{"id":2528,"title":"PROPOSAL FORM FOR BURGLARY INSURANCE","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/burglary-insurance-policy/Burglary-Insurance-Policy-pf.pdf","sha256":"731a1ec761ffe30a0fa2bf8eacfca0ade7c21dc7f8a1be0ddc471756ce5631bb","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (individual or business) to apply for burglary insurance coverage by providing details about the premises, security, and property to be insured.","notes":["Use block letters for name and address","Attach separate sheet if space is insufficient","Premium will be quoted on application","Liability starts only after acceptance and premium payment","Section 41 of Insurance Act, 1938 applies regarding rebates","Keep policy details updated for smooth service","Contact details and update options provided via app, WhatsApp, call center, SMS, email, website, agent or branch"],"title":"PROPOSAL FORM FOR BURGLARY INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Write your full name and address in block letters","type":"text","label":"Name and address of the Proposer: (in full) (BLOCK LETTERS)","options":[],"required":true,"pdf_field":""},{"help":"Provide name(s) of financial institution(s) if applicable","type":"text","label":"Name of the financial institution/s (if any financial interest is involved)","options":[],"required":false,"pdf_field":""},{"help":"Describe your trade or business","type":"text","label":"Nature of Trade or Business","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premises and Bank Details","fields":[{"help":"Provide full address of the insured premises","type":"text","label":"Address of the premises to be insured","options":[],"required":true,"pdf_field":""},{"help":"Tick if you agree to receive claim payments in this bank account","type":"checkbox","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["accept"],"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":"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":"Tick to 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":["confirm"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"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":"Premises Details","fields":[{"help":"Specify type of premises","type":"text","label":"Whether warehouse, godown, shop or office?","options":[],"required":true,"pdf_field":""},{"help":"Specify duration of occupancy","type":"text","label":"How long have you been an occupant of the premises?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are you the sole occupant?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide names of other occupants if any","type":"text","label":"If not, who are other occupants","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Protection Details","fields":[{"help":"Describe any special security measures","type":"text","label":"Mention any special precautions you have adopted for safeguarding your property","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Occupancy and Security","fields":[{"help":"Specify night occupancy details","type":"text","label":"Are the premises occupied by you at night? If not, by whom?","options":[],"required":true,"pdf_field":""},{"help":"Provide details of watchmen and timings","type":"text","label":"Are the premises guarded by Watchmen? If so, by how many and during what time?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are the premises at any time left unoccupied?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify frequency and duration of unoccupancy","type":"text","label":"If so, how often and for how long?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Safe Details","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Are all valuables secured in a safe(s) outside business hours?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide safe specifications","type":"text","label":"Give (1) Maker's name (2) Height (3) Width (4) Depth and (5) Weight of Safe(s)","options":[],"required":false,"pdf_field":""},{"help":"Describe key custody and opening mechanism","type":"text","label":"How many keys are there to the safe(s) and with whom are they kept? Can the safe(s) be opened by single key or by a combination of two or more keys?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Stock and Records","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Are stock and sales book maintained?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify frequency of entries","type":"text","label":"How frequently are these entered?","options":[],"required":false,"pdf_field":""},{"help":"Specify stock taking frequency","type":"text","label":"How often is stock taken?","options":[],"required":false,"pdf_field":""},{"help":"Specify location of books after hours","type":"text","label":"Where are these books kept out of business hours?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Burglary History","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Have any premises occupied by you been entered by burglars?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of burglary incidents","type":"text","label":"If so, give full particulars stating when and how access was obtained and the extent of the loss.","options":[],"required":false,"pdf_field":""},{"help":"Describe preventive measures taken","type":"text","label":"What precautions have been adopted to prevent such a recurrence?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Existing Insurance Details","fields":[{"help":"Provide name of insurer if any","type":"text","label":"The name of your existing insurance company","options":[],"required":false,"pdf_field":""},{"help":"Provide policy number","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Provide policy period","type":"text","label":"Period.","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has any company in respect of your Burglary Insurance: Declined your proposal?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Cancelled or refused to renew your policy?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Claims History","fields":[{"help":"Provide claim details if any","type":"text","label":"Have you ever claimed upon any insurance for loss by burglary or house breaking? If so, give details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Contents Insurance","fields":[{"help":"Provide insured amount and insurer name","type":"text","label":"Amount for which contents are currently insured against fire and name of the Insurer","options":[],"required":false,"pdf_field":""},{"help":"Describe contents to be insured","type":"text","label":"Give full description of contents (i.e. the property to be insured) of the premises.","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Cover","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Do you need cover against riot and strike, terrorist activities on the payment of additional premium?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Period","fields":[{"help":"Enter start date (DDMMYY)","type":"date","label":"Policy period sought : From","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Security Systems","fields":[{"help":"Describe alarm system details","type":"text","label":"If yes or will be installed, please give details of the alarm system.","options":[],"required":false,"pdf_field":""},{"help":"Describe other security systems","type":"text","label":"Are there any other security systems or aids deployed, and if so what?","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is the burglar alarm system under a maintenance contract?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Will the burglar alarm system and any other security systems or aids mentioned be maintained as required so that they are in good working order and deployed for the prevention of any claim under the policy sought?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Physical Proposal Form Declarations","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"It is mandatory to keep your policy with updated contact and bank details (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter date","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter witness name","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"Date of witness signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of witness signature","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Any Physical deformity or handicap (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide disability details and certificate info","type":"text","label":"If Yes, Please provide details","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"},{"title":"Agent / Intermediary Declaration","fields":[{"help":"Provide agent license number","type":"text","label":"IRDAI COR No./ License No.(Advisor/Corporate Agent/Broker/Relationship Officer)","options":[],"required":true,"pdf_field":""},{"help":"Agent 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 IMD signature","type":"signature","label":"Agent / IMD (SP/DP/ BQP) signature and their code","options":[],"required":true,"pdf_field":""},{"help":"Name of SP/BQP/DP/PoS","type":"text","label":"SP/ BQP /DP/ PoS Name","options":[],"required":false,"pdf_field":""},{"help":"CoR number of SP/BQP/DP/PoS","type":"text","label":"SP/ BQP /DP/ PoS CoR No.","options":[],"required":false,"pdf_field":""},{"help":"Signature of SP/BQP/DP/PoS","type":"signature","label":"SP/ BQP /DP/ PoS Signature","options":[],"required":false,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Burglary Insurance","attachments":["If there is insufficient space in this proposal for you to provide relevant information, attach a separate sheet","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability"],"declarations":["The statements made in this proposal are true and complete to the best of the proposer's knowledge","The proposal and declarations form the basis of the insurance contract","The proposer agrees to pay premium on the estimated amount at the end of each policy period","The proposer undertakes to exercise all ordinary and reasonable precautions for safety of the property","The company may share the proposer's information within group entities","The liability of the company does not commence until the proposal is accepted and premium paid","No person shall offer or accept any rebate of commission or premium except as allowed by published prospectuses","Non-disclosure or untrue statements may lead to policy being void and forfeiture of premiums","Consent to verify identity/address proof through various government portals","Declaration that premium is paid from legally acquired sources","Consent to share personal information with group companies for products and services","It is mandatory to keep policy with updated contact and bank details for faster service","Agent declares that the proposal form contents have been explained to the proposer in vernacular"],"dropped_labels":24},"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/2528-proposal-form-for-burglary-insurance"}