claim is outstanding","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Insured","fields":[{"help":"Agree to the declaration that statements are true and complete","type":"checkbox","label":"Declaration by Insured","options":["agree"],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration - Physical Proposal Form","fields":[{"help":"Select Yes or No","type":"choice","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter witness name","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"Date of witness signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of witness signature","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Disability Declaration","fields":[{"help":"Select Yes or No","type":"choice","label":"Any Physical deformity or handicap","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide disability details and certificate","type":"text","label":"If Yes, Please provide details (Disability Certificate issued by Medical Board)","options":[],"required":false,"pdf_field":""},{"help":"If signed by authorized representative, provide name","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Authorized representative signature","type":"signature","label":"Signature of Authorised representative","options":[],"required":false,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Place of signature","type":"text","label":"Place","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer or authorized representative"},{"title":"Claim Documents Confirmation","fields":[{"help":"Confirm submission of required documents","type":"checkbox","label":"I/we hereby confirm that I/we have provided all relevant and supporting documents sought by the company","options":["confirm"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Agent/Intermediary Declaration","fields":[{"help":"Provide agent license number","type":"text","label":"IRDAI COR No./ License No.","options":[],"required":true,"pdf_field":""},{"help":"Agent signature","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":"agent"},{"title":"Agent / IMD Details","fields":[{"help":"Enter SP/BQP/DP/PoS name if applicable","type":"text","label":"SP/BQP/DP/PoS Name","options":[],"required":false,"pdf_field":""},{"help":"Enter SP/BQP/DP/PoS code of registration number","type":"text","label":"SP/BQP/DP/PoS CoR No.","options":[],"required":false,"pdf_field":""},{"help":"Signature of SP/BQP/DP/PoS","type":"signature","label":"SP/BQP/DP/PoS Signature","options":[],"required":false,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Householders insurance policies covering home building, home contents, valuables, personal accident, and related covers","attachments":["Separate sheet for additional information if insufficient space","Valuation certificate for jewellery items valued over Rs.5000","List of items and sum insured for Valuable Contents on Agreed Value Basis","Disability Certificate issued by Medical Board if applicable"],"declarations":["The statements made in this proposal form are true and complete to the best of the proposer's knowledge.","The proposal and declarations form the basis of the insurance contract.","The proposer agrees to pay the premium as estimated at the end of each policy period.","The proposer undertakes to exercise all reasonable precautions for safety of the property.","The company may share the proposer's information within group entities.","The liability of the company commences only after acceptance of the proposal and payment of full premium.","Premiums have been paid from legally acquired sources.","Consent is given for KYC verification through authorized portals.","Consent is given for sharing personal information with group companies.","The agent declares that the proposal form contents have been explained to the proposer in vernacular.","Non-disclosure or untrue statements may lead to policy being void and premiums forfeited."],"dropped_labels":27},"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/2435-householders-insurance-policy-proposal-form"}