{"id":2498,"title":"PROPOSAL FORM FOR PUBLIC LIABILITY INSURANCE","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/public-liability-insurance-policy/Public-Liability-pf.pdf","sha256":"d6f2de835a98f5d9995e5134e8247e5fb92f19dfd18dc63bbc8123b5391700ee","pages":12,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (individual or company) to apply for Public Liability Insurance for industrial and storage risks with Bajaj General Insurance Limited.","notes":["Answer all questions fully and accurately to avoid claim rejection or policy avoidance.","Attach separate sheets if space is insufficient for answers.","The liability of the company starts only after proposal acceptance and premium payment.","Territorial limit of the policy is anywhere in India.","Use block letters where applicable.","Attach copy of consent letter from PCD if pollution control consent is claimed.","This form is for industrial and storage risks only."],"title":"PROPOSAL FORM FOR PUBLIC LIABILITY INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Section A: Proposer Information","fields":[{"help":"","type":"text","label":"1) Name of Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"Provide full registered address","type":"text","label":"2) Registered Address","options":[],"required":true,"pdf_field":""},{"help":"Provide website URL if available","type":"text","label":"Company website:","options":[],"required":false,"pdf_field":""},{"help":"Describe the nature of your business","type":"text","label":"3) Description of Business Activity","options":[],"required":true,"pdf_field":""},{"help":"Year when the company was incorporated","type":"number","label":"4) Year of Incorporation","options":[],"required":true,"pdf_field":""},{"help":"Paid up capital amount","type":"amount","label":"5) Paid up Capital","options":[],"required":true,"pdf_field":""},{"help":"Estimated turnover in INR","type":"amount","label":"6) Estimated Annual Turnover for the Proposed period of insurance","options":[],"required":true,"pdf_field":""},{"help":"Actual turnover in INR","type":"amount","label":"7) Actual Annual Turnover for the Proposed period of insurance","options":[],"required":true,"pdf_field":""},{"help":"Select the constitution type of your business","type":"choice","label":"Constitution Details","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO","Company","Trust","Society","Proprietorship Firm","Others (Please specify)"],"required":true,"pdf_field":""},{"help":"Provide DARPAN registration details if NGO/NPO","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section B: Premises Details","fields":[{"help":"Provide address and details of premises","type":"text","label":"8) Premises to be Insured","options":[],"required":true,"pdf_field":""},{"help":"Indicate if go downs are dedicated","type":"yes-no","label":"9) Go downs are dedicated","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details if go downs are not dedicated","type":"text","label":"If “NO”, Please provide details of the same","options":[],"required":false,"pdf_field":""},{"help":"Tick applicable surrounding area types","type":"checkbox","label":"10) a) Description of Surrounding Areas and Third Party Property","options":["Industrial Area within a Radius on 2 km","Agricultural Area within a Radius of 2 km","Residential Area within a Radius of 2 km","Any others (please specify)"],"required":true,"pdf_field":""},{"help":"Provide details of each premises in the table","type":"table","label":"S.No, Address, Occupancy (e.g. factory/warehouse/go down), Description of activities undertaken at Premise, Revenue for proposed period of insurance (in INR Crores)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section C: Safety and Security Precautions","fields":[{"help":"Indicate if such substances are handled or used","type":"yes-no","label":"11) (a) Do you handle or use gases, pressure-storage, explosive, hazardous substances, asbestos, toxic, radioactive materials and hydrocarbons?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details of hazardous substances handled","type":"text","label":"If yes, please provide details as per below: Hazardous Substance, Quantity, Storage Facilities, Precautionary Measures","options":[],"required":false,"pdf_field":""},{"help":"Describe precautions taken to prevent leakage","type":"text","label":"If “YES”, what are the precautions taken?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"12) (a) Are the premises fenced and /or locked?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section C continued: Fire and Safety Measures","fields":[{"help":"","type":"yes-no","label":"13) (a) Is there a programme for the prevention of Fire, explosion incidents?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Describe fire and explosion prevention programme","type":"text","label":"If “YES” please provide details of the same:","options":[],"required":false,"pdf_field":""},{"help":"Describe precautions for welding, gas cutting or hot work","type":"text","label":"If “YES”, what are the precautions taken?","options":[],"required":false,"pdf_field":""},{"help":"Describe precautions for vibrations","type":"text","label":"If “YES”, what are the precautions taken?","options":[],"required":false,"pdf_field":""},{"help":"Describe sub-contracted work","type":"text","label":"14) (a) Please provide details of sub-contracted work within your premises","options":[],"required":false,"pdf_field":""},{"help":"Provide details of sub-contractors' insurance","type":"text","label":"If “YES”, give full details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section D: Previous Insurance History","fields":[{"help":"Provide previous insurance details for each year","type":"table","label":"Year, Insurer, Limit of Indemnity, Premium, Deductible","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section E: Claims & Known Circumstances","fields":[{"help":"Provide claims history details","type":"table","label":"16) (a) 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":"Provide details of known circumstances","type":"text","label":"If “YES”, please give particulars","options":[],"required":false,"pdf_field":""},{"help":"Provide details of insurer's decision","type":"text","label":"If “YES”, please give particulars","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section F: Coverage and Extensions Required","fields":[{"help":"Specify start and end date/time of insurance period","type":"date","label":"17) Period of Insurance required: From (time) of ---------- (date) To 12.00 midnight of --------- (date)","options":[],"required":true,"pdf_field":""},{"help":"Specify limit for any one claim in INR","type":"amount","label":"18) Limit of Indemnity Required Any one claim","options":[],"required":true,"pdf_field":""},{"help":"Specify aggregate limit for the period in INR","type":"amount","label":"Aggregate during the Period of Insurance","options":[],"required":true,"pdf_field":""},{"help":"Specify voluntary excess amount applicable to each claim","type":"amount","label":"19) Please indicate voluntary excess","options":[],"required":false,"pdf_field":""},{"help":"Tick extensions required and specify others if any","type":"checkbox","label":"20) Please indicate extensions required","options":["AOG Perils","72 Hour Sudden and Accidental Pollution","Transportation Extension","Carriage of effluents (outside premises)","Any other (please specify)"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"For 72 Hour Sudden and Accidental Pollution Extension: a) Whether risk is situated in vulnerable zone such as Water Protection Zones, Water conservation areas?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Tick applicable substances","type":"checkbox","label":"b) is there any use production & storage of Inflammable gases, Liquid with flashpoint below +55 degree C, Substances with explosive properties, Toxic substances with lethal doses value below 5mg/kg","options":["Inflammable gases","Liquid with flashpoint below +55 degree C","Substances with explosive properties","Toxic substances with lethal doses value below 5mg/kg"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"c) Whether there are Treatment/Disposal Control systems for solid, liquid and gaseous wastes or effluents?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Tick all that apply and attach consent letter if applicable","type":"checkbox","label":"d) Are the following in compliance with the official regulations put forward by PCB or any equivalent regulatory authority? Equipment, operations and processes; Plant has consent of PCD [copy of Consent letter to be attached]; Release/Discharge of effluents; Emissions from all stocks are periodically Measured and % of constituents logged","options":["Equipment, operations and processes","Plant has consent of PCD","Release/Discharge of effluents","Emissions from all stocks are periodically Measured and % of constituents logged"],"required":false,"pdf_field":""},{"help":"Provide details of hazardous substances in transit","type":"text","label":"For Transportation Extension: a) Particulars of dangerous/hazardous substances","options":[],"required":false,"pdf_field":""},{"help":"Specify turnover in INR","type":"amount","label":"b) Expected turnover of such materials in transit in a year (incoming raw materials and dispatch of finished products)","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"c) Whether pollution coverage is required","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select mode of transportation","type":"choice","label":"d) Mode of transportation Rail/Road/Pipeline","options":["Rail","Road","Pipeline"],"required":false,"pdf_field":""},{"help":"Provide pipeline details and monitoring system","type":"text","label":"e) If by Pipeline please provide: Dimensions of Pipe, Total Length, Terminal Points, Underground/overhead/submerged, Layout plan, System or supervision & monitoring against leakage/damage","options":[],"required":false,"pdf_field":""},{"help":"Specify limits for transportation extension","type":"amount","label":"f) Limits of Indemnity required [forming part of and not in addition to the aggregate limit of indemnity under the policy]: Any one claim, Aggregate during the Period of Insurance","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"For Carriage of Effluents Outside Premises Extension: a) Is effluent discharged by way of pipelines?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"b) Are effluents treated before discharge","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Specify length of pipeline","type":"text","label":"c) Total length of pipeline from compound of premise to terminal point","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"d) Discharge of effluent treatment plant conforming to the prevalent pollution laws","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"PEP means Politically Exposed Persons as defined","type":"yes-no","label":"Are you or any of the proposal applicants a PEP* or a close relative of PEP*? If yes, please share the details","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Consent for KYC verification","type":"yes-no","label":"I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through CERSAI records or National Securities Depository Limited Portal for the purpose of undertaking KYC verification.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Declaration of legal source of premium payment","type":"yes-no","label":"I/we hereby declare and confirm that the premium has been paid out of legally acquired sources of income and the subsequent premiums if any, will continue to be paid out of legally declared and assessed source of income.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Consent for sharing personal information","type":"yes-no","label":"I/We hereby give voluntary consent to Bajaj General/Company to share my/our personal information and data provided in this proposal form with its group companies or any other person in connection with the Insurance Policy or otherwise, including for providing products and services of group companies that may be of interest to me/us, to be used in accordance with their respective privacy policies and subject to appropriate measures being in place to safeguard my/our personal information.","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Consent to keep contact and bank details updated","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, to process any of your service requests faster and hassle-free in future.","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Signature and Date","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Public Liability Insurance for industrial and storage risks","attachments":["Copy of Consent letter from PCD (if applicable)","Separate sheet for additional information if space is insufficient"],"declarations":["The proposer declares all statutory provisions relating to the business are complied with.","The proposer declares all statements and particulars are true and no material fact is omitted or misstated.","The declaration forms the basis of the contract between proposer and company.","Prohibition of rebates as per Section 41 of Insurance Act 1938 applies.","Consent is given for KYC verification through specified portals.","Premiums are paid from legally acquired sources.","Consent may be given to share personal information with group companies.","Policyholder must keep contact and bank details updated for faster service."],"dropped_labels":11},"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/2498-proposal-form-for-public-liability-insurance"}