{"id":2552,"title":"EDUCATION 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/EDUCATION-PACKAGE-POLICY-Laghu-Udyam-Suraksha-Proposal-form.pdf","sha256":"7ea921c059c79acb98c5db61b995470af3b1b8621cd35211f2674bfcba143559","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for an education package insurance policy to be filled by the educational institution (proposer) seeking insurance coverage.","notes":["Please answer all questions in BLOCK letters.","Liability of the company does not commence until the proposal is accepted and full premium is paid.","This proposal form is the basis of the insurance contract and must be filled fully and accurately.","Use original documents and attach separate sheets wherever required.","Equipments older than 10 years cannot be insured under Electronic and Portable Equipments covers.","For Fire and Allied Perils Cover, fill the attached annexure form.","Section 41 of Insurance Act, 1938 prohibits rebates except as allowed by published prospectuses.","Keep policy updated with contact and bank details for faster service.","If proposer has disability, an authorised representative may sign on their behalf after explaining the form.","The form includes office use only fields which are not to be filled by the proposer."],"title":"EDUCATION PACKAGE POLICY- LAGHU UDYAM SURAKSHA- PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter the full name of the educational institution in BLOCK letters.","type":"text","label":"Name of the Proposer (Educational Institution):","options":[],"required":true,"pdf_field":""},{"help":"Enter the full postal address of the institution.","type":"text","label":"Address","options":[],"required":true,"pdf_field":""},{"help":"Enter office telephone number.","type":"phone","label":"Telephone No. 1 (Office):","options":[],"required":false,"pdf_field":""},{"help":"Enter alternate office telephone number if any.","type":"phone","label":"Telephone No. 2 (Office):","options":[],"required":false,"pdf_field":""},{"help":"Enter fax number if available.","type":"phone","label":"Fax No. (Office):","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number of the contact person.","type":"phone","label":"Mobile Number of the Contact Person","options":[],"required":true,"pdf_field":""},{"help":"Enter email address.","type":"email","label":"E-mail:","options":[],"required":false,"pdf_field":""},{"help":"Specify the type of institution.","type":"text","label":"Type of Educational Institution: School/ College (please specify:) / Any Other (please specify:)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer (educational institution)"},{"title":"Nominee Details","fields":[{"help":"Enter nominee's full name.","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Enter date of birth in dd/mm/yyyy format.","type":"date","label":"DOB (dd/mm/yyyy)","options":[],"required":true,"pdf_field":""},{"help":"Nominee for self (primary insured) must be one of the mentioned relations.","type":"text","label":"Nominee*","options":[],"required":true,"pdf_field":""},{"help":"Enter appointee details 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 IFSC code of the bank branch.","type":"text","label":"IFSCCode","options":[],"required":true,"pdf_field":""},{"help":"Confirm acceptance to pay and receive claim amount in this bank account.","type":"yes-no","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select if you want to open an e-lA account.","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 if you are an existing customer.","type":"choice","label":"Are you an exisiting customer of BajajGeneral? Yes No","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":"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":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Cover Details","fields":[{"help":"Enter policy start date.","type":"date","label":"Proposed Policy Period: From:","options":[],"required":true,"pdf_field":""},{"help":"Enter policy end date.","type":"date","label":"To","options":[],"required":true,"pdf_field":""},{"help":"Select type of education continuity cover.","type":"choice","label":"Type of Cover Required for Education Continuity Cover: Death only/ Death and Permanent Total Disability","options":["Death only","Death and Permanent Total Disability"],"required":false,"pdf_field":""},{"help":"Enter age of the insured person.","type":"number","label":"Age","options":[],"required":false,"pdf_field":""},{"help":"Specify relation of insured person.","type":"text","label":"Relation","options":[],"required":false,"pdf_field":""},{"help":"Select type of group personal accident cover for students.","type":"choice","label":"Type of Cover Required for Group Personal Accident Cover for Students: Death only/ Death and Permanent Total Disability/ Death, Permanent Total Disability and Permanent Partial Disability","options":["Death only","Death and Permanent Total Disability","Death, Permanent Total Disability and Permanent Partial Disability"],"required":false,"pdf_field":""},{"help":"Select if you want medical expenses reimbursement extension.","type":"choice","label":"Would you like to opt for Medical Expenses Reimbursement Extension for the above mentioned students?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want hospital confinement allowance.","type":"choice","label":"Would you like to opt for Hospital Confinement Allowance for the above mentioned students?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want Staff Secure cover.","type":"choice","label":"Cover 2: Staff Secure - Do you wish to opt for this cover?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select type of cover for staff secure.","type":"choice","label":"Type of Cover Required: Basic / Wider / Comprehensive","options":["Basic","Wider","Comprehensive"],"required":false,"pdf_field":""},{"help":"Fill in details of staff members to be covered.","type":"table","label":"Details of Members to be Covered (Total number of staff members to be covered, Nature of work (Teaching/ Non-Teaching) of staff members, Sum Insured per staff member and Total Sum Insured (in Rs.) for Group Personal Accident Cover for Staff Members)","options":[],"required":true,"pdf_field":""},{"help":"Select if you want medical expenses reimbursement extension for staff.","type":"choice","label":"Would you like to opt for Medical Expenses Reimbursement Extension for the above mentioned staff members?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want hospital confinement allowance for staff.","type":"choice","label":"Would you like to opt for Hospital Confinement Allowance for the above mentioned staff members?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want public liability cover.","type":"choice","label":"Cover 3(a): Public Liability Cover - Do you wish to opt for this cover?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter indemnity limit in rupees.","type":"amount","label":"Please provide the limit of indemnity required for any one year: Rs.","options":[],"required":false,"pdf_field":""},{"help":"Indicate facilities and provide numbers/details as applicable.","type":"table","label":"Please tick on the facility provided at the institute: Hostel, Mess / Canteen, Lift / Escalator / Elevator, Swimming Pool (Yes/No for each) and related details","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if any past incidents occurred.","type":"choice","label":"Have there been any instances of third party bodily injury and/or property damage in the past? Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of past incidents if any.","type":"text","label":"If yes, please provide details:","options":[],"required":false,"pdf_field":""},{"help":"Select if you want workmen's compensation cover.","type":"choice","label":"Cover 3(b): Workmen's Compensation Act Cover - Do you wish to opt for this cover?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Fill employee details for workmen's compensation cover.","type":"table","label":"Details of Employees to be Covered (Number of employees to be covered, Nature of work, Monthly Salary (in Rs.) per employee)","options":[],"required":false,"pdf_field":""},{"help":"Indicate if security measures exist.","type":"choice","label":"Are there any security measures to prevent accidents? Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Describe security measures if any.","type":"text","label":"If yes, please provide details:","options":[],"required":false,"pdf_field":""},{"help":"Indicate if any past accidents occurred.","type":"choice","label":"Has there or have there been any instances of accidents in the premises in the past? Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of past accidents if any.","type":"text","label":"If yes, please provide details:","options":[],"required":false,"pdf_field":""},{"help":"Attach filled annexure for fire and allied perils cover.","type":"attachment","label":"Cover 4(a): Fire and Allied Perils Cover - Note: Kindly fill Annexure attached to this proposal for opting cover under this section.","options":[],"required":false,"pdf_field":""},{"help":"Select if you want first loss basis cover.","type":"choice","label":"Would you like to opt for a cover on a first loss basis @ 30% of the total value at risk? Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want money insurance cover.","type":"choice","label":"Cover 4(c): Money Insurance Cover - Do you wish to opt for this cover?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of electronic equipments to be insured.","type":"table","label":"Details of Electronic Equipments to be Covered (Description, Type and Capacity, Year of manufacture, Name of manufacturer, Sum to be Insured)","options":[],"required":false,"pdf_field":""},{"help":"Select if you want plate glass cover.","type":"choice","label":"Cover 4(f): Plate Glass Cover - Do you wish to opt for this cover?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of plate glass to be insured.","type":"text","label":"If yes, please provide a description, location and value of the plate glass that you wish to insure:","options":[],"required":false,"pdf_field":""},{"help":"Select if you want neon sign/glow sign cover.","type":"choice","label":"Cover 4(g): Neon Sign/ Glow Sign Cover - Do you wish to opt for this cover?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of neon/glow signs to be insured.","type":"text","label":"If yes, please provide a description, year of production, name of the manufacturer, location and value of the neon signs/ glow signs that you wish to insure:","options":[],"required":false,"pdf_field":""},{"help":"Select if you want fidelity guarantee cover.","type":"choice","label":"Cover 4(h): Fidelity Guarantee Cover - Do you wish to opt for this cover?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of employees for fidelity guarantee cover.","type":"table","label":"Details of Employees to be Covered (Name, Designation, Monthly Salary in Rs.)","options":[],"required":false,"pdf_field":""},{"help":"Indicate if reference system exists.","type":"choice","label":"Is there a system to obtain references from previous employers? Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Describe practice if no reference system.","type":"text","label":"If not, specify practice followed:","options":[],"required":false,"pdf_field":""},{"help":"Indicate if any honesty issues.","type":"choice","label":"Has there been any occasion to question honesty or conduct of any person proposed for guarantee? Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of honesty issues if any.","type":"text","label":"If yes, please provide details:","options":[],"required":false,"pdf_field":""},{"help":"Specify frequency of accounting.","type":"text","label":"How often are the employees required to account for money?","options":[],"required":false,"pdf_field":""},{"help":"Indicate if books are balanced daily.","type":"choice","label":"Are books of accounts balanced everyday? Yes/No","options":["Yes","No"],"required":false,"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":false,"pdf_field":""},{"help":"Provide details of losses if any.","type":"text","label":"If yes, please give details:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Mode of Payment","fields":[{"help":"Enter cheque number if paying by cheque.","type":"text","label":"By Cheque: Cheque No.:","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name for cheque payment.","type":"text","label":"Bank:","options":[],"required":false,"pdf_field":""},{"help":"Enter amount if paying by cash.","type":"amount","label":"By Cash:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Previous Insurance Details","fields":[{"help":"Indicate if previous policy was with Bajaj General.","type":"choice","label":"Is your previous insurance policy with Bajaj General Insurance Limited? Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter branch name if applicable.","type":"text","label":"Branch:","options":[],"required":false,"pdf_field":""},{"help":"Enter previous policy number.","type":"text","label":"If yes, kindly provide the previous Policy No:","options":[],"required":false,"pdf_field":""},{"help":"Enter expiry date of previous policy.","type":"date","label":"Policy Expiry Date:","options":[],"required":false,"pdf_field":""},{"help":"Provide previous insurer details if not Bajaj General.","type":"text","label":"If no, kindly provide name of the previous insurer (if any) and Previous Policy No., along with the Policy Expiry Date:","options":[],"required":false,"pdf_field":""},{"help":"Provide claims history details.","type":"table","label":"Please provide the claims history for past 3 yrs: No. of Claims made, Cause of Loss, Total Claimed Amount","options":[],"required":false,"pdf_field":""},{"help":"Indicate if any increased premium or special conditions applied.","type":"choice","label":"Required an increased premium or imposed special conditions? Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if any.","type":"text","label":"If yes in either case, please provide details:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Warranty","fields":[{"help":"Sign to declare that all information is true and accurate and agree to terms.","type":"signature","label":"Declaration and Warranty","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Annexure for Fire and Allied Perils Cover","fields":[{"help":"Provide details about business and property.","type":"text","label":"Details about business covered at the insured location (type of property, goods stored, products manufactured, factory status)","options":[],"required":true,"pdf_field":""},{"help":"Enter distance to nearest fire brigade.","type":"text","label":"Distance between the risk to be covered and nearest Fire Brigade","options":[],"required":false,"pdf_field":""},{"help":"Provide details if insured elsewhere.","type":"text","label":"Whether You have insured the same property with any other Insurance Company with the same type of coverage (details)","options":[],"required":false,"pdf_field":""},{"help":"Provide details if insurance was declined.","type":"text","label":"Whether Insurance was declined by any other Company (details)","options":[],"required":false,"pdf_field":""},{"help":"Provide premium and claim details for past 3 years.","type":"table","label":"Premium / Claim details for the past 36 months excluding the expiring policy period (year-wise)","options":[],"required":false,"pdf_field":""},{"help":"Provide sum insured details for insured property.","type":"table","label":"Sum Insured and Other details of Insured Property (description and sum insured for building, plant & machinery, furniture, raw material, stock in process, finished stock, other contents)","options":[],"required":true,"pdf_field":""},{"help":"Signature of person explaining the form if proposer did not fill it.","type":"signature","label":"Certified that the contents of the proposal form and documents have been fully explained to the Proposer","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration - Physical Proposal Form","fields":[{"help":"Declare if you or applicant is a Politically Exposed Person.","type":"choice","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP? Yes/No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Signature of proposer confirming understanding.","type":"signature","label":"Declaration: The content of this form and its particulars have been explained by me in vernacular to the proposer","options":[],"required":true,"pdf_field":""},{"help":"Declare any physical disability and provide certificate details.","type":"choice","label":"Disability Declaration: Any Physical deformity or handicap (Yes/No) and details if Yes","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer and agent"}],"deadlines":[],"applies_to":"Education Package Policy - Laghu Udyam Suraksha","attachments":["Annexure attached to this proposal for opting cover under Fire and Allied Perils Cover","Separate sheet wherever required for Property Secure covers","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability"],"declarations":["The information provided in this proposal form is complete, true and accurate to the best of the proposer's knowledge.","The insurance contract is effective only upon acceptance by the company and receipt of premium.","The proposer agrees to inform the company of any material changes after submission of this proposal.","The proposer undertakes to exercise all ordinary and reasonable precautions for safety of the property.","The proposer consents to verification of identity/address through specified government portals.","The premium has been paid from legally acquired sources and future premiums will be similarly paid.","The proposer consents to sharing personal information with group companies for insurance and related services.","The proposer confirms that all relevant documents have been provided for policy issuance and claims.","The agent/intermediary confirms that the proposal form contents have been explained to the proposer and that the information is accurate.","The proposer declares whether they or any applicant is a Politically Exposed Person (PEP)."],"dropped_labels":28},"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/2552-education-package-policy-laghu-udyam-suraksha-proposal-form"}