{"id":2524,"title":"BAJAJ GENERAL POULTRY 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/commercial-general/Poultry-Insurance-pf.pdf","sha256":"ea352ac05a2e742bccb3874b8819d4a376a316f82fb3ba18af600fd89004149e","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for poultry insurance to be filled by the proposer (poultry farm owner or representative) seeking insurance coverage for their poultry farm.","notes":["Answer all questions in BLOCK letters","Liability of the company starts only after proposal acceptance and premium payment","Proposal form is basis of the insurance contract","Use original and accurate information to avoid policy cancellation","Keep policy contact and bank details updated for faster service","Agent/intermediary must explain contents in vernacular language if required","Read declaration carefully before signing"],"title":"BAJAJ GENERAL POULTRY INSURANCE POLICY: PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Write the full name of the proposer in BLOCK letters","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Provide full postal address and phone number","type":"text","label":"Communication Address with Contact Number","options":[],"required":true,"pdf_field":""},{"help":"Provide full name and address of the poultry farm","type":"text","label":"Name and address of the Poultry Farm","options":[],"required":true,"pdf_field":""},{"help":"Provide bank details if applicable","type":"text","label":"Name and address of the Financing Bank","options":[],"required":false,"pdf_field":""},{"help":"Name as per bank records","type":"text","label":"Bank Details: Name as pr Bank","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of Bank","options":[],"required":false,"pdf_field":""},{"help":"Provide bank account number","type":"text","label":"Bank Account No.","options":[],"required":false,"pdf_field":""},{"help":"Provide IFSC code of the bank branch","type":"text","label":"IFSC Code","options":[],"required":false,"pdf_field":""},{"help":"Tick to accept payment through the above bank account","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 deposit your insurance policy","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you want to open e-lA account: Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Are you an existing customer of Bajaj General? Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide PIO number if existing customer","type":"text","label":"If yes. Please provide PIO No:","options":[],"required":false,"pdf_field":""},{"help":"Provide policy number if existing customer","type":"text","label":"/ Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Select the type of birds to be insured","type":"choice","label":"Type of Birds: Broilers / Layers / Hatchery","options":["Broilers","Layers","Hatchery"],"required":true,"pdf_field":""},{"help":"Select one indemnity level","type":"choice","label":"Indemnity Level you want to opt for? a) 65% b) 75% c) 85%","options":["65%","75%","85%"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Poultry Farm Details","fields":[{"help":"Enter total number of sheds","type":"number","label":"Number of Sheds","options":[],"required":true,"pdf_field":""},{"help":"Enter capacity per shed","type":"number","label":"Shed Capacity","options":[],"required":true,"pdf_field":""},{"help":"Enter number of rotations","type":"number","label":"Number of Rotations","options":[],"required":true,"pdf_field":""},{"help":"Fill details for each unit: Unit, Date of Hatch of birds, Date of Purchase, No of birds purchased as per delivery challan, Total no of birds in the unit at proposal, Breed strain, Age in weeks at proposal, Source of purchase, Expected date of disposal","type":"table","label":"Description of the Birds to be insured","options":[],"required":true,"pdf_field":""},{"help":"Select housing system for each house type","type":"choice","label":"What is the system of Housing of the Birds? i. In Brooding House Deep Litter / Cage System ii. In Grower House Deep Litter / Cage System iii. In Layer House Deep Litter / Cage System","options":["Deep Litter","Cage System"],"required":true,"pdf_field":""},{"help":"Provide number of feeders, drinkers, and brooders","type":"number","label":"Equipment’s: i. No of feeders ii. No of Drinkers iii. No of Brooders","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is a qualified Vet. Surgeon employed to look after the farm: Yes / No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide vet surgeon details if employed","type":"text","label":"If yes, please give details of Vet. Surgeon: i. Name ii. Qualification iii. Regd. No. iv. Is he residing at the farm 24 hours Yes / No","options":[],"required":false,"pdf_field":""},{"help":"Provide details of alternative veterinary services","type":"text","label":"If qualified Vet. Surgeon Not employed then on whose services you depend upon","options":[],"required":false,"pdf_field":""},{"help":"List other technical persons with their qualifications and job descriptions","type":"table","label":"Details of other Technical persons residing at the farm premises: Name, Qualification, Job Description","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are the diagnostic equipment/agents maintained at the farm: Yes / No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you stock essential medicines at the farm: Yes / No","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Farm Information","fields":[{"help":"Specify feed source","type":"text","label":"Do you manufacture your own feed or get it from the market","options":[],"required":true,"pdf_field":""},{"help":"Provide experience or training details","type":"text","label":"Is the owner/partner/associate experienced in poultry farming or have undergone any training","options":[],"required":true,"pdf_field":""},{"help":"Provide vaccination details for each unit","type":"table","label":"Details of vaccination conducted during last six months: Unit, No., Date of vaccination, Age of birds, Disease against which vaccinated, Trade No, Name of vaccine, Batch No, Vaccination done","options":[],"required":true,"pdf_field":""},{"help":"Provide debeaking details if applicable","type":"table","label":"Details of debeaking: Unit No., Date of Debeaking","options":[],"required":false,"pdf_field":""},{"help":"Provide deworming details if applicable","type":"table","label":"Details of deworming: Unit No., Date of Debeaking","options":[],"required":false,"pdf_field":""},{"help":"Describe any epidemic outbreaks","type":"text","label":"Has there been any epidemic outbreak during last 3 years? If so, give details","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you wish to cover Coccidiosis? Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Describe preventive measures if covering Coccidiosis","type":"text","label":"If Yes, please provide the anti coccidial preventive measures taken in your farm","options":[],"required":false,"pdf_field":""},{"help":"Provide establishment date","type":"date","label":"Since when the Poultry farm is established?","options":[],"required":true,"pdf_field":""},{"help":"Provide previous insurance company details if any","type":"text","label":"Have you earlier at any time proposed your birds for insurance? If so, give name and address of the Insurance Company","options":[],"required":false,"pdf_field":""},{"help":"Provide details if any insurance company declined or refused renewal","type":"text","label":"Has any Insurance Company: i. Declined to issue a policy to you? ii. Declined to continue insurance? iii. Not invited renewal of policy? If yes for any of the above questions, kindly provide details","options":[],"required":false,"pdf_field":""},{"help":"Provide start and end dates of insurance period","type":"date","label":"Period of Insurance for the present proposal: From / / to / /","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Select payment mode and frequency","type":"choice","label":"Payment Mode: Full Payment / Instalment Payment: Monthly / Quarterly / Half Yearly / Annual","options":["Full Payment","Monthly","Quarterly","Half Yearly","Annual"],"required":true,"pdf_field":""},{"help":"Select payment method","type":"choice","label":"Payment Details: Cash / Cheque / DD / Credit Card / Debit Card / UPI","options":["Cash","Cheque","DD","Credit Card","Debit Card","UPI"],"required":true,"pdf_field":""},{"help":"Select who gave the cheque if applicable","type":"choice","label":"Cheque Given By: Spouse / Father / Mother / Son/Daughter / Financer / Employer/Employ","options":["Spouse","Father","Mother","Son/Daughter","Financer","Employer/Employ"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Agree to weekly mortality reporting","type":"checkbox","label":"I/ We agree to declare daily mortality details on weekly basis to the company.","options":["agree"],"required":true,"pdf_field":""},{"help":"Confirm truthfulness of information","type":"checkbox","label":"I/ We declare that the foregoing statements are true to the best of my/our knowledge and belief, that I/We have disclosed all particulars affecting the assessment of the risk.","options":["agree"],"required":true,"pdf_field":""},{"help":"Acknowledge consequences of incorrect information","type":"checkbox","label":"I/We agree that the Policy shall become null and void, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material particular in the proposal form/personal statement, declaration and connected documents, or any material information has been withheld by me/us or anyone acting on my/our behalf to obtain any benefit under this Policy.","options":["agree"],"required":true,"pdf_field":""},{"help":"Agree policy issuance depends on cheque clearance","type":"checkbox","label":"I/We agree that the issuance of Policy shall be subject to realisation of premium cheque.","options":["agree"],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Provide witness name","type":"text","label":"Name of Witness","options":[],"required":false,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"Signature of Witness","options":[],"required":false,"pdf_field":""},{"help":"Provide disability details and certificate","type":"text","label":"If yes. Please provide details (Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability)","options":[],"required":false,"pdf_field":""},{"help":"If proposer is disabled, name of authorized representative","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorized representative","type":"signature","label":"Signature of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Agent or IMD name","type":"text","label":"Agent/IMD Name","options":[],"required":true,"pdf_field":""},{"help":"Agent or IMD code","type":"text","label":"Agent/IMD Code","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":""},{"help":"Signature of sales person or point of sale","type":"signature","label":"SP / BQP / DP / PoS Signature","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer and agent"}],"deadlines":[],"applies_to":"Poultry insurance policies","attachments":["Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability","Any relevant and supporting documents sought by the company for issuance of the policy"],"declarations":["Agree to declare daily mortality details on weekly basis to the company","Declare that all statements are true and all particulars affecting risk assessment are disclosed","Policy becomes void if any untrue or incorrect statement or non-disclosure is made","Policy issuance is subject to realization of premium cheque","Consent to KYC verification through CERSAI or NSDL portals","Confirm premium paid from legally acquired sources","Consent to sharing personal information with group companies for services","Acknowledgement of Insurance Act 1938 Section 41 prohibiting rebates"],"dropped_labels":7},"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/2524-bajaj-general-poultry-insurance-policy-proposal-form"}