{"id":2557,"title":"MOTOR DEALER PACKAGE POLICY- SOOKSHMA 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/Motor-Dealer-Package-Policy-Sookshma-Udyam-Suraksha-Proposal-Form.pdf","sha256":"c82f8213f1b90dd3ca15e5a1667bc1fd5a5a66edaca9841de68e7108d2bc5041","pages":16,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for insurance under the Motor Dealer Package Policy - Sookshma Udyam Suraksha. It is filled by the proposer (policy applicant) to provide details about their business, assets, and insurance requirements to Bajaj General Insurance Limited.","notes":["Section 1 (Standard Fire and Special Perils Cover) is mandatory","If more than one location is proposed for insurance, attach separate proposal form for each location","Use original documents and provide complete and accurate information to avoid claim rejection","Policy is not effective until proposal is accepted and premium is paid","Keep policy contact details updated for faster service","Disability certificate required if proposer has physical deformity or handicap"],"title":"MOTOR DEALER PACKAGE POLICY- SOOKSHMA UDYAM SURAKSHA: PROPOSAL FORM","submit":{"to":"Bajaj General Insurance Limited","how":"","address":"Bajaj Insurance House, Airport Road, Yerawada, Pune - 411006"},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter your full legal name","type":"text","label":"Full Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter your current mailing address","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"Enter the address of the location to be insured; if multiple locations, attach separate forms","type":"text","label":"Address of Premises Proposed for Insurance","options":[],"required":true,"pdf_field":""},{"help":"Enter your email address","type":"email","label":"E-Mail","options":[],"required":false,"pdf_field":""},{"help":"Enter your bank account number","type":"text","label":"Bank Account No.","options":[],"required":false,"pdf_field":""},{"help":"Enter your bank branch's IFSC code","type":"text","label":"IFSC Code","options":[],"required":false,"pdf_field":""},{"help":"Tick to confirm acceptance","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 available","type":"text","label":"Electronic-Insurance Account: Please provide e-lA 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-lA account","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide your existing PID or Policy Number","type":"text","label":"If Yes. Please provide PID No / Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Enter start date of insurance period","type":"date","label":"Period of Insurance: From","options":[],"required":true,"pdf_field":""},{"help":"Enter your PAN number","type":"text","label":"PAN No","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Enter DARPAN registration number if applicable","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Proposed","fields":[{"help":"Section 1 is mandatory; fill attached annexure for details","type":"checkbox","label":"SECTION 1: STANDARD FIRE AND SPECIAL PERILS COVER","options":["Opt for Section 1"],"required":true,"pdf_field":""},{"help":"Select if you want burglary and robbery cover","type":"checkbox","label":"SECTION 2: BURGLARY AND ROBBERY COVER","options":["Opt for Section 2"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Electronic Equipments, Portable Equipments and Neon Sign covered under contents Sum Insured?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select all that apply","type":"checkbox","label":"Security measures available","options":["CCTV","24X7 Watch & Ward","Burglary Alarm Functioning","Locker/Safe","Common Watchman","None"],"required":false,"pdf_field":""},{"help":"Select all that apply","type":"checkbox","label":"Entry Exit Restrictions","options":["Premises Enclosed by boundary wall with security gate locked at night","Premises Enclosed by boundary wall with no gate","Security personnel 24X7","Restricted Access","Well lit premises","No Boundary Wall"],"required":false,"pdf_field":""},{"help":"Select one excess option","type":"choice","label":"Amount of Excess opted","options":["5% of the Claim amount subject to a minimum of 5000","5% of the Claim amount subject to minimum of Rs. 10000"],"required":false,"pdf_field":""},{"help":"Indicate if you have past claims; if yes, provide details","type":"yes-no","label":"Past Claims Experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 3: Damage to Registered Motor Vehicle Belonging to Customers and Held in Trust","fields":[{"help":"Provide sum insured and details","type":"text","label":"Registered Motor Vehicles belonging to Customers and held in trust by the Insured - Sum Insured/Details","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is showroom and workshop located in the same premises?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is there a Standard Operating Procedure (SOP) in place for handling registered vehicles?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select applicable option","type":"choice","label":"SOP is supervised by","options":["Showroom/Workshop Manager","Dedicated Officer","SOP is not Supervised"],"required":false,"pdf_field":""},{"help":"Select one excess option","type":"choice","label":"Amount of Excess opted","options":["5% of the Claim amount subject to a minimum of 2500","5% of the Claim amount subject to minimum of Rs.5000","5% of the Claim amount subject to minimum of Rs. 7000"],"required":false,"pdf_field":""},{"help":"Indicate if you have past claims; if yes, provide details","type":"yes-no","label":"Past Claims Experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 4: Neon Sign","fields":[{"help":"Indicate if you have past claims; if yes, provide details","type":"yes-no","label":"Past Claims Experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 5: Plate Glass","fields":[{"help":"Indicate if you have past claims; if yes, provide details","type":"yes-no","label":"Past Claims Experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 6: Fidelity Guarantee","fields":[{"help":"Select Yes or No; if No, specify practice","type":"choice","label":"Is there a system to obtain references from previous employers?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If Yes, provide details","type":"choice","label":"Has there been any occasion to question honesty or conduct of any person proposed for guarantee?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Are books of accounts balanced every day?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Describe audit system and frequency","type":"text","label":"What independent system including audits is there to check sums received and how often are audits done?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 7: Portable Equipments","fields":[{"help":"Select Yes or No","type":"choice","label":"Do you want coverage on worldwide basis?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If Yes, provide details","type":"yes-no","label":"Past Claims Experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 8: Employees Compensation","fields":[{"help":"Describe safety measures","type":"text","label":"Are there any safety measures to prevent accidents? If yes, provide details","options":[],"required":false,"pdf_field":""},{"help":"If Yes, provide details","type":"choice","label":"Any past history or accident in the premises in last 3 years","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If Yes, provide details","type":"yes-no","label":"Past Claims Experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 9: Electronic Equipment","fields":[{"help":"Select Yes or No","type":"choice","label":"Do you require cover for External Data Media?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Enter amount in rupees","type":"amount","label":"Reinstatement value of Data Media (Rs.)","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you require cover for reproduction of Data lost following indemnifiable damage?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Enter amount in rupees","type":"amount","label":"If Yes, what is the limit required?","options":[],"required":false,"pdf_field":""},{"help":"If Yes, provide details","type":"yes-no","label":"Past Claims Experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 10: Public Liability","fields":[{"help":"If Yes, provide details","type":"choice","label":"Any instances of third party Bodily Injury and/or Property Damage in the past?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If Yes, provide details","type":"yes-no","label":"Past Claims Experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 11: Money Insurance","fields":[{"help":"Provide addresses","type":"text","label":"Addresses of premises between which the money will be carried","options":[],"required":false,"pdf_field":""},{"help":"Specify distance","type":"text","label":"Maximum distance over which the money will be conveyed","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is the safe fixed to the wall or floor?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Enter number of keys","type":"number","label":"How many keys are necessary to open the safe?","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is it possible to open the safe by a combination?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is the insured location protected by a burglary alarm system?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is the burglary alarm system under a maintenance contract?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Have you ever sustained any loss of money whilst in transit or premises?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Describe measures","type":"text","label":"Have any measures been taken to prevent such damages in future?","options":[],"required":false,"pdf_field":""},{"help":"If Yes, provide details","type":"yes-no","label":"Past Claims Experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Cover 1: Accidental Damage to Stock of Unregistered Motor Vehicle Belonging to Insured","fields":[{"help":"Select Yes or No","type":"choice","label":"Do you wish to cover accidental damage to your own unregistered vehicles?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Are all these employees holding valid Driving License?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If Yes, provide details","type":"yes-no","label":"Past claims experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Cover 2: Theft Cover","fields":[{"help":"Select Yes or No","type":"choice","label":"Do you wish to cover contents and motor vehicles against theft?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If Yes, provide details","type":"yes-no","label":"Past claims experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Cover 4: Loss or Damage to Unregistered Vehicle for Exhibition Purpose","fields":[{"help":"Select Yes or No","type":"choice","label":"Do you wish to cover unregistered motor vehicle for exhibition purpose?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you wish to cover loss or damage caused by flood, storm, tempest, typhoon, hurricane, tornado?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If Yes, provide details","type":"yes-no","label":"Past Claims Experience","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Business and Risk Details","fields":[{"help":"Enter full name","type":"text","label":"Name of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter address","type":"text","label":"Address of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter landline number","type":"phone","label":"Telephone No (Landline)","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile No","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E-Mail","options":[],"required":false,"pdf_field":""},{"help":"Describe business activity","type":"text","label":"Business of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Provide address, pin code, occupancy, age of unit, floor","type":"table","label":"Location of risk/business to be covered - full postal address with Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Industrial / manufacturing risks","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Storage outside Industrial/manufacturing risks","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Tanks / gas holders outside industrial/manufacturing risks","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Utilities located outside Industrial/manufacturing risks","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Boundary wall","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Select Yes or No; if Yes, provide value stored","type":"choice","label":"Basement storage","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Specify other property types","type":"text","label":"Others (please specify)","options":[],"required":false,"pdf_field":""},{"help":"Enter number of floors","type":"number","label":"Number of Floors","options":[],"required":false,"pdf_field":""},{"help":"Select age range","type":"choice","label":"Age of the Building","options":["Less than 5 years","5-10 years","10-20 years","Above 20 years"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you want to opt for Floater Cover?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you want to opt for Declaration Policy?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter amount in rupees","type":"amount","label":"Stocks which fluctuate in value to be covered on (monthly) declaration basis - Amount","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Authorizations","fields":[{"help":"Sign here","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Declare any physical deformity or handicap","type":"choice","label":"Disability Declaration","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Motor Dealer Package Policy for enterprises with insurable assets between ₹5 Crore and ₹50 Crore","attachments":["Annexure attached to this proposal for opting cover under Section 1","Separate sheet if insufficient space for information"],"declarations":["All information provided is true and accurate to the best of the proposer's knowledge","Proposer agrees to inform company immediately of any changes after submission","Contract of insurance effective only upon company acceptance and premium payment","Premiums paid from legally acquired sources","Consent to share personal data with group companies if agreed","Proposer confirms understanding of form content in vernacular","Agent confirms explanation of form contents to proposer"],"dropped_labels":88},"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/2557-motor-dealer-package-policy-sookshma-udyam-suraksha-proposal-form"}