{"id":2526,"title":"BANKER'S INDEMNITY PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/bankers-indemnity-policy/Bankers-Indemnity-Policy-pf.pdf","sha256":"e6a65133343504deeff13d4a2a942353ab5710fa18db103921f9301b933873f3","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for a Banker's Indemnity insurance policy, to be filled by the bank or its authorized representative seeking insurance coverage.","notes":["Use original documents for claims processing and submit additional documents on demand.","The term 'Boiler' includes fittings, integral super heaters and integral economisers but excludes certain piping unless specifically listed.","Value of Boiler and/or Pressure Plant older than 20 years must be indicated separately.","Section 41 of Insurance Act 1938 prohibits rebates as inducements for insurance.","Keep policy updated with mobile number, email ID, PAN card and bank account details.","For updating details, use Caringly yours App, WhatsApp service, call center, missed call, SMS, email, website, agent or branch."],"title":"BANKER'S INDEMNITY PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Bank Details","fields":[{"help":"","type":"text","label":"Name of Bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address (i) Regd Office.","options":[],"required":null,"pdf_field":""},{"help":"Enter total number of branches","type":"number","label":"State the total no. of branches in India and abroad existing at present. Total","options":[],"required":null,"pdf_field":""},{"help":"Provide bank name as per bank records","type":"text","label":"Name as pr Bank 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":"Confirm acceptance to pay and receive claim amount in given bank account","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 deposite your insurance policy.","options":[],"required":false,"pdf_field":""},{"help":"Select if you want to open an e-lA account","type":"choice","label":"Do you want to open e-lA account:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select if you are an existing customer","type":"choice","label":"Are you an exisiting customer of BajajGeneral?","options":["Yes","No"],"required":null,"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":"Confirm no change in KYC details","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":[],"required":null,"pdf_field":""}],"filled_by":"proposer (bank or authorized representative)"},{"title":"Insurance History and Constitution Details","fields":[{"help":"Select yes or no and provide details if yes","type":"yes-no","label":"Are you at present insured under a Banker's Indemnity Policy? If so State the name of the company and the amount and period of insurance.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select applicable constitution type","type":"checkbox","label":"If Yes Specify Constitution","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":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Loss History","fields":[{"help":"Select yes or no and provide details if yes","type":"yes-no","label":"Have you ever sustained a loss or losses of money/ Securities: (i) Whilst lying at the premises","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select yes or no and provide details if yes","type":"yes-no","label":"(iv) Whilst in transit","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select yes or no and provide details if yes","type":"yes-no","label":"(v) Whilst in postal transit","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of losses in last five years","type":"text","label":"If so, please give details in respect of the past five years giving date of occurrence, date of discovery amount of loss and brief particulars","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured Details","fields":[{"help":"Enter the basic sum insured amount","type":"amount","label":"What is the amount for which cover is required (i.e. Basic Sum Insured)?","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Select mode of payment","type":"choice","label":"Mode of Payment","options":["Cheque","DD","Cash","Other"],"required":null,"pdf_field":""},{"help":"Select who gave the cheque if applicable","type":"choice","label":"Cheque - Given by","options":["Spouse","Father","Mother","Son/Daughter","Employer / Employee","Financier"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"Sign the form","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Declare if you or any applicant is a 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":"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 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":"Confirm source of premium payment is legal","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":"Consent to share 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","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Acknowledge requirement to keep contact and bank details updated","type":"checkbox","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":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Disability Declaration","fields":[{"help":"Declare if any physical deformity or handicap exists","type":"yes-no","label":"Any Physical deformity or handicap","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details and attach Disability Certificate issued by Government Medical Board","type":"text","label":"If Yes. Please provide details","options":[],"required":false,"pdf_field":""},{"help":"If proposer is disabled, authorized representative name","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":"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 authorized representative"},{"title":"Agent/Intermediary Declaration","fields":[{"help":"Agent's signature","type":"signature","label":"Signature of Agent","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":"Agent or intermediary code and signature","type":"text","label":"Agent / IMD (SP/DP/BQP) signature and their code","options":[],"required":null,"pdf_field":""},{"help":"Agent or IMO name","type":"text","label":"Agent/IMO Name","options":[],"required":null,"pdf_field":""},{"help":"Agent or IMO code","type":"text","label":"Agent/IMO Code","options":[],"required":null,"pdf_field":""},{"help":"Name of SP/BQP/DP/PoS","type":"text","label":"SP/BQP/DP/PoS Name","options":[],"required":null,"pdf_field":""},{"help":"Code of SP/BQP/DP/PoS","type":"text","label":"SP/BQP/DP/PoS CoR No.","options":[],"required":null,"pdf_field":""},{"help":"Signature of SP/BQP/DP/PoS","type":"signature","label":"SP/BQP/DP/PoS Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"agent or intermediary"}],"deadlines":[],"applies_to":"Banker's Indemnity insurance policies","attachments":["Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability"],"declarations":["The statements and particulars given are true and complete and form the basis of the contract.","Consent is given to share information within group entities.","Premiums are paid from legally acquired sources.","Consent is given to share personal information with group companies and others as per privacy policies.","Policyholder must keep contact and bank details updated for faster service.","Agent declares that the proposal form contents have been explained to the proposer in vernacular.","Non-disclosure or untrue statements may lead to policy variation or cancellation 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/2526-banker-s-indemnity-proposal-form"}