{"id":2507,"title":"Freight Services Liability Insurance 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/Freight-Services-Liability-Insurance-Policy/Proposal_Form_Freight.pdf","sha256":"c6c5865734118cbac2d5ff06774e06866ff94bd3d4224d194f59d3cac9c2a786","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is used to apply for Freight Services Liability Insurance and is to be completed by the policyholder or their insurance broker.","notes":["This form should be completed with or by your Insurance Broker.","Attach sample contracts or trading conditions unless standard forms are used.","Provide details on separate sheets if space is insufficient.","Use additional sheets for any other answers or information.","Keep policy updated with contact and bank details for faster service.","Declarations and signatures are mandatory for proposal acceptance.","The Insurance Act 1938 Section 41 prohibits rebates and non-compliance may lead to fines."],"title":"Freight Services Liability Insurance Policy Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"General Information","fields":[{"help":"","type":"text","label":"NAME OF BROKER","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Contact","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Fax","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Telex","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Assured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Fax","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Telex","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No for each constitution type and specify if others","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":null,"pdf_field":""},{"help":"Provide DARPAN registration details if applicable","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":null,"pdf_field":""},{"help":"Provide bank name, account number, IFSC code","type":"text","label":"Bank Details","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide e-lA number if available","type":"text","label":"Electronic-Insurance Account: Please provide e-lA No. to deposit your insurance policy","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you want to open e-lA account","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Year your business was formed","type":"number","label":"Year Formed","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Total Number of Employees","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Total Number of Directors/Partners","options":[],"required":null,"pdf_field":""},{"help":"Tick as appropriate","type":"choice","label":"Operations for which you require insurance","options":["Freight Services","Container Operator","Ship Agent","Vessel/Slot Charterer/Operator","Terminal Operator","Port Authorities"],"required":null,"pdf_field":""},{"help":"Provide trade association details if applicable","type":"text","label":"Are you a member of any Trade Association, if so please provide details","options":[],"required":null,"pdf_field":""},{"help":"Provide any relevant background information","type":"text","label":"Please provide any background or general information regarding your organisation","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder or insurance broker"},{"title":"Operational Information","fields":[{"help":"Provide percentage and conditions for each business area: Freight Forwarder (Agent/Principal), NVOCC, Road Carrier (Own/Sub-Contract), Rail Carrier (Own/Sub-Contract), Air Carrier (Own/Sub-Contract), Warehousekeeper (Own/Sub-Contract), Other (specify)","type":"table","label":"Please describe the main areas of your business and trading conditions","options":[],"required":null,"pdf_field":""},{"help":"Attach sample contracts or trading conditions","type":"attachment","label":"Please attach a sample Contract/Trading Conditions for each of the above applicable operations, unless they are standard forms i.e. FIATA, COGSA, CMR, BIFA etc.","options":[],"required":null,"pdf_field":""},{"help":"Provide percentage traffic for Road, Rail, Cont. (Sea), USA/Canada, Mexico, C/S America, Middle East, Europe, Italy, C.I.S, India/Pakistan, China, Far East, Africa, Non Cont. (Sea), Air, Australasia","type":"table","label":"Please advise the percentages of your Traffic to/from or within the following areas","options":[],"required":null,"pdf_field":""},{"help":"Provide percentage for Personal Effects, Wines, Spirits, Cigarettes, Jewellery, Computers/Related Equipment, Hi-fis CD Players etc., Video Tapes CDs, Other high value cargo (specify), Temperature/Atmosphere Controlled Cargoes","type":"table","label":"Please advise the percentages of your traffic for the following types/categories of cargo","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No for each; if yes, provide details on a separate sheet","type":"checkbox","label":"Do you own or operate any of the following","options":["Containers","Trailers","Trucks/Vans","Rail Wagons","Tractor Units","Fork Lifts","Cranes","Warehouses","Depots"],"required":null,"pdf_field":""},{"help":"Provide number of staff for Directors/Senior Management, Senior Technical, Clerical/Secretarial, Operational, Drivers, Warehousemen, Others (specify)","type":"table","label":"Please advise the numbers of staff employed in the following categories","options":[],"required":null,"pdf_field":""},{"help":"Provide turnover for Next 12 Months, Current Year, Current Year Minus One, Current Year Minus Two","type":"table","label":"Please provide turnover as follows","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder or insurance broker"},{"title":"Insurance History","fields":[{"help":"Provide Broker and Insurers details for Current, Minus 1, Minus 2, Minus 3 years","type":"table","label":"Details of your Insurers and Broker during the last 4 years","options":[],"required":null,"pdf_field":""},{"help":"Provide Paid and Outstanding claims for Current, Minus 1, Minus 2, Minus 3 years","type":"table","label":"Details of paid and outstanding claims for the last 4 years","options":[],"required":null,"pdf_field":""},{"help":"Provide deductible amounts for Current, Minus 1, Minus 2, Minus 3 years","type":"table","label":"Confirm the deductible(s) that were applicable during the last 4 years","options":[],"required":null,"pdf_field":""},{"help":"Specify deductible and limit required","type":"text","label":"What deductible and limit do you require","options":[],"required":null,"pdf_field":""},{"help":"Provide claim details if applicable","type":"text","label":"Details of any claim which exceeded (or is likely to exceed) USD25,000 or which accounts for more than 25% of the total claims in any one year","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder or insurance broker"},{"title":"Other Information","fields":[{"help":"Use additional sheets if needed","type":"text","label":"Please provide below any other information that may be material to the insurers","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder or insurance broker"},{"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?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Proposer","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":"","type":"text","label":"Name of Witness","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Witness","options":[],"required":null,"pdf_field":""},{"help":"If yes, provide details and attach Disability Certificate issued by Government Medical Board","type":"yes-no","label":"Disability Declaration: Any Physical deformity or handicap","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Authorised Representative","options":[],"required":null,"pdf_field":""},{"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":null,"pdf_field":""},{"help":"Agent/IMD to sign and provide code","type":"signature","label":"Agent / IMD (SP/DP/ BQP) signature and their code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"SP/ BQP /DP/ PoS Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"SP/ BQP /DP/ PoS CoR No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"SP/ BQP /DP/ PoS Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer and agent"}],"deadlines":[],"applies_to":"Freight Services Liability Insurance policies","attachments":["Sample Contract/Trading Conditions for applicable operations","Disability Certificate issued by the Medical Board appointed by the Government (if applicable)"],"declarations":["The form has been completed accurately and all material information disclosed.","Completion of this form is not binding on either party.","Premiums are paid from legally acquired sources and will continue to be so.","Consent is given to verify identity/address proof through government portals for KYC.","Consent is given to share personal information with group companies or others for insurance purposes.","Policyholder agrees to keep contact and bank details updated for faster service.","Agent confirms that the form contents have been explained to the proposer in their vernacular language.","Non-disclosure or untrue statements may lead to policy being void and premiums forfeited."],"dropped_labels":16},"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/2507-freight-services-liability-insurance-policy-proposal-form"}