{"id":2495,"title":"PROPOSAL FORM FOR PRODUCT LIABILITY INSURANCE","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/product-liability-insurance-policy/Product-Liability_PF.pdf","sha256":"9acef6ca8bde3e8fc76ce95f9dd5349ab547f8d8f1df385898b92d7ef2813bde","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (applicant) to apply for product liability insurance coverage with Bajaj General Insurance Limited. The proposer must provide detailed information about their business, products, and insurance history.","notes":["Answer all questions fully and accurately; attach separate sheets if needed.","Liability of the company starts only after proposal acceptance and premium payment.","Use original and accurate information; failure may lead to claim rejection or policy avoidance.","Keep policy contact details and bank account updated for faster service.","PEP declaration is mandatory.","Physical deformity or handicap must be declared with certificate if applicable.","Agent must explain the form contents to the proposer in their vernacular language.","The form includes a prohibition of rebates as per Insurance Act 1938 section 41."],"title":"PROPOSAL FORM FOR PRODUCT LIABILITY INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter your full legal name","type":"text","label":"Name of the Proposer ( in full )","options":[],"required":true,"pdf_field":""},{"help":"Enter your full postal address","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"Enter the state of your address","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter your email address","type":"email","label":"E mail ID","options":[],"required":true,"pdf_field":""},{"help":"Enter your mobile phone number","type":"phone","label":"Mobile Number","options":[],"required":true,"pdf_field":""},{"help":"Provide bank name, account number, IFSC code as per your bank","type":"text","label":"Bank Details","options":[],"required":true,"pdf_field":""},{"help":"Name as per bank records","type":"text","label":"Name as pr Bank","options":[],"required":true,"pdf_field":""},{"help":"Name of your bank","type":"text","label":"Name Of Bank","options":[],"required":true,"pdf_field":""},{"help":"Your bank account number","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"IFSC code of your bank branch","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Tick to confirm acceptance","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":""},{"help":"Provide e-lA number if available","type":"text","label":"Electronic-Insurance Account: 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":""},{"help":"Select Yes or No","type":"choice","label":"Are you an exisiting customer of BGIL ?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide PID or Policy number if existing customer","type":"text","label":"If Yes. Please provide PID No: /Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Tick to confirm","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":""},{"help":"Enter postal pin code","type":"text","label":"Pin Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Business and Constitution Details","fields":[{"help":"Describe your business activity","type":"text","label":"Description of Business Activity","options":[],"required":true,"pdf_field":""},{"help":"List subsidiaries or associated companies","type":"text","label":"Name of any Subsidiary Company & Associated Company (in full)","options":[],"required":false,"pdf_field":""},{"help":"Select your business constitution","type":"choice","label":"Constitution Details","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section B: Product Details","fields":[{"help":"List all products to be insured","type":"text","label":"Name of Products to be insured","options":[],"required":true,"pdf_field":""},{"help":"Describe main components of products","type":"text","label":"Principal Components","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you manufacture the complete product","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"List purchased components if not manufacturing complete product","type":"text","label":"If \"NO\" please specify components/parts that are purchased","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you retain rights of recovery against the manufacturers?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you alter, adapt or change the form of any product which you do not manufacture?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details of alterations if applicable","type":"text","label":"If \"YES\" please furnish details","options":[],"required":false,"pdf_field":""},{"help":"Specify duration products have been marketed","type":"text","label":"How long has the products been in the market","options":[],"required":true,"pdf_field":""},{"help":"Specify expected product life","type":"text","label":"Expected life of product","options":[],"required":true,"pdf_field":""},{"help":"Describe intended customers or end users","type":"text","label":"Intended customer/ultimate end user","options":[],"required":true,"pdf_field":""},{"help":"Select if date of manufacture is identifiable by factory number","type":"yes-no","label":"Date of manufacture of each product identifiable By factory number stamped on it","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide warranty details if any","type":"text","label":"Warranties as to use of product","options":[],"required":false,"pdf_field":""},{"help":"Provide details of any technical collaboration","type":"text","label":"Technical Know-How Collaboration","options":[],"required":false,"pdf_field":""},{"help":"List products planned for marketing next year","type":"text","label":"Please specify particulars of products to be marketed during next 12 months","options":[],"required":true,"pdf_field":""},{"help":"Provide purpose and estimated turnover for offshore or aircraft use","type":"text","label":"If \"YES\" to either (i) or (ii) please state purpose of use and estimated turnover applicable for the next 12 months for each product","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section C: Quality and Precautionary Measures","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Do you have a R&D Department","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"List discontinued, recalled or withdrawn products","type":"text","label":"Please furnish details and lists of products discontinued or recalled or withdrawn during the last 5 years.","options":[],"required":false,"pdf_field":""},{"help":"Provide details of hazardous products and precautions","type":"text","label":"Please specify any products which are inflammable/explosive, dangerous, radioactive, harmful to health, poisonous by themselves or in combination with other products. Please give full details and state what precautions are taken.","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Whether goods are sold or supplied subject to a Disclaimer notice?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide full disclaimer text if applicable","type":"text","label":"If \"YES\", please give full text of such disclaimer notice.","options":[],"required":false,"pdf_field":""},{"help":"Describe your complaints and accident reporting system","type":"text","label":"Please provide details of the Complaints/accident reporting system in your organisation.","options":[],"required":false,"pdf_field":""},{"help":"Describe quality control and testing procedures","type":"text","label":"Please give details of checks or examinations or controls including batch control and testing carried out or effected to discover possible defects or errors in products.","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do your products comply with any recognized standards, such as ISI? Please furnish details","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide failure rate details","type":"text","label":"What is the failure rate of each product after hand over?","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you issue guarantees and/or warrantees to purchaser?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Specify guarantee/warranty period","type":"text","label":"If so, for what period do you guarantee and/or warrant your product?","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Particulars regarding directions for use: a) Is it by printing on the container or the product?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"b) Is it by separate leaflet or brochure?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"c) Is the hazard warning clearly shown?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section D: Turnover details","fields":[{"help":"Provide sales turnover by year and region: India, USA/Canada, OECD, Other countries","type":"table","label":"Actual Turnover: Please furnish actual turnover details for the current financial year previous 3 financial years","options":[],"required":true,"pdf_field":""},{"help":"Provide projected turnover in Rs Crores by region: India, US/Canada, OECD, Non-OECD","type":"table","label":"Estimated (Projected) Turnover: Please furnish estimated turnover details for the proposed period of insurance","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you require coverage for exports?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide duration of export to each region","type":"text","label":"If \"YES\", How long have you been exporting to these countries: USA/Canada, OECD, Non OECD","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you have any assets and/or representation and/or any domiciled operation and/or activities and/or association (Financial, Technical or otherwise) in the USA/Canada or other foreign countries?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details of assets or operations abroad","type":"text","label":"If \"YES\" please furnish details","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you comply with USA/Canadian State/Federal Laws/Standards applicable to each product to be exported to such countries?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide compliance details","type":"text","label":"If \"YES\" please furnish details","options":[],"required":false,"pdf_field":""},{"help":"Provide power of attorney details if any","type":"text","label":"Please give details of any power of attorney on assets in USA/Canada","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section E: Previous Insurance History","fields":[{"help":"Provide previous insurance details for last years","type":"table","label":"Year, Insurer, Limit of Indemnity, Premium, Deductible","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section F: Claims & Known Circumstances","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Have your products ever been the subject of any enquiry or investigation by any Government agency, concerning the efficiency/adequacy or labeling, hazardous contents or safety?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details of enquiry or investigation","type":"text","label":"If \"YES\", please give full details","options":[],"required":false,"pdf_field":""},{"help":"Provide claims history details","type":"table","label":"Please give claims history for the last 3 years in the following format: Year, Nature of claim, Claim amount paid including defense cost, Insurer, Status of the claim","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are you aware of any incidents, Conditions, defects, circumstances or suspected defects which may result in a claim?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details of possible claims","type":"text","label":"If \"YES\", please give particulars","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has your proposal or renewal been declined or premium been increased or special terms been imposed by any insurer?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details of declined or special terms","type":"text","label":"If \"YES\", please give particulars","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section G: Coverage and Extensions Required","fields":[{"help":"Specify indemnity limit per claim in INR","type":"amount","label":"Limit of Indemnity Required Any one claim","options":[],"required":true,"pdf_field":""},{"help":"Specify aggregate indemnity limit in INR","type":"amount","label":"Aggregate during the Period of Insurance","options":[],"required":true,"pdf_field":""},{"help":"Specify voluntary excess amount in INR","type":"amount","label":"Please indicate voluntary excess (This excess will apply to each and every Claim)","options":[],"required":false,"pdf_field":""},{"help":"Select if vendor's extension is required","type":"yes-no","label":"Please indicate extensions required: a) Vendor's Extension","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select if technical collaborator's extension is required","type":"yes-no","label":"b) Technical Collaborator's Extension","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Specify any other extensions required","type":"text","label":"c) Any other (please specify)","options":[],"required":false,"pdf_field":""},{"help":"Select mode of payment","type":"choice","label":"Mode of Payment : Cheque, DD, Cash, Other","options":["Cheque","DD","Cash","Other"],"required":true,"pdf_field":""},{"help":"Select who gave the cheque if applicable","type":"choice","label":"Cheque - Given by : Spouse, Father, Mother, Son/Daughter, Employer / Employee, Financier","options":["Spouse","Father","Mother","Son/Daughter","Employer / Employee","Financier"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Declarations","fields":[{"help":"Politically Exposed Persons declaration","type":"yes-no","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":"Confirm understanding of mandatory updates","type":"yes-no","label":"It is mandatory to keep your policy with updated contact (Mobile No., Email ID and PAN Card) and bank account details","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration: Explanation in Vernacular","fields":[{"help":"Proposer signs to confirm explanation","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Name of witness","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":"agent and proposer"},{"title":"Disability Declaration and Authorised Representative Consent","fields":[{"help":"Declare any disability","type":"yes-no","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","options":[],"required":false,"pdf_field":""},{"help":"If proposer disabled, name authorised representative","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorised representative","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 authorised representative"},{"title":"Agent/Intermediary Declaration","fields":[{"help":"Agent signs to confirm explanation","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"Date of agent signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of agent signature","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Name of sales person or point of sale","type":"text","label":"SP/BQP/DP/PoS Name","options":[],"required":false,"pdf_field":""},{"help":"Code of sales person or point of sale","type":"text","label":"SP/BQP/DP/PoS CoR No.","options":[],"required":false,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Product Liability Insurance under Product Code: 3302","attachments":["Separate sheet if insufficient space to provide information","Copy of contract with vendors for Vendor's Extension","Copy of contract along with contract specific turnover bifurcation for Contract Specific Cover","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability (if applicable)"],"declarations":["The proposer declares all information is true and no material facts are omitted or misstated.","The proposer agrees this declaration forms the basis of the insurance contract.","The proposer consents to sharing information within group entities.","The proposer confirms premium is paid from legally acquired income.","The proposer consents to sharing personal data with group companies for services.","The proposer must keep policy contact and bank details updated for service requests.","The proposer confirms understanding of the form content explained in vernacular.","Agent declares having explained the form contents to the proposer in vernacular.","Non-disclosure or misstatement may lead to policy being void and forfeiture of premiums."],"dropped_labels":10},"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/2495-proposal-form-for-product-liability-insurance"}