{"id":2538,"title":"Office Package Insurance - Proposal Form","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/office-package-insurance/Office-Package-Policy-pf.pdf","sha256":"f8a9fae1cc88443cb000bb34bdd5bc4153d74f5832a167c210e5ccfd85660a23","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (potential policyholder) to apply for an Office Package Insurance policy with Bajaj General Insurance Limited. The proposer fills it to provide details about themselves, their business premises, nominee, and coverage requirements.","notes":["The issue of this form is not an admission of liability.","Answer all questions fully and accurately; attach separate sheets if needed.","Nominee for self must be one of the specified relations.","Policy liability starts only after acceptance of proposal and full premium payment.","Use original documents for claims processing as required.","Keep policy contact and bank details updated for faster service.","The form includes a physical proposal declaration and agent declaration sections.","The form must be signed and dated by proposer, witness, authorised representative (if any), and agent/intermediary."],"title":"Office Package Insurance - Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter full name of the proposer","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Enter contact phone number","type":"phone","label":"Phone No.","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"e-mail","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premises to be Covered","fields":[{"help":"Enter address of first premises","type":"text","label":"Location and address of all premises to be covered : (Please attach separate sheet, if required) 1.","options":[],"required":true,"pdf_field":""},{"help":"Enter address of second premises if any","type":"text","label":"Location and address of all premises to be covered : (Please attach separate sheet, if required) 2.","options":[],"required":false,"pdf_field":""},{"help":"Enter address of third premises if any","type":"text","label":"Location and address of all premises to be covered : (Please attach separate sheet, if required) 3.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Enter nominee's full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's date of birth in dd/mm/yyyy format","type":"date","label":"DOB (dd/mm/yyyy)","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's age","type":"number","label":"Age","options":[],"required":true,"pdf_field":""},{"help":"Enter relation of nominee to proposer","type":"text","label":"Relation","options":[],"required":true,"pdf_field":""},{"help":"Select nominee relation from given options","type":"checkbox","label":"Nominee*","options":["Father","Mother","Son","Daughter","Spouse","Others"],"required":true,"pdf_field":""},{"help":"Enter name of appointee if nominee is minor","type":"text","label":"Appointee (If nominee is minor)","options":[],"required":false,"pdf_field":""},{"help":"Specify relation and reason if nominee is 'Others'","type":"text","label":"If Nominee is \"Others\" please specify the relation and reason for such nomination:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details","fields":[{"help":"Enter name as per bank records","type":"text","label":"Name as pr Bank","options":[],"required":true,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name Of Bank","options":[],"required":true,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"Enter bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Tick to accept payment through above bank account","type":"checkbox","label":"* I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic-Insurance Account","fields":[{"help":"Enter e-Insurance Account number if available","type":"text","label":"Please provide e-IA 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-IA account:","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Existing Customer Details","fields":[{"help":"Select Yes or No","type":"choice","label":"Are you an existing customer of BGeneral?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter PID number if existing customer","type":"text","label":"If Yes, please provide PID No:","options":[],"required":false,"pdf_field":""},{"help":"Enter policy number if existing customer","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Tick if 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":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Occupation and Policy Period","fields":[{"help":"Enter occupation or business activity","type":"text","label":"Occupation / Business Activity","options":[],"required":true,"pdf_field":""},{"help":"Enter policy start date","type":"date","label":"Policy Period From","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Part","fields":[{"help":"This section is compulsory; tick to opt for this cover","type":"checkbox","label":"Cover 1 A - Building and Contents (Excluding Valuables)","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No; if Yes, fill annexure","type":"choice","label":"Cover 11 - Hospital Cash Allowance: Do you opt for this cover?","options":["Yes","No"],"required":false,"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":true,"pdf_field":""},{"help":"Select who gave the cheque","type":"choice","label":"Cheque - Given by","options":["Spouse","Father","Mother","Son/Daughter","Employer/Employee","Financier"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Warranty","fields":[{"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":"Sign the form","type":"signature","label":"Proposer's Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration - Physical Proposal Form","fields":[{"help":"Select Yes or No","type":"choice","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if PEP","type":"text","label":"If yes, please share the details","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","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":"Select Yes or No","type":"choice","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":"Select Yes or No","type":"choice","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","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Sign here","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","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Witness Details","fields":[{"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":""}],"filled_by":"witness"},{"title":"Disability Declaration","fields":[{"help":"Select Yes or No","type":"choice","label":"Any Physical deformity or handicap","options":["Yes","No"],"required":true,"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":"Authorised representative to fill name and confirm understanding","type":"text","label":"I ________________ authorised representative of Mr./Miss/Mrs. ________________ hereby giving consent on the behalf of the proposer due to his/her disability, that he/she has understood the content of this form and its particulars and confirmed the same.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Authorised Representative Details","fields":[{"help":"Enter name","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Enter date","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Enter place","type":"text","label":"Place","options":[],"required":false,"pdf_field":""}],"filled_by":"authorised representative"},{"title":"Agent / Intermediary Declaration","fields":[{"help":"Agent to fill name and confirm explanation","type":"text","label":"I, ______________________________ acting in my capacity as an Insurance Advisor/Specified Person of the Corporate Agent/Authorized Employee of the Broker/Relationship Officer, hereby declare that I have explained all the contents of this Proposal Form, including the nature of the questions contained herein, to the Proposer in their vernacular language, if required.","options":[],"required":true,"pdf_field":""},{"help":"Enter 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 signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signature","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter agent or IMD name","type":"text","label":"Agent/IMD Name","options":[],"required":false,"pdf_field":""},{"help":"Enter agent or IMD code","type":"text","label":"Agent/IMD Code","options":[],"required":false,"pdf_field":""},{"help":"Agent or IMD signature","type":"signature","label":"Agent/IMD Signature","options":[],"required":false,"pdf_field":""},{"help":"Enter SP/BQP/DP/PoS name","type":"text","label":"SP / BQP / DP / PoS Name","options":[],"required":false,"pdf_field":""},{"help":"Enter SP/BQP/DP/PoS CoR number","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 or intermediary"}],"deadlines":[],"applies_to":"Office Package Insurance policies","attachments":["Separate sheet for additional premises addresses if required","Annexure for Hospital Cash Allowance cover if opted","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability"],"declarations":["The proposer declares all statements are true and complete and agrees to pay premium and accept policy conditions.","The proposer agrees to exercise reasonable precautions for safety of the property.","The proposer allows the company to share information within group entities.","The proposer confirms no rebate or inducement has been offered or accepted in violation of Section 41 of Insurance Act, 1938.","The proposer consents to KYC verification through specified government portals.","The proposer declares premiums are paid from legally acquired sources.","The proposer consents to sharing personal information with group companies for services and products.","The proposer confirms understanding of the form content and particulars, including by authorised representative if applicable.","The agent/intermediary declares having explained the form contents to the proposer and understands consequences of non-disclosure or untrue statements."],"dropped_labels":1},"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/2538-office-package-insurance-proposal-form"}