{"id":2447,"title":"Health Guard Proposal Form","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/digital-pf/Health-Guard-pf-digital.pdf","sha256":"f63f99e1f3f40ffaf9cdb5c24d9ece9dcf11c5015e101beadc794e9237887f9a","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals proposing to purchase the Health Guard insurance policy from Bajaj General Insurance. The proposer fills it to provide personal, health, and policy details for underwriting.","notes":["Please answer all questions in BLOCK letters.","The liability of the company does not commence until the proposal is accepted and premium paid.","Use original documents for attachments.","Nominee for primary insured must be one of the specified relations.","Policyholder must keep contact and bank details updated for faster service.","If the proposal form is not filled by the proposer or proposer does not know English, the form must be explained in vernacular language and signed by witness.","No person shall offer or accept any rebate other than as allowed by the insurer's published prospectus.","Submission of proposal or payment does not oblige the company to issue a policy.","Provide last 4 digits of Aadhaar only.","Attach photocopy of existing policy documents for portability.","Fill all dates in DD/MM/YYYY format."],"title":"Health Guard Proposal Form","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":"fill_1"},{"help":"Select Yes or No; if Yes, provide policy number","type":"choice","label":"Are you an existing Bajaj General Customer: Yes No, if Yes please share below details a. the Policy No.","options":["Yes","No"],"required":null,"pdf_field":"Policy NoRow1"},{"help":"Provide your existing customer PID number if applicable","type":"text","label":"Existing Customer (PID) No.","options":[],"required":false,"pdf_field":"Loan Account NumberRow1"},{"help":"Check if 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":false,"pdf_field":"EmpLG CodeRow1"},{"help":"Select your gender","type":"choice","label":"Gender: Male Female Other","options":["Male","Female","Other"],"required":true,"pdf_field":"G1"},{"help":"Enter date of birth in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":"DOB"},{"help":"Enter your PAN number","type":"text","label":"Pan No.","options":[],"required":false,"pdf_field":"pan no"},{"help":"Enter last 4 digits of Aadhaar number","type":"text","label":"Aadhaar No. Enter last 4 digits only","options":[],"required":false,"pdf_field":"Enter last 4 digits only"},{"help":"Provide employee code if applicable","type":"text","label":"Bajaj Employee Code, if Proposer is General/Life Employee","options":[],"required":false,"pdf_field":"IMD Code"},{"help":"Select your marital status","type":"choice","label":"Marital Status: Married Single Divorced Widowed","options":["Married","Single","Divorced","Widowed"],"required":false,"pdf_field":"G4"},{"help":"Enter number of sons and daughters","type":"number","label":"No. of children: ___Sons/ ___ Daughters","options":[],"required":false,"pdf_field":"G5"},{"help":"Select your occupation","type":"choice","label":"Occupation Business Salaried Professional Student House wife Retired Other","options":["Business","Salaried","Professional","Student","House wife","Retired","Other"],"required":false,"pdf_field":"G6"},{"help":"Select Yes or No; if Yes, provide ABHA number below","type":"choice","label":"Are you or any of your family members registered under the Ayushmaan Bharat Yojana? 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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. 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