{"id":2550,"title":"GROUP AFFINITY INSURANCE POLICY - PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/group-affinity-insurance-policy/Group-Affinity-Insurance-Policy-pf.pdf","sha256":"71a71d7457454ca1ac9930f11c2d5989627f1534461854b9713238f4ded59e95","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for a group affinity insurance policy to be filled by the proposer who is applying for insurance coverage for a group or association.","notes":["Answer all questions fully and accurately; attach separate sheet if space is insufficient.","Use block letters where applicable.","Attach all required documents as specified.","Section 1 cover is mandatory for group policy.","Coverage offered to all members of the group shall be identical and cannot vary for individual members.","For long term policy, period shall not exceed 10 years.","Keep policy updated with contact and bank details for hassle-free service.","Valuation certificate requirement is waived if sum insured is up to 5 Lakh and individual item value does not exceed 1 Lakh.","This proposal form is also deemed to be proposal form for renewal of cover from time to time."],"title":"GROUP AFFINITY INSURANCE POLICY - PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Full name of the proposer; if a company, provide full incorporated name; if proprietorship or partnership, provide respective names.","type":"text","label":"Name of the Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"Provide PAN or TAN number as applicable.","type":"text","label":"PAN/TAN Number","options":[],"required":true,"pdf_field":""},{"help":"Full postal address including state and pin code.","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"Provide a valid email address.","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Provide contact telephone number.","type":"phone","label":"Telephone Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details","fields":[{"help":"Name as per bank records.","type":"text","label":"Name as pr Bank","options":[],"required":true,"pdf_field":""},{"help":"Name of the bank.","type":"text","label":"Name Of Bank","options":[],"required":true,"pdf_field":""},{"help":"Bank account number for claim payments.","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"IFSC code of the bank branch.","type":"text","label":"IFSCCode","options":[],"required":true,"pdf_field":""},{"help":"Tick to accept payment and receipt of claim amount in the above bank account.","type":"checkbox","label":"* I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["accept"],"required":true,"pdf_field":""},{"help":"Provide e-lA number if applicable.","type":"text","label":"Electronic-Insurance Account","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"choice","label":"Do you want to open e-lA 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 exisiting customer of BGI L?","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":"Select Yes or No.","type":"yes-no","label":"Partnership Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"yes-no","label":"Limited Liability/Partnership Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No and provide DARPAN registration if Yes.","type":"yes-no","label":"NGO/NPO - Provide DARPAN Portal Registration, if applicable","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"yes-no","label":"Company","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"yes-no","label":"Trust","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"yes-no","label":"Society","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"yes-no","label":"Section 8 Company","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"yes-no","label":"Proprietorship Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify other constitution if applicable.","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Group Details","fields":[{"help":"Provide details of the group or association.","type":"text","label":"Please mention detail of the Group/ Association/ Institution/ Corporate Body whose members are being covered under the Policy ?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No.","type":"choice","label":"Is the group being formed with the sole purpose of obtaining Insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain relationship if group not solely for insurance.","type":"text","label":"If answer to Question 6 is \"No\" please mention the relationship between the members and the group manager for services other than Insurance","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"choice","label":"Please state whether all members of the Group/ Association/ Institution/ Corporate Body are proposed for Insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select who will bear the premium.","type":"choice","label":"If answer to Question 8 is \"Yes\" kindly specify who shall bear the premium?","options":["Group Manager","Members of Group"],"required":false,"pdf_field":""},{"help":"Provide initial number of persons covered.","type":"number","label":"Please mention the total number of persons to be covered initially:","options":[],"required":true,"pdf_field":""},{"help":"Provide expected number of persons during policy period.","type":"number","label":"Please mention the expected no of persons to be covered during the policy period?","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured Beneficiary & Insured Asset Details","fields":[{"help":"Provide details including Name, Nature of Beneficiary, Aadhar and PAN Number, Insured Property Details (make, model, type, serial/IMEI number), Address, Invoice Number and Date, Owned/Leased, Co-Pay if opted, Sum Insured, Cover Period.","type":"table","label":"Insured Beneficiary & Insured Asset Details","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No.","type":"yes-no","label":"Cover Period for individual members of the group can be identical or may vary for different members of the group","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Selection","fields":[{"help":"Select all applicable covers; Section 1 is mandatory.","type":"checkbox","label":"Please select coverage required under the group policy:","options":["Section 1 - Standard Fire and Special Perils (Mandatory cover)","Section 2 - Burglary and Robbery Cover","Section 3 - Breakdown Cover","Section 4 - Accidental Damage Cover","Extension 1 - Theft Cover","Extension 2 - Terrorism Damage Cover","Extension 3 - Worldwide Cover"],"required":true,"pdf_field":""},{"help":"Provide number of cities.","type":"number","label":"Kindly mention the number of cities within India where the products will be sold by you?","options":[],"required":false,"pdf_field":""},{"help":"Provide if deviation from standard scale is required.","type":"text","label":"Depreciation schedule applicable to Total Loss Claims","options":[],"required":false,"pdf_field":""},{"help":"Provide any other relevant information.","type":"text","label":"Additional Information (if any)","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"choice","label":"Has any company/Insurer in respect of Insurance Declined Your Proposal?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"choice","label":"Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"choice","label":"Past Claims Experience, if any","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide Date of Occurrence, Details of loss, Amount of loss (In Rs), Name of the Insurer & Policy Number.","type":"table","label":"If yes please provide details below","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Proposer","fields":[{"help":"Sign and date the form.","type":"signature","label":"Signature of the Proposer","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":""}],"filled_by":"proposer"},{"title":"Annexure - Section 1: Standard Fire and Special Perils Cover (Mandatory)","fields":[{"help":"Full name of proposer.","type":"text","label":"Name of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Full postal address.","type":"text","label":"Address of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Email address.","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"List all parties with insurable interest.","type":"text","label":"Policy to be issued in favour of (list out all the parties who have insurable interest) including the financial institutions","options":[],"required":true,"pdf_field":""},{"help":"Specify number of years if long term policy.","type":"number","label":"No of Years in case of long term policy","options":[],"required":false,"pdf_field":""},{"help":"Name of nominee.","type":"text","label":"Nominee Name","options":[],"required":false,"pdf_field":""},{"help":"Relationship of nominee with insured.","type":"text","label":"Relationship with the insured","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"choice","label":"Is there any policy in place for the same property?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of existing policy if any.","type":"text","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Select the cover required.","type":"choice","label":"Cover/s required","options":["Home Building & Home Contents","Home Building Only","Home Contents Only"],"required":true,"pdf_field":""},{"help":"Provide full address including pin code.","type":"text","label":"Location of Home Building - full postal address with Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Select the type of building.","type":"choice","label":"Is it in a multi-storey building or is it a standalone house?","options":["Multi-storey","Standalone"],"required":true,"pdf_field":""},{"help":"Provide floor number if applicable.","type":"number","label":"In case of multi-storey building, please provide the floor number of Your house","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"yes-no","label":"Is there a basement to Your house?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Amount required to construct the home building at policy commencement date.","type":"amount","label":"Sum Insured (SI) for Home Building","options":[],"required":true,"pdf_field":""},{"help":"Provide carpet area in square meters.","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":true,"pdf_field":""},{"help":"Provide prevailing rate of cost of construction.","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date","options":[],"required":true,"pdf_field":""},{"help":"Sum insured for residential structure.","type":"amount","label":"SI for residential structure of Your Home including fittings and fixtures (in ₹)","options":[],"required":true,"pdf_field":""},{"help":"Sum insured for additional structures.","type":"amount","label":"SI for additional structures (in ₹)","options":[],"required":false,"pdf_field":""},{"help":"Select age category of home building.","type":"choice","label":"Age of Home Building","options":["Less than 5 years","5 - 10 years","10 - 20 years","Above 20 years"],"required":true,"pdf_field":""},{"help":"Provide sum insured for furniture, fixtures, fittings, electrical/electronic items, and others.","type":"table","label":"Item wise Sum Insured for General Contents (in ₹)","options":[],"required":false,"pdf_field":""},{"help":"Provide sum insured for basement contents if any.","type":"amount","label":"In case of Basement, If there are contents in it, please provide the Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No.","type":"choice","label":"Do You require 'Personal Accident Cover' for Yourself and Your spouse?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No and attach list of items and sum insured if Yes.","type":"choice","label":"Do You require 'Cover for Valuable Contents on Agreed Value Basis (under Home Contents cover)'?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach valuation certificate if required.","type":"choice","label":"Valuation certificate attached?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide Date of Loss, Cause of Loss, Claimed Amount, Settled Amount or specify if claim is outstanding.","type":"table","label":"Claims details - Please specify details of any loss to the proposed Property in last 3 years","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Consent","fields":[{"help":"Sign the declaration.","type":"signature","label":"Signature of the Proposer","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":""}],"filled_by":"proposer"},{"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":"Sign the declaration.","type":"signature","label":"Signature of Proposer","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":"Name of witness if applicable.","type":"text","label":"Name of Witness","options":[],"required":false,"pdf_field":""},{"help":"Signature of witness if applicable.","type":"signature","label":"Signature of Witness","options":[],"required":false,"pdf_field":""},{"help":"Declare any physical disability.","type":"choice","label":"Disability Declaration - Any Physical deformity or handicap","options":["Yes","No"],"required":false,"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":"If proposer is disabled, name of authorized representative.","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorized representative.","type":"signature","label":"Signature of Authorised Representative","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Agent/Intermediary Declaration","fields":[{"help":"Agent/intermediary 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 and code details.","type":"text","label":"Agent / IMD (SP/DP/ BQP) signature and their code","options":[],"required":false,"pdf_field":""},{"help":"Name of SP/BQP/DP/PoS.","type":"text","label":"SP/ BQP /DP/ PoS Name","options":[],"required":false,"pdf_field":""},{"help":"Code 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":"Group Affinity Insurance Policy","attachments":["Separate sheet if insufficient space to provide relevant information","Annexure attached to this proposal for opting the cover under section 1","List of items and Sum Insured for Valuable Contents if opting for Agreed Value Basis cover","Valuation Certificate if Sum Insured for Valuable Contents exceeds 5 Lakh or individual item value exceeds 1 Lakh","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability"],"declarations":["The statements and particulars given in this proposal form are true and complete to the best of the proposer's knowledge and belief.","The information provided will form the basis of the insurance policy and is subject to the Company's underwriting policy.","Any incorrect, untrue, or misleading information may lead to rejection of claim and cancellation of policy with forfeiture of premium.","The proposer agrees to immediately inform the Company of any changes after submission of this proposal form.","The contract of insurance is effective only upon Company's acceptance and receipt of full premium.","The salient features, terms and conditions have been explained in vernacular language and agreed by the proposer.","No person shall offer or accept any rebate in violation of Insurance Act 1938 Section 41.","The proposer consents to verification of identity/address proof through specified government portals.","The premium has been paid from legally acquired sources of income.","The proposer consents to sharing personal information with group companies or others for insurance related purposes.","The proposer agrees to keep policy contact and bank details updated for faster service.","The agent/intermediary declares having explained all contents of the proposal form to the proposer in vernacular language."],"dropped_labels":17},"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/2550-group-affinity-insurance-policy-proposal-form"}