{"id":2537,"title":"MOTOR DEALER PACKAGE COVER:  PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/motor-dealer-package-policy/Motor-Dealer-Package-Policy-pf.pdf","sha256":"0cf3946685b35e759d0e64c5566edeae96c391a822ed4fb051936f4be70877a0","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for motor dealer package insurance to be filled by the proposer (applicant) seeking insurance coverage for their business premises, contents, vehicles, and related risks.","notes":["It is mandatory to keep your policy with updated contact (Mobile No., Email ID and PAN Card) and bank account details to process service requests faster.","Use separate sheets if space is insufficient to provide required information.","Equipments older than 10 years cannot be insured under Breakdown of Business Equipment and Electronic Equipment sections.","Sum insured for building should represent new reinstatement value.","Sum insured for Business Interruption is estimated Gross Profit for next 12 months.","Maximum age for Personal Accident cover is 60 years.","Policy does not cover liability under Public Liability Insurance Act.","Use block letters and provide accurate and complete information to avoid claim rejection or policy avoidance."],"title":"MOTOR DEALER PACKAGE COVER:  PROPOSAL FORM","submit":{"to":"Bajaj General Insurance Limited","how":"","address":"Bajaj Insurance House, Airport Road, Yerawada, Pune - 411 006"},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Name of the Proposer:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address:","options":[],"required":true,"pdf_field":""},{"help":"Attach separate sheet if required","type":"text","label":"Location and address of all premises to be covered:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Occupation / Business Activity:","options":[],"required":true,"pdf_field":""},{"help":"Start date of policy","type":"date","label":"Policy Period: From:","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Tick applicable 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":true,"pdf_field":""},{"help":"Provide registration details if NGO/NPO","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Parts","fields":[{"help":"This section is compulsory","type":"checkbox","label":"COVER 1 - BUILDING AND CONTENTS (EXCLUDING VALUABLES)","options":["Select if required"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Construction of External Walls:","options":["Brick","Concrete","Glass","Asbestos","Others (Please specify)"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Construction of Roof:","options":["Concrete","Asbestos","Tiles","Others (Please specify)"],"required":true,"pdf_field":""},{"help":"In years","type":"number","label":"Age of the building:","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the Building owned by you? :","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you the sole occupant of the Building?:","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of other occupants if not sole occupant","type":"text","label":"If No, who are the other occupants? Please give details:","options":[],"required":false,"pdf_field":""},{"help":"Sum insured should represent new reinstatement value of the building","type":"amount","label":"If you are the owner of the Building please indicate the sum To be insured: Rs","options":[],"required":true,"pdf_field":""},{"help":"Provide sum insured in Rs for each item: Furniture, Fixture and Fittings; Office Equipments (other than Electronic Equipments and Portable Computers covered under Section 7); Cash in safe or locked cupboard; Other items (specify)","type":"table","label":"Contents (Please specify the sum to be insured for contents)","options":[],"required":true,"pdf_field":""},{"help":"Provide sum insured in Rs for Furniture, Fixture and Fittings; Office Equipments (other than Electronic Equipments and Portable Computers covered under Section 7); Cash in safe or locked cupboard; Cash in Till /counter; Other items (specify)","type":"table","label":"Please give break up of sum to be insured:","options":[],"required":false,"pdf_field":""},{"help":"Answer the following questions","type":"group","label":"COVER 3 – DAMAGE TO MOTOR VEHICLES","fields":[{"help":"","type":"amount","label":"Please specify the maximum value of the model of the Vehicle handled by you?","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"What is the Any One Incident Limit:","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"What is the annual limit:","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you provide pick & drop facility to customers?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Did you have or are you having any Insurance Policy for this Cover with any other Insurer?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you ever suffered any losses due to damage to motor vehicle by an employee or by a customer, while driving a motor vehicle for a trial run?","options":["Yes","No"],"required":true,"pdf_field":""}],"options":[],"required":false,"pdf_field":""},{"help":"Answer the following questions","type":"group","label":"COVER 4 – NEON SIGN","fields":[{"help":"","type":"text","label":"Please give the location of the Neon Sign in the insured Premises:","options":[],"required":true,"pdf_field":""},{"help":"Year","type":"number","label":"What is the year of installation:","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"What is the estimated Reinstatement Cost:","options":[],"required":true,"pdf_field":""}],"options":[],"required":false,"pdf_field":""},{"help":"Answer the following questions","type":"group","label":"COVER 5 – BUSINESS INTERRUPTION","fields":[{"help":"","type":"amount","label":"What is the Turnover for last 12 months:","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"What is the estimated Turnover for next 12 months:","options":[],"required":true,"pdf_field":""},{"help":"Estimated Gross Profit for next 12 months (Turnover less purchases and other variable business expenses)","type":"amount","label":"What is the sum to be insured:","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"What is the indemnity period opted (Max 12 months) :","options":["6 months","9 months","12 months"],"required":true,"pdf_field":""}],"options":[],"required":false,"pdf_field":""},{"help":"List equipment older than 10 years cannot be insured; sum insured should be new replacement value; columns: Sr. No., Description of the equipment, Type and Capacity, Year of Manufacture and Name of Manufacturer, Sum to be Insured (Rs). Attach separate sheet if required.","type":"table","label":"COVER 6 – BREAKDOWN OF BUSINESS EQUIPMENT","options":[],"required":false,"pdf_field":""},{"help":"Answer the following questions","type":"group","label":"COVER 7 – MONEY INSURANCE","fields":[{"help":"","type":"text","label":"Please specify the locations between which the transit Of money to be covered?","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"What is the Any One Transit Limit","options":[],"required":true,"pdf_field":""}],"options":[],"required":false,"pdf_field":""},{"help":"Provide details of plate glass to be insured","type":"group","label":"COVER 8 - PLATE GLASS","fields":[{"help":"","type":"text","label":"Position of each square of pane of glass","options":[],"required":true,"pdf_field":""},{"help":"Provide height and width in cm","type":"text","label":"Size of each square of pane of glass (Height in cm, Width in cm)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Description of glass (State whether plain, plate or plain sheet, silvered, embossed, stained, bent or ornamental etc)","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"Value (Rs)","options":[],"required":true,"pdf_field":""},{"help":"","type":"number","label":"How many transits take place in a month:","options":[],"required":true,"pdf_field":""},{"help":"","type":"number","label":"What is the estimated Annual Transit:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"What is the mode of transit:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Please specify security provided, if any?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether casual employees are used for carrying money?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide details","type":"yes-no","label":"Is there any plate glass in the insured premises that is Not included in the above?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Is there at present any broken or damaged plate glass? If Yes, please describe the position and size","options":[],"required":false,"pdf_field":""}],"options":[],"required":false,"pdf_field":""},{"help":"Equipments older than 10 years cannot be insured; sum insured should be new replacement value; specify external data media to insure; columns: Sr. No., Description of the equipment, Type and Capacity, Year of Manufacture and Name of Manufacturer, Sum to be Insured (Rs). Attach separate sheet if required.","type":"table","label":"COVER 9 – ELECTRONIC EQUIPMENT","options":[],"required":false,"pdf_field":""},{"help":"Answer the following questions","type":"group","label":"COVER 10 – FIDELITY GUARANTEE","fields":[{"help":"Attach separate sheet if necessary with date, circumstances, amount of loss","type":"text","label":"Have there been any reported losses (insured or not) due to fraud or dishonesty of employees, partners or directors during last five years? Yes/No. If yes provide details","options":[],"required":false,"pdf_field":""},{"help":"","type":"table","label":"Details of Employees to be covered: Category of staff, No. of employees, Employee Sum Insured (Rs)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Please specify which of the equipments are covered under: Maintenance agreement?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is there a requirement of dual signatories for cheques issuance, and is such requirement met?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do the employees who receive cash and cheques in the course of their duties issue pre-numbered official receipts as confirmation of the receipt?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are all the cash and cheques received banked in daily or at the latest the next banking day? If no please specify","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Is there an imprest system for handling of petty cash funds? If yes, specify persons authorised to manage petty cash funds.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"What is the system of operation of Bank account followed and what are the precautions taken?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether such payments/withdrawals are authorized by a senior employee and compared with supporting documents?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"How often are the bank reconciliations and check of receipt counterfoils and vouchers being carried out?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Under what circumstances will your customers qualify for credit privileges?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"How often is the balancing and control of debtor accounts with statements sent to all debtors?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are there stocks (of any kind) kept for the conduct of your business?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"How often are stock-takings conducted?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Please list the persons responsible for carrying out stock-taking","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are all deliveries to and from stores properly authorised?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"When was the last stock audit undertaken, by whom, and what did it reveal?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"When was the proposer last audited, by whom, and what did the audit reveal?","options":[],"required":false,"pdf_field":""}],"options":[],"required":false,"pdf_field":""},{"help":"Provide details of employees to be covered and cover opted. Maximum age 60 years. Attach separate sheet if required.","type":"group","label":"COVER 11 – PERSONAL ACCIDENT","fields":[{"help":"","type":"text","label":"Name of the Employee","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"Monthly Salary","options":[],"required":true,"pdf_field":""},{"help":"Sum insured per employee restricted to specified times monthly salary","type":"amount","label":"Sum Insured (Rs)","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Coverage Required","options":["Part A for Death only","Part A & B for Death and Permanent Total Disability","Part A, B & C for Death, Permanent Total Disability and Permanent Partial Disability","Add Part D if Temporary Disability is opted (only if A,B and C are opted)"],"required":true,"pdf_field":""}],"options":[],"required":false,"pdf_field":""},{"help":"Coverage is for 5% of the sum insured under Section 1","type":"yes-no","label":"COVER 12 – OMISSION TO INSURE ADDITIONS UNDER COVER 1","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Coverage is for maximum 24 months","type":"group","label":"COVER 13 – ADDITIONAL EXPENSES FOR RENT","fields":[{"help":"","type":"yes-no","label":"Do you wish to opt this extension?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"What is the extent of cover required","options":["12 months","18 months","24 months"],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"What is the sum insured opted? : Rs.","options":[],"required":false,"pdf_field":""}],"options":[],"required":false,"pdf_field":""},{"help":"Liability under Public Liability Insurance Act is not covered. Select limits to be insured.","type":"group","label":"COVER 14 – PUBLIC LIABILITY & WORKMEN COMPENSATION","fields":[{"help":"","type":"amount","label":"Please select the limit to be insured per accident : Rs.","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Please select the limit to be insured in the aggregate : Rs.","options":[],"required":false,"pdf_field":""},{"help":"Provide details of workers and wages","type":"table","label":"PLEASE ANSWER THE FOLLOWING IF WC COVER IS REQUIRED. Category/ Position, No. of workers, Annual wages","options":[],"required":false,"pdf_field":""}],"options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signature","fields":[{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Proposer’s Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations – Physical Proposal Form","fields":[{"help":"PEP means 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":"","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":true,"pdf_field":""},{"help":"","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":true,"pdf_field":""},{"help":"","type":"yes-no","label":"I/We hereby give voluntary consent to BGIL/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":"Motor Dealer Package Policy","attachments":["Separate sheet if insufficient space to provide relevant information","Separate sheet for Constitution Details if Others specified","Separate sheet for additional details in Coverage sections where required","Separate sheet for Fidelity Guarantee loss details if necessary","Separate sheet for Personal Accident employee details if required"],"declarations":["The statements made in the proposal are true and complete and form the basis of the 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 as if uninsured.","The proposer allows the company to share information collected in this proposal within group entities.","The liability of the company does not commence until the proposal is accepted and full premium paid.","No person shall offer or accept any rebate of commission or premium except as allowed by published prospectuses or tables.","Failure to comply with the Insurance Act provisions may result in penalty up to ten lakhs rupees.","Consent to verify identity/address proof through specified government portals for KYC.","Declaration that premium is paid from legally acquired sources and future premiums will be similarly paid.","Voluntary consent to share personal information with group companies for products and services."],"dropped_labels":2},"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/2537-motor-dealer-package-cover-proposal-form"}