{"id":2440,"title":"FLEXI HOME SHIELD PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/flexi-home-shield/FLEXI-HOME-SHIELD-Proposal-Form.pdf","sha256":"8292025b77e2b4dd4106aa34bf46611f61a400ad0f79fa12b866892750151c14","pages":20,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or groups proposing to insure their home building and/or home contents against specified perils under the Flexi Home Shield policy by Bajaj General Insurance Ltd. The proposer fills this form to provide details about the property, coverage options, and sum insured.","notes":["Read the Prospectus/Key Features Document/Policy Wordings before filling the form.","Attach separate sheets if space is insufficient to provide information.","Policy period for long term policies shall not exceed 30 years.","General Contents cover is automatically provided at 20% of Home Building sum insured subject to maximum ₹ 10 Lakh when both covers are opted.","Common Contents cover can only be opted along with Home Building cover for Co-Operative Housing Society (CHSL).","Construction type must be specified as Kutcha or Pucca by striking out the non-applicable option.","Use block letters and provide original documents where required."],"title":"FLEXI HOME SHIELD PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details and Policy Period (Individual Basis)","fields":[{"help":"Full name of the insured person","type":"text","label":"Name of Insured","options":[],"required":true,"pdf_field":""},{"help":"Full postal address of the proposer","type":"text","label":"Address of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":true,"pdf_field":""},{"help":"Email address","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"Provide any one of these identification numbers","type":"text","label":"PAN / TAN / GST / AADHAR Number","options":[],"required":false,"pdf_field":""},{"help":"Name of contact person if proposer is not an individual","type":"text","label":"Contact person details, if not an individual - a. Name","options":[],"required":false,"pdf_field":""},{"help":"List all parties with insurable interest","type":"text","label":"Policy to be issued in favour of (list out all the parties who have insurable interest) including the financial institutions","options":[],"required":true,"pdf_field":""},{"help":"Start date of policy","type":"date","label":"Policy Period From","options":[],"required":true,"pdf_field":""},{"help":"End date of policy","type":"date","label":"Policy Period To","options":[],"required":true,"pdf_field":""},{"help":"Enter number of years if long term policy (max 30 years)","type":"number","label":"No of Years in case of long term policy","options":[],"required":false,"pdf_field":""},{"help":"Name of nominee","type":"text","label":"Nomination: Nominee Name","options":[],"required":false,"pdf_field":""},{"help":"Provide details of other active policies","type":"text","label":"Details of other active Policies of Bajaj General Insurance (if any)","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are You Co-Operative Housing Society (CHSL)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No and provide details if Yes","type":"yes-no","label":"Is there any Commercial Space such as Shop, Club House, Restaurant, Café, Food Joints, Clinic, Hospital, School, Mall, Gymnasium, Common Spaces and Offices in Co-Operative Housing Society (CHSL), If Yes please provide details","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Describe commercial spaces if applicable","type":"text","label":"Details of Commercial Space","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Covers and Insured Events Opted","fields":[{"help":"Select the cover option required","type":"choice","label":"Cover Option - Cover Opted","options":["Home Building & General Contents (Flat/Apartment/Individual House)","Home Building Only","General Contents Only","Home Building Only (Co-Operative Housing Society - CHSL)","Common Contents"],"required":true,"pdf_field":""},{"help":"Select Yes or No for Group 1","type":"yes-no","label":"Choose from the listed Group of Insured Events - Group 1","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No for Group 2","type":"yes-no","label":"Choose from the listed Group of Insured Events - Group 2","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No for Group 3","type":"yes-no","label":"Choose from the listed Group of Insured Events - Group 3","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No for Group 4","type":"yes-no","label":"Choose from the listed Group of Insured Events - Group 4","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No for Group 5","type":"yes-no","label":"Choose from the listed Group of Insured Events - Group 5","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter percentage of waiver for underinsurance","type":"number","label":"Please mention % of waiver for Underinsurance to be opted","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No and specify percentage if Yes","type":"yes-no","label":"Do you want to opt for Franchise? If yes, Please mention % of Sum Insured to be opted as Franchise limit","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify franchise limit percentage if opted","type":"number","label":"Franchise limit (%)","options":[],"required":false,"pdf_field":""},{"help":"Specify any other cover details","type":"text","label":"Others (please specify)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Property and Building Details","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Is there any policy in place for the same property?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of existing policy if any","type":"text","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Full address including pin code","type":"text","label":"Location of Home Building - full postal address with Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Postal pin code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Specify 'multi-storey' or 'standalone'","type":"text","label":"Is it in a multi-storey building or is it a standalone house?","options":[],"required":true,"pdf_field":""},{"help":"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":""},{"help":"Select the age category of the building","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":""},{"help":"Select Yes or No","type":"yes-no","label":"Indicate whether AMC (Annual Maintenance Contract) is in force","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify details of AMC for fire safety equipment","type":"text","label":"If Yes please specify for below: Fire Safety Equipment","options":[],"required":false,"pdf_field":""},{"help":"Specify distance in km or meters","type":"text","label":"Distance between the risk to be covered and nearest Fire Brigade","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured Details","fields":[{"help":"Enter sum insured amount in ₹","type":"amount","label":"Sum Insured Details – Co-Operative Housing Society Limited (CHSL) - Building - Residential Structure","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in ₹","type":"amount","label":"Sum Insured Details – Co-Operative Housing Society Limited (CHSL) - Building - Additional Structure","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in ₹","type":"amount","label":"Sum Insured Details – Co-Operative Housing Society Limited (CHSL) - General Contents - Furniture, Fixtures and Fittings (Home Furnishings)","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in ₹","type":"amount","label":"Sum Insured Details – Co-Operative Housing Society Limited (CHSL) - General Contents - Electrical / Electronic","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in ₹","type":"amount","label":"Sum Insured Details – Co-Operative Housing Society Limited (CHSL) - General Contents - Other Items","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in ₹","type":"amount","label":"Sum Insured Details – Co-Operative Housing Society Limited (CHSL) - General Contents - Contents kept in Basement","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in ₹","type":"amount","label":"Sum Insured Details – Co-Operative Housing Society Limited (CHSL) - Common Contents - Furniture, Fixtures and Fittings (Home Furnishings)","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in ₹","type":"amount","label":"Sum Insured Details – Co-Operative Housing Society Limited (CHSL) - Common Contents - Electrical / Electronic","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in ₹","type":"amount","label":"Sum Insured Details – Co-Operative Housing Society Limited (CHSL) - Common Contents - Other Items","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in ₹","type":"amount","label":"Sum Insured Details – Co-Operative Housing Society Limited (CHSL) - Common Contents - Contents kept in Basement","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Covers","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Cover for Valuable Contents on Agreed Value Basis - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach valuation certificate if applicable","type":"yes-no","label":"Valuation Certificate attached – Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Personal Accident Cover - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide spouse's name and age","type":"text","label":"Name and age of your Spouse","options":[],"required":false,"pdf_field":""},{"help":"Your age in years","type":"number","label":"Your Age","options":[],"required":false,"pdf_field":""},{"help":"Nominee name and relationship","type":"text","label":"Nominee Name and Relation","options":[],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Usually is there movement of Contents within the premises on regular basis – Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Electrical/ Electronic Appliances Clause (Applicable only for Group 1) - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is there a valid Annual Maintenance Contract (AMC) in place for items proposed to be covered under this Add-On – Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"EMI Protection Cover - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select roof type","type":"choice","label":"Roof Type - Slanting / Non Slanting","options":["Slanting","Non Slanting"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Drainage system of Roof - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Waiver of Improvement/ Involuntary Betterment - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Deliberate Damage Cover - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Incidental Costs - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Immediate Repairs - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Growing Plants, Crops and Trees, Landscaping - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Escalation Clause - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Impact Damage due to Vehicle, Animal or Aircraft Belonging to or Owned by Insured or their Employee while acting in Course Of Employment (Can be opted only where Group 1 is opted) - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Protection and Preservation of Property - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Dewatering Expenses - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of each and every loss not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Adequacy of Sum Insured - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify amount","type":"amount","label":"Amount (₹)","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Additions, Alterations Or Extensions - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Specify amount for money cover","type":"amount","label":"Cover For Specific Contents - Money Amount (₹)","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Costs For Removal Of Debris (Excluding External Debris) - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of loss and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Costs For Removal Of Foreign/External Debris - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of loss and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Costs Compelled By Municipal Regulations / Local Authority Clause - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of loss and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Expediting Costs And Expenses For Loss Minimization - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of loss and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Pair And Set/Consequential Reduction In Value - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Fire Extinguishing / Fighting Expenses - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of loss and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Waiver of Subrogation - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Seventy-Two Hours Clause (Only applicable for Group 2 and/or Group 3 of Clause B Optional Insured Events is Opted) - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Broad Water Damage Clause - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Damage to Building (Occasioned by Theft) - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify amount","type":"amount","label":"Amount (₹) in the aggregate of Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Mould & Fungi Endorsement - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Specify deductible percentage","type":"number","label":"Deductibles (%)","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Sprinkler Up-Gradation Cost - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Undamaged Foundations - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Destruction of Sound Property - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Leakage of Firefighting Equipment - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of loss and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Professional Fees - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of loss and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Property under Care Custody and Control - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Voluntary Deductible Clause - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Tenants Liability - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Pet Insurance - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify breed","type":"text","label":"Breed","options":[],"required":false,"pdf_field":""},{"help":"Provide unique ID mark if any","type":"text","label":"Unique Identification mark","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Accidental Hospitalisation Cover - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Number of persons covered","type":"number","label":"Persons to be covered","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Keys & Locks Replacement Cover - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify percentage and amount limit","type":"number","label":"If yes, % of Sum insured and not exceeding Amount (₹) in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Emergency Assistance Services (Cannot be opted by CHSL) - Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select plan if Emergency Assistance Services opted","type":"choice","label":"Plan 1 / Plan 2","options":["Plan 1","Plan 2"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Claims and Premium Details","fields":[{"help":"Provide details if insurance was declined","type":"text","label":"Whether Insurance was declined by any other Company (Give details)","options":[],"required":false,"pdf_field":""},{"help":"Provide year-wise premium and claim amounts for past 36 months","type":"table","label":"Premium / Claim details for the past 36 months excluding the expiring policy period - Year","options":[],"required":false,"pdf_field":""},{"help":"Specify mode of payment","type":"text","label":"Mode of Payment","options":[],"required":false,"pdf_field":""},{"help":"Provide payment details","type":"text","label":"Payment Details","options":[],"required":false,"pdf_field":""},{"help":"Specify amount paid","type":"amount","label":"Amount (in ₹)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Group Policy Proposer Details (if cover opted on group basis)","fields":[{"help":"Name of group manager","type":"text","label":"Name of Group Manager","options":[],"required":true,"pdf_field":""},{"help":"Address of group proposer","type":"text","label":"Address of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Mobile number","type":"phone","label":"Mobile No.","options":[],"required":true,"pdf_field":""},{"help":"Email address","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"Provide identification number","type":"text","label":"PAN / TAN / GST / AADHAR Number","options":[],"required":false,"pdf_field":""},{"help":"Contact person name","type":"text","label":"Contact person details, if not an individual - a. Name","options":[],"required":false,"pdf_field":""},{"help":"List all parties with insurable interest","type":"text","label":"Policy to be issued in favour of (list out all the parties who have insurable interest) including the financial institutions","options":[],"required":true,"pdf_field":""},{"help":"Policy start date","type":"date","label":"Policy Period From","options":[],"required":true,"pdf_field":""},{"help":"Policy end date","type":"date","label":"Policy Period To","options":[],"required":true,"pdf_field":""},{"help":"Number of years (max 30)","type":"number","label":"No of Years in case of long term policy","options":[],"required":false,"pdf_field":""},{"help":"Nominee name","type":"text","label":"Nomination: Nominee Name","options":[],"required":false,"pdf_field":""},{"help":"Details of group or association","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":"Select Yes or No","type":"yes-no","label":"Please state whether all members of the Group/ Association/ Institution/ Corporate Body are proposed for Insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Number of persons initially covered","type":"number","label":"Please mention the total number of persons to be covered initially","options":[],"required":true,"pdf_field":""},{"help":"Expected number of persons during policy period","type":"number","label":"Please mention the expected no of persons to be covered during the policy period","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are You Co-Operative Housing Society (CHSL)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No and provide details if Yes","type":"yes-no","label":"Is there any Commercial Space such as Shop, Club House, Restaurant, Café, Food Joints, Clinic, Hospital, School, Mall, Gymnasium, Common Spaces and Offices in Co-Operative Housing Society (CHSL), If Yes please provide details","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Describe commercial spaces if applicable","type":"text","label":"Details of Commercial Space","options":[],"required":false,"pdf_field":""}],"filled_by":"group proposer"}],"deadlines":[],"applies_to":"Home Building and/or Home Contents insurance proposals for individual or group policies under Flexi Home Shield","attachments":["Valuation Certificate (if opting for Valuable Contents cover above ₹ 5 Lakh or individual item value exceeds ₹ 1 Lakh)"],"declarations":["The proposer must answer all questions fully and accurately and disclose all relevant information.","The insurance cover commences only after acceptance of the proposal and payment of premium.","Failure to disclose relevant information may lead to claim rejection or policy avoidance."],"dropped_labels":38},"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/2440-flexi-home-shield-proposal-form"}