{"id":2502,"title":"Port & Terminal Operators' Policy Proposal Form","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/Port-and-Terminal-Operators-Policy/Proposal_Form_Port_and_Terminal.pdf","sha256":"9f3c7e7dc48e9136ce7d733759b606cdc32694c22dd9dc9e9d86cb7de0909435","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer (applicant) to apply for a Port & Terminal Operators insurance policy with Bajaj General Insurance Limited.","notes":["Use vernacular language explanation if needed for proposer understanding.","Keep policy contact and bank details updated via app, WhatsApp, call center, email, website, agent or branch.","The form includes a legal warning about prohibition of rebates under Insurance Act 1938 Section 41.","Agent must sign and provide license details confirming explanation of the form to the proposer.","The proposer and witness must sign and date the declaration section.","If proposer has disability, an authorised representative may sign on their behalf with consent."],"title":"Port & Terminal Operators' Policy Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Assured and Facility Details","fields":[{"help":"","type":"text","label":"Name and address of Assured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Location(s)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Description of each facility","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are water depths checked regularly?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are channels dredged regularly?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe vessel types including tonnage and type","type":"text","label":"Vessel types using facilities i.e. tonnage, type etc:","options":[],"required":null,"pdf_field":""},{"help":"List types of cargo handled","type":"text","label":"Types of cargoes loaded and unloaded","options":[],"required":null,"pdf_field":""},{"help":"Provide annual tonnage split by cargo type","type":"text","label":"Annual tonnage handled preferably split between general, bulk and liquid cargoes:","options":[],"required":null,"pdf_field":""},{"help":"Describe cargo handling methods","type":"text","label":"Methods of handling cargoes","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is Assured involved in stuffing and/or destuffing of containers?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details on tank storage and warehousing as per subpoints","type":"text","label":"Describe tank storage and any warehousing facilities, please advise : a) Types of cargoes stored b) Maximum storage time c) Maximum value at risk at any one time d) Size and number of tanks","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Select the constitution type and provide DARPAN details if applicable","type":"choice","label":"Constitution Details","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO - Provide DARPAN Portal Registration, if applicable","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":null,"pdf_field":""},{"help":"Provide DARPAN Portal Registration number if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Operational and Financial Details","fields":[{"help":"","type":"number","label":"Approximate number of vessels docking per annum:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Approximate number of barges docking per annum:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Approximate number of vessel days per annum:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Approximate number of barge days per annum:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Maximum number of vessels in care, custody and control any one time:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Maximum number of barges in care, custody and control any one time:","options":[],"required":null,"pdf_field":""},{"help":"Provide payroll amount for stevedores","type":"amount","label":"Stevedores payroll","options":[],"required":null,"pdf_field":""},{"help":"Provide anticipated gross receipts split by operations","type":"text","label":"Gross Receipts anticipated. Split, if possible, between Stevedoring operations, Berthing facilities and Warehousing:","options":[],"required":null,"pdf_field":""},{"help":"Provide details of loss record for last 5 years","type":"text","label":"Loss Record for last 5 years","options":[],"required":null,"pdf_field":""},{"help":"Provide current insurer and premium rates if known","type":"text","label":"Present carrier and rates if available","options":[],"required":false,"pdf_field":""},{"help":"Specify insurance limits and deductibles desired","type":"text","label":"Limits and deductible required:","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details and Electronic Insurance Account","fields":[{"help":"","type":"text","label":"Name Of Bank","options":[],"required":null,"pdf_field":""},{"help":"Provide bank account number for claim payments","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Provide IFSC code of the bank branch","type":"text","label":"IFSCCode","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["Yes"],"required":null,"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":"","type":"yes-no","label":"Do you want to open e-lA account:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you an exisiting customer of Bajaj General?","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":"","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":["Yes"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"PEP means Politically Exposed Person","type":"yes-no","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through Central KYC Registry or Goods and Service Tax Portal or Ministry Of Corporate Affairs Portal or National Securities Depository Limited portal for the purpose of undertaking KYC","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","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":null,"pdf_field":""},{"help":"","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":null,"pdf_field":""},{"help":"You can update details via app, WhatsApp, call center, email, website, agent or branch","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":null,"pdf_field":""},{"help":"Signature of proposer and witness with date and place","type":"signature","label":"Declaration : The content of this form and its particulars have been explained by me in vernacular to the proposer who has understood and confirmed the same.","options":[],"required":true,"pdf_field":""},{"help":"If yes, provide details and disability certificate","type":"yes-no","label":"Disability Declaration : Any Physical deformity or handicap","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of disability","type":"text","label":"If Yes. Please provide details:","options":[],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Claim Docs: I/we hereby confirm that I/we have provided all relevant and supporting documents sought by the company, required for the issuance of the policy. Any document(s) as may be required, for claims processing, shall be submitted by me on demand by the company.","options":["Confirmed"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Agent/Intermediary Declaration","fields":[{"help":"","type":"text","label":"IRDAI COR No./ License No.(Advisor/Corporate Agent/Broker/Relationship Officer)","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Agent/IMO Name, Code and signature; SP/BQP/DP/PoS Name, Code and signature","type":"signature","label":"Agent / IMD (SP/DP/ BQP) signature and their code","options":[],"required":null,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Port & Terminal Operators Policy","attachments":["Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability","All relevant and supporting documents sought by the company for policy issuance and claims processing"],"declarations":["No person shall offer or accept any rebate of commission or premium except as allowed by the insurer's published prospectus.","The proposer confirms whether they or close relatives are Politically Exposed Persons (PEP).","Consent is given to verify identity/address proof through official government portals for KYC.","Premiums are declared to be paid from legally acquired sources of income.","Consent is given to share personal information with group companies for insurance and related services.","Policyholder must keep contact and bank details updated for faster service.","The form content has been explained in vernacular and understood by the proposer.","Disability details must be declared with supporting certificate if applicable.","Agent declares having explained the form contents to the proposer and understands the consequences of non-disclosure or false information.","Claim documents provided are complete and further documents will be submitted on demand."],"dropped_labels":3},"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/2502-port-and-terminal-operators-policy-proposal-form"}