{"id":2539,"title":"PROPOSAL FORM FOR MONEY INSURANCE","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/money-insurance-policy/Money-Insurance-pf.pdf","sha256":"74ecb7b79699383e9d1fe5f0cb7fd6aea1b87cde12ef27007e16115e056d31f1","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for Money Insurance to be filled by the proposer (policy applicant) to provide details about the insured premises, money in transit, security measures, and other relevant information for underwriting the insurance policy.","notes":["Answer all questions fully and accurately; failure may result in claim rejection or policy avoidance.","Use block letters for name fields.","Attach separate sheet if space is insufficient.","Original bills and documents may be required for claims.","No person shall offer or accept rebates except as allowed by insurer's published prospectus.","Policyholder must keep KYC and bank details updated for service requests.","Disability declaration requires government-issued certificate if applicable."],"title":"PROPOSAL FORM FOR MONEY INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer and Insured Details","fields":[{"help":"","type":"text","label":"Agent / Broker","options":[],"required":null,"pdf_field":""},{"help":"Write full name in block letters","type":"text","label":"Name of Insured (Complete in BLOCK LETTERS)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Street and House No.","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Postal Code, Location","options":[],"required":true,"pdf_field":""},{"help":"Address or description of premises","type":"text","label":"Premises to be insured","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Nature of Business or Trade","options":[],"required":true,"pdf_field":""},{"help":"Select applicable constitution type","type":"choice","label":"Constitution Details","options":["Trader","Manufacturer","Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":null,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN No.","options":[],"required":null,"pdf_field":""},{"help":"Required if premium is Rs.1,00,000 or more","type":"text","label":"Bank Details","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name Of Bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["accept"],"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":"","type":"choice","label":"Do you want to open e-lA account","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","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":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Estimated Money and Transit Details","fields":[{"help":"Provide full addresses","type":"text","label":"Addresses of premises between which the money will be carried","options":[],"required":true,"pdf_field":""},{"help":"Distance in kilometers","type":"number","label":"What is the maximum distance over which the money will be conveyed?","options":[],"required":true,"pdf_field":""},{"help":"List employee categories or names","type":"text","label":"Which employees are authorized by you to and will be carrying money?","options":[],"required":true,"pdf_field":""},{"help":"If yes, provide details","type":"yes-no","label":"Are employees authorized by you to carry/handle money covered under a Fidelity Guarantee Policy?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe carrying method","type":"text","label":"How is money carried? (i.e. whether in bags, trunks etc.)","options":[],"required":true,"pdf_field":""},{"help":"Select applicable transport means","type":"choice","label":"What means of transport do the persons carrying the money use?","options":["own car","public transport","Others"],"required":true,"pdf_field":""},{"help":"If no, state what protection is provided","type":"yes-no","label":"Are the persons carrying the money accompanied by an armed guard/s?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you need cover against Riot & Strike and Terrorist Activities on payment of additional premium?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the safe fixed to the wall or floor?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Number of keys","type":"number","label":"How many keys are necessary to open the safe?","options":[],"required":true,"pdf_field":""},{"help":"If yes, how many people know the combination","type":"yes-no","label":"Is it possible to open the safe by a combination?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Key should not be in the same premises","type":"choice","label":"Where are the keys of the safe or Strong room stored outside the business hours?","options":["outside of the room, where the safe is located, but within the insured building","outside the Insured building"],"required":true,"pdf_field":""},{"help":"If yes or will be installed, provide details and installation timeline","type":"yes-no","label":"Is the insured location protected by a burglary alarm system?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, specify","type":"yes-no","label":"Are there any other security systems or aids deployed?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, specify quarterly, half-yearly or annual maintenance","type":"yes-no","label":"Is the burglary alarm system under a maintenance contract?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide brief description","type":"yes-no","label":"Have you ever sustained any loss of money whilst in transit or whilst in your premises?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, describe prevention measures","type":"yes-no","label":"Have any measures been taken to prevent such damages in future?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"General Questions about Building and Premises","fields":[{"help":"Select applicable use","type":"choice","label":"Use / kind of building","options":["Residential and business building","Business Building","Shop, department store, shopping centre","Barrack, improvised construction","Others"],"required":true,"pdf_field":""},{"help":"If no, mention other occupants","type":"yes-no","label":"Are you the sole occupant of the building?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select applicable location type","type":"choice","label":"Is the building situated in","options":["a pure residential area","a residential cum business area","a shopping street, pedestrian zone","a commercial or industrial area","Others"],"required":true,"pdf_field":""},{"help":"If more than 50 metres, specify distance in meters","type":"choice","label":"Distance of the building from the next permanent occupied building","options":["less than 50 metres","more than 50 metres"],"required":true,"pdf_field":""},{"help":"Select applicable location","type":"choice","label":"The insured rooms are located in","options":["Cellar","Ground floor/1st Floor","Other floor"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Are there doors, windows or other openings reachable by outside bars, stairs, balconies, ramps, scaffolds, facade construction, fire ladders or similar?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, mention number of consecutive days","type":"yes-no","label":"Are the premises at any time left un-occupied?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, specify details","type":"yes-no","label":"Is there any guard at the insured location outside of the daily business hours?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe door protection and locks","type":"text","label":"How are the doors protected? Which kind of locks?","options":[],"required":true,"pdf_field":""},{"help":"Describe protection measures","type":"text","label":"How are the windows and other openings protected?","options":[],"required":true,"pdf_field":""},{"help":"If yes, describe precautions","type":"yes-no","label":"Are there any other special precautions you have adopted for safeguarding your property?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Previous Insurance and Claims History","fields":[{"help":"If yes, provide insurance company name, policy number, period, rate charged, and special terms","type":"yes-no","label":"Has the risk been previously insured?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide details","type":"yes-no","label":"Have you ever claimed against other insurers in respect of money insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, mention insurance company name and policy period","type":"yes-no","label":"Do you have other insurance policies currently (e.g. Fire)?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Select payment mode","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 Signatures","fields":[{"help":"Sign to declare all information is true and complete","type":"signature","label":"Proposer's Signature","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"Agent name and code","type":"text","label":"Name and Code No.","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and agent"},{"title":"Declaration - Physical Proposal Form","fields":[{"help":"Politically Exposed Persons declaration","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":"","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"If yes, provide details and disability certificate","type":"choice","label":"Disability Declaration: Any Physical deformity or handicap","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer and witness"},{"title":"Agent / Intermediary Declaration and Signature","fields":[{"help":"","type":"text","label":"Agent/IMO Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Agent/IMO Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"SP/BQP/DP/PoS Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"SP/BQP/DP/PoS CoR No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"signature","label":"SP/BQP/DP/PoS Signature","options":[],"required":false,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Money Insurance policies","attachments":["Separate sheet if insufficient space to provide relevant information","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability (if applicable)"],"declarations":["The proposer declares that all statements 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 consents to sharing information within group entities.","The proposer confirms premium is paid from legally acquired sources.","The proposer consents to sharing personal information with group companies for services and products.","The proposer agrees to keep policy contact and bank details updated for faster service.","The agent declares having explained the proposal form contents to the proposer in vernacular and confirms the information forms the basis of the contract.","Non-disclosure or untrue statements may lead to policy variation or nullification and forfeiture of premiums."],"dropped_labels":25},"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/2539-proposal-form-for-money-insurance"}