{"id":2533,"title":"PROPOSAL FORM FOR JEWELLER’S BLOCK INSURANCE","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/jewellers-block-insurance-cover/jewellers-block-proposal-form.pdf","sha256":"40146153618adc5250fdfe3d85d78c4052f42d175b38b704a5e38ec96fd3aa42","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (potential policyholder) to apply for Jeweller’s Block Insurance coverage by providing details about their business, premises, security measures, stock, and previous insurance history.","notes":["Answer all questions fully; if none, state 'NONE'.","Window display at night is not covered.","Stocks kept out of the safe after business hours and at night are not covered.","Use separate statements for multiple premises or additional details as requested.","References are required unless this is a renewal proposal."],"title":"PROPOSAL FORM FOR JEWELLER’S BLOCK INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details and Premises","fields":[{"help":"Full legal name of the proposer","type":"text","label":"Name of Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"Complete postal address for correspondence","type":"text","label":"Address to which all communication should be sent.","options":[],"required":true,"pdf_field":""},{"help":"List all premises addresses and floors if multiple","type":"text","label":"State address of all premises to which the Policy is to apply (if more than one please attach a statement the floor(s) on which your premises are situated in each location).","options":[],"required":true,"pdf_field":""},{"help":"Date or year when the business was established","type":"date","label":"Since when established","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nature of Business","fields":[{"help":"Percentage of business that is wholesale","type":"number","label":"Wholesale %","options":[],"required":true,"pdf_field":""},{"help":"Percentage of business that is retail","type":"number","label":"Retail %","options":[],"required":true,"pdf_field":""},{"help":"Percentage of business that is manufacturing","type":"number","label":"Manufacturing %","options":[],"required":true,"pdf_field":""},{"help":"Percentage of business that is pawn broking","type":"number","label":"Pawn Broking %","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Safe and Security Details","fields":[{"help":"Provide safe maker name, cost, condition, and security marking","type":"text","label":"Give the Safe Maker’s name, cost when purchased (state whether new or secondhand and whether marked “Thief resisting” or “Burglar proof”)","options":[],"required":true,"pdf_field":""},{"help":"Indicate if proposer or staff occupy premises at night","type":"yes-no","label":"Will the premises be occupied at night by the Proposer?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate presence of watchman on premises","type":"yes-no","label":"Will there be a watchman on the insured premise(s). If Yes specify:","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify if watchman(s) are employees working 24 hours","type":"yes-no","label":"Whether he / they is / are your employees and is / are employed for all 24 hours of the day","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe watchman coverage area","type":"text","label":"Whether he / they is / are common watchman for the whole building / locality or only a night watchman to guard the insured premises/s or the building or the locality","options":[],"required":null,"pdf_field":""},{"help":"Describe burglar alarm or other protection systems","type":"text","label":"Is a burglar alarm system installed or any other special means of protection adopted? If so state what protection","options":[],"required":null,"pdf_field":""},{"help":"Describe window protection measures","type":"text","label":"Is an inside grill fitted to your Gold and Gems showroom, Window or is any other protection installed against loss by window smashing? If so, state what protection.","options":[],"required":null,"pdf_field":""},{"help":"Indicate if roller shutters protect display windows after hours","type":"yes-no","label":"Are your display windows, protected by Roller Shutter outside business hours?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe door security after hours","type":"text","label":"How are the doors secured outside business hours?","options":[],"required":null,"pdf_field":""},{"help":"Describe window protection","type":"text","label":"How are the windows protected?","options":[],"required":null,"pdf_field":""},{"help":"Describe protection for skylights if present","type":"text","label":"How are Skylights. If any, protected?","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Window Display","fields":[{"help":"Provide max value of single article displayed in window per location","type":"amount","label":"State the approximate maximum value of any one article of jewelery or gem stock which will be displayed in the window (A pad or tray containing a number of rings or other articles to be counted as one article) (Give separate answer for each location). Note: Window display at Night is not covered.","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Stock and Cash Values","fields":[{"help":"Specify stock value and type left outside safes if any","type":"text","label":"Will the whole of your stock when on your premises be kept if safe at night and at all times when the premises are closed? If not state value and class of stock, which will be left outside safes.","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Valuation Basis","fields":[{"help":"State if stock values are cost price or other basis","type":"text","label":"Are the figures in this form compiled on the basis of cost price for your own Stock? If not give details.","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Loss History","fields":[{"help":"Indicate if any past losses occurred","type":"yes-no","label":"Have you ever sustained a loss or losses?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of losses in last 5 years","type":"text","label":"If so, give statement covering past five years with particulars.","options":[],"required":null,"pdf_field":""},{"help":"Provide insurer name and claim payment details","type":"text","label":"Were you insured and if so, give the name of the insurance Company and whether they paid the claim in full or part thereof? (Please state how much)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Property and Stock to be Insured","fields":[{"help":"Describe property insured on premises","type":"text","label":"Property Insured on the premises.","options":[],"required":true,"pdf_field":""},{"help":"Describe property insured in display windows during business hours","type":"text","label":"Property Insured in display windows during business hours","options":[],"required":true,"pdf_field":""},{"help":"Describe property insured in locked safe during business hours","type":"text","label":"Property Insured in Locked safe on the Premises during business hours.","options":[],"required":true,"pdf_field":""},{"help":"Amount of cash and currency notes insured","type":"amount","label":"Cash and Currency Notes.","options":[],"required":true,"pdf_field":""},{"help":"Value of stock and cash kept in safe after hours","type":"amount","label":"Stock including Cash & Currency kept in the safe/strong room after business hours","options":[],"required":true,"pdf_field":""},{"help":"Value of stock held by insured, partners, employees","type":"amount","label":"Stock in the custody of the insured’s, his partners and his employees.","options":[],"required":true,"pdf_field":""},{"help":"Provide details and values of stock in transit by each mode","type":"text","label":"Stock in Transit a) By registered insured post parcel b) By air transit to … c) By Angadia (Specify destination within India only)","options":[],"required":true,"pdf_field":""},{"help":"Value of furniture, fixtures, fittings and safes","type":"amount","label":"Furniture Fixtures, Fitting at premises not used as residence and safes at residence","options":[],"required":true,"pdf_field":""},{"help":"Value of trade equipment per premises","type":"amount","label":"Trade Equipment (Give separate values for each premises to be covered)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"References","fields":[{"help":"Provide two trade references if not renewal","type":"text","label":"Unless proposing for renewal, give two references from your trade.","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Previous Insurance History","fields":[{"help":"Indicate if any insurer cancelled or refused insurance","type":"yes-no","label":"Has any insurer ever cancelled or refused to issue or to continue any insurance for your?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide previous insurer details, coverage and amount","type":"text","label":"Have you been previously insured? If so state with whom, risk covered and for what amount","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signature","fields":[{"help":"Date of signing the proposal","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing the proposal","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Signature of the proposer","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Politically Exposed Person (PEP) Declaration and Consent","fields":[{"help":"Declare if proposer or relatives are Politically Exposed Persons","type":"yes-no","label":"Are you or any of the proposal applicants a PEP* or a close relative of PEP*? If yes, please share the details","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Consent for KYC verification","type":"checkbox","label":"I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through CERSAI records or National Securities Depository Limited Portal for the purpose of undertaking KYC verification.","options":["Yes"],"required":true,"pdf_field":""},{"help":"Declaration of legal source of premium payment","type":"checkbox","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"],"required":true,"pdf_field":""},{"help":"Consent to share personal information with group companies","type":"choice","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":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Jeweller’s Block Insurance policies","attachments":["Statement of floors on which your premises are situated if more than one premises","Statement covering past five years with particulars of losses (if any)","Two trade references (unless proposing for renewal)"],"declarations":["Signing this form does not bind the proposer to complete the insurance but forms the basis of contract if policy is issued.","The proposer confirms the information is true and complete to the best of their knowledge.","Protection and safeguards mentioned shall not be withdrawn or varied without underwriters' consent.","Consent is given for KYC verification through specified portals.","Premiums are declared to be paid from legally acquired sources.","Consent is given or declined for sharing personal information with group companies."],"dropped_labels":5},"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/2533-proposal-form-for-jewellers-block-insurance"}