{"id":2551,"title":"COMMERCIAL PACKAGE POLICY- LAGHU UDYAM SURAKSHA: PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/commercial-pf/COMMERCIAL-PACKAGE-POLICY-Laghu-Udyam-Suraksha-Proposal-form.pdf","sha256":"356eac9e7080e72a7a6457860b5721c4627ea632209cf31e2a7b71b93b9626f6","pages":12,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for insurance under the Commercial Package Policy - Laghu Udyam Suraksha, to be filled by the proposer (policyholder) seeking insurance coverage for their business assets and risks.","notes":["This proposal is for enterprises with insurable assets between Rs. 5 Crore and Rs. 50 Crore.","Read the Prospectus/Key Features Document/Policy Wordings before filling the form.","The property is not covered until the proposal is accepted and premium is paid.","Attach separate sheets if space is insufficient for any information.","Use original and accurate information to avoid claim rejection or policy avoidance.","Keep policy updated with mobile number, email ID, PAN card, and bank details for faster service.","The form must be signed by the proposer and witnessed if filled by someone else.","Agent must fill and sign their declaration and provide license details."],"title":"COMMERCIAL PACKAGE POLICY- LAGHU UDYAM SURAKSHA: PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter your residential phone number","type":"phone","label":"Telephone (Res.)","options":[],"required":false,"pdf_field":""},{"help":"Enter your mobile phone number","type":"phone","label":"Mobile No","options":[],"required":true,"pdf_field":""},{"help":"Enter your email address","type":"email","label":"E-Mail","options":[],"required":false,"pdf_field":""},{"help":"Provide nominee details including relation and appointee if nominee is minor","type":"text","label":"Nominee Details: Name DOB (dd/mm/yyyy) Age Relation Nominee* Appointee (If nominee is minor) If Nominee is \"Others\" please specify the relation and reason for such nomination","options":[],"required":null,"pdf_field":""},{"help":"Provide bank details for claim payments","type":"text","label":"Bank Details Name as pr Bank Name Of Bank Bank Account No. IFSC Code * I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":[],"required":true,"pdf_field":""},{"help":"Provide e-Insurance Account number or indicate if you want to open one","type":"choice","label":"Electronic-Insurance Account: Please provide e-lA No. to deposite your insurance policy. Do you want to open e-lA account: Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"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":[],"required":null,"pdf_field":""},{"help":"Enter your occupation or business type","type":"text","label":"Occupation/Business","options":[],"required":null,"pdf_field":""},{"help":"Provide contact person details if proposer is not an individual","type":"text","label":"Contact person details, if not an individual: a. Name b. Designation","options":[],"required":null,"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":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Indicate if proposer is a partnership firm","type":"yes-no","label":"Partnership Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if proposer is a limited liability or partnership firm","type":"yes-no","label":"Limited Liability/Partnership Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if proposer is NGO/NPO and provide DARPAN registration if applicable","type":"yes-no","label":"NGO/NPO - Provide DARPAN Portal Registration, if applicable","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if proposer is a company","type":"yes-no","label":"Company","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if proposer is a trust","type":"yes-no","label":"Trust","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if proposer is a society","type":"yes-no","label":"Society","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if proposer is a Section 8 company","type":"yes-no","label":"Section 8 Company","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if proposer is a proprietorship firm","type":"yes-no","label":"Proprietorship Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify other constitution type if applicable","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Period of Insurance","fields":[{"help":"Enter insurance start date","type":"date","label":"From","options":[],"required":true,"pdf_field":""},{"help":"Enter insurance end date","type":"date","label":"To","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Details","fields":[{"help":"Tick if you want this cover and fill annexure","type":"checkbox","label":"SECTION 1 : STANDARD FIRE & SPECIAL PERILS COVER - Note: Kindly fill Annexure attached to this proposal for opting cover under this section.","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Would you like to opt for a cover on a first loss basis @ 25% of the total value at risk? YES/NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Would you like to opt for a Theft extension cover? YES/NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Indicate if 24-hour security is provided and details if yes","type":"text","label":"Whether 24 hours security provided for the building? YES/NO If yes, please give details","options":[],"required":null,"pdf_field":""},{"help":"Indicate if burglar alarm is provided and details if yes","type":"text","label":"Whether any burglar alarm or similar security devices are provided? YES/NO If yes, please give details","options":[],"required":null,"pdf_field":""},{"help":"Enter amount limit per transit","type":"amount","label":"Any One Transit Limit","options":[],"required":null,"pdf_field":""},{"help":"Enter number of transits per month","type":"number","label":"How many transits take place in a month?","options":[],"required":null,"pdf_field":""},{"help":"Enter estimated annual transit amount","type":"amount","label":"Estimated Annual Transit","options":[],"required":null,"pdf_field":""},{"help":"Describe mode of transit","type":"text","label":"Mode of transit","options":[],"required":null,"pdf_field":""},{"help":"Describe security measures","type":"text","label":"Security provided, if any","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Whether casual employees are used for carrying money? YES/NO","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Is there a daily written record of the money in transit and is it updated every day? YES/NO","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Enter sum insured for cash in safe if yes","type":"amount","label":"Do you want to cover cash in safe/strong room? YES/NO If yes, sum to be insured","options":[],"required":null,"pdf_field":""},{"help":"Enter sum insured for cash in till if yes","type":"amount","label":"Do you want to cover cash in till/counter? YES/NO If yes, sum to be insured","options":[],"required":null,"pdf_field":""},{"help":"Describe any additional plate glass","type":"text","label":"Is there any plate glass in the insured premises not included above? YES/NO If yes, describe position and size","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Describe broken or damaged plate glass","type":"text","label":"Is there at present any broken or damaged plate glass? YES/NO If yes, describe position and size","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide breakdown and repair cost history","type":"text","label":"Provide details of breakdown and repair cost incurred during last 3 years for above equipments","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"SECTION 7: ELECTRONIC EQUIPMENTS INSURANCE COVER - Do you wish to opt for this cover? YES/NO","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide breakdown and repair cost history","type":"text","label":"Provide details of breakdown and repair cost incurred during last 3 years for above equipments","options":[],"required":false,"pdf_field":""},{"help":"Indicate if cover for external data media is required and provide value","type":"amount","label":"Do you require cover for external data media? YES/NO If yes, provide reinstatement value","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Do you require cover for reproduction of data lost following indemnifiable damage? YES/NO","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Do you wish to opt for Terrorism cover? YES/NO","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Indicate reference system or practice","type":"text","label":"Is there a system to obtain references from previous employers? YES/NO If not, specify practice followed","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Has there been any occasion to question honesty or conduct of any person proposed for guarantee? YES/NO If yes, provide details","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Describe independent checking system","type":"text","label":"What independent system is there to check that all sums received by employees are accounted for?","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Do you wish to opt for Medical Expenses cover? YES/NO","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Do you wish to opt for Hospital Confinement cover? YES/NO","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Enter indemnity limits","type":"amount","label":"Please provide the limit to indemnity required for any one accident and any one year: Rs.","options":[],"required":null,"pdf_field":""},{"help":"Describe security measures","type":"text","label":"Are there any security measures to prevent accidents? YES/NO If yes, provide details","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide breakdown and repair cost history","type":"text","label":"Provide details of breakdown and repair cost incurred during last 3 years for above equipments","options":[],"required":false,"pdf_field":""},{"help":"Enter estimated turnover","type":"amount","label":"Estimated turnover for next 12 months (Rs.)","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured (estimated gross profit)","type":"amount","label":"Sum to be insured (Rs.)","options":[],"required":false,"pdf_field":""},{"help":"Select indemnity period","type":"choice","label":"Indemnity period opted (6 months / 9 months / 12 months)","options":["6 months","9 months","12 months"],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Do you wish to opt for terrorism cover extension? YES/NO (only if opted under Section 1)","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Mode of Payment","fields":[{"help":"Provide cheque details if paying by cheque","type":"text","label":"By Cheque: Cheque No. Bank Branch","options":[],"required":null,"pdf_field":""},{"help":"Provide cash amount if paying by cash","type":"amount","label":"By Cash","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Previous Insurance Details","fields":[{"help":"Indicate if previous policy was with Bajaj General Insurance","type":"yes-no","label":"Is your previous insurance policy with Bajaj General Insurance? YES/NO","options":["YES","NO"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Warranty","fields":[{"help":"Agree to safety precautions","type":"checkbox","label":"I/We undertake to exercise all ordinary and reasonable precautions for safety of the property as if uninsured.","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration - Physical Proposal Form","fields":[{"help":"Sign and date the form","type":"signature","label":"Signature of Proposer, Date, Place","options":[],"required":true,"pdf_field":""},{"help":"Declare any disability and provide certificate","type":"text","label":"Disability Declaration: Any Physical deformity or handicap? Yes/No If yes, provide details and disability certificate","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Agent/Intermediary Declaration","fields":[{"help":"Provide agent license number","type":"text","label":"IRDAI COR No./ License No.","options":[],"required":true,"pdf_field":""},{"help":"Agent signs and dates","type":"signature","label":"Signature of Agent, Date, Place","options":[],"required":true,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Enterprises with total insurable assets at a location exceeding Rs. 5 Crore but not exceeding Rs. 50 Crore, covering various business and property risks.","attachments":["Annexure attached to this proposal for opting cover under Section 1","Separate sheets wherever required for details of risk locations, breakdown and repair costs, neon signs, electronic equipment, fidelity guarantee, group personal accident, public liability, workmen's compensation, portable equipment, baggage insurance, pedal cycles, business interruption, and any other additional information"],"declarations":["The statements and particulars given in this proposal form are complete, true and accurate to the best of my/our knowledge and belief.","I/We agree to inform the Company of any changes in material facts after submission of this proposal.","The contract of insurance will be effective only upon Company's acceptance and receipt of premium.","I/We undertake to exercise all ordinary and reasonable precautions for safety of the property as if uninsured.","I/We declare that the premium has been paid from legally acquired sources and subsequent premiums will be paid similarly.","I/We consent to verification of identity/address proof through specified portals for KYC purposes.","I/We consent to sharing personal information with group companies for insurance and related services.","I/We agree to keep policy updated with contact and bank details for faster service.","The contents of this form have been explained in vernacular and understood by the proposer.","Agent declares that the proposal form contents have been explained to the proposer and understood."],"dropped_labels":59},"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/2551-commercial-package-policy-laghu-udyam-suraksha-proposal-form"}