{"id":2558,"title":"ASSET SURAKSHA – FLEXI GUARD Proposal Form","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/asset-suraksha/ASSET-SURAKSHA-Proposal-Form.pdf","sha256":"4b88be9ff2d2704b372a897f55c2a3088c8aebf46fb23ce91bce22e351e9675e","pages":12,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for insurance coverage under the Asset Suraksha – Flexi Guard policy by Bajaj General Insurance Limited. It is filled by the proposer who wishes to insure assets against various risks.","notes":["Policy liability starts only after proposal acceptance and premium payment.","Use separate sheet if space is insufficient to provide information.","Asset value must be as per valuation certificate or invoice not older than six months.","Valuation certificate is waived if sum insured is up to ₹5 Lakh and individual item value does not exceed ₹1 Lakh.","Proposal form must be filled fully and accurately to avoid claim rejection or policy avoidance.","Insurance Act 1938 Section 41 prohibits rebates as inducement for insurance."],"title":"ASSET SURAKSHA – FLEXI GUARD Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Full name of the proposer","type":"text","label":"Name of the Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"Provide any of these identification numbers","type":"text","label":"PAN / TAN / GST / AADHAR Number","options":[],"required":true,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"Contact phone number","type":"phone","label":"Telephone Number","options":[],"required":true,"pdf_field":""},{"help":"Indicate if you are an employee and provide employee code if yes","type":"yes-no","label":"Are you an Employee of BGIL/ Group Companies of BGIL :____________ Emp. Code:______________","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"List other active policies if any","type":"text","label":"Kindly provide details of any other active policy of Bajaj General Insurance Ltd. held by you:","options":[],"required":false,"pdf_field":""},{"help":"Your current occupation or profession","type":"text","label":"Occupation/Profession","options":[],"required":true,"pdf_field":""},{"help":"Provide email address","type":"email","label":"E mail ID","options":[],"required":false,"pdf_field":""},{"help":"State of residence","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Postal pin code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Asset Details and Coverage Options","fields":[{"help":"Provide details for each asset including Serial No., Make/Model, Invoice Date and Name, Asset Type (New/Refurbished/Used), Asset Value/Invoice Value, Cover Opted Under (Part1/Part2/Part3), Cover Type (Individual/Floater), Cover Period (up to 365 days or years), and insured event options and restricted covers (Yes/No for each)","type":"table","label":"Asset(s) Details","options":[],"required":true,"pdf_field":""},{"help":"Specify maximum days limit if opting for inconvenience benefit","type":"number","label":"Below extensions can be opted on payment of additional premium (Maximum Number of Days Limit in Inconvenience Benefit/ Incidental Cost Benefit if opted)","options":[],"required":false,"pdf_field":""},{"help":"Attach valuation certificate if sum insured exceeds ₹5 Lakh or individual item value exceeds ₹1 Lakh","type":"yes-no","label":"Valuation Certificate attached – Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify if opting for third party liability and provide sum insured if yes","type":"yes-no","label":"Do you want to opt for Third Party Liability – Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Sum insured amount for third party liability","type":"amount","label":"If “Yes” please specify Sum Insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History and Claims Experience","fields":[{"help":"Indicate if any insurer declined your proposal","type":"yes-no","label":"Has any company/Insurer in respect of insurance Declined your Proposal?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if any policy was cancelled or renewal refused","type":"yes-no","label":"Cancelled or refused to renew your policy?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if proposal was accepted on special terms","type":"yes-no","label":"Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Date when loss occurred","type":"date","label":"Date of Occurrence","options":[],"required":false,"pdf_field":""},{"help":"Describe the loss details","type":"text","label":"Details of Loss","options":[],"required":false,"pdf_field":""},{"help":"Amount claimed or loss amount","type":"amount","label":"Amount of Loss","options":[],"required":false,"pdf_field":""},{"help":"Name of insurer and policy number for past claims","type":"text","label":"Name of Insurer and Policy Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Group Cover Details (if applicable)","fields":[{"help":"Full name of the group proposer","type":"text","label":"Name of the Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"PAN or TAN number of the group proposer","type":"text","label":"PAN/TAN Number","options":[],"required":true,"pdf_field":""},{"help":"Address for communication","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"Contact phone number","type":"phone","label":"Telephone Number","options":[],"required":true,"pdf_field":""},{"help":"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":"Indicate if group is solely for insurance","type":"yes-no","label":"Is the group being formed with the sole purpose of obtaining Insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe relationship if group is 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":"Indicate if all members are proposed for insurance","type":"yes-no","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":"Specify who will pay the premium","type":"choice","label":"If answer to Question 8 is “Yes” kindly specify who shall bear the premium? Group Manager / Members of Group","options":["Group Manager","Members of Group"],"required":true,"pdf_field":""},{"help":"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":"Expected number of persons covered 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":""},{"help":"Specify maximum days limit if opting for inconvenience benefit","type":"number","label":"Below extensions can be opted on payment of additional premium (Maximum Number of Days Limit in Inconvenience Benefit/ Incidental Cost Benefit if opted)","options":[],"required":false,"pdf_field":""},{"help":"Attach valuation certificate if sum insured exceeds ₹5 Lakh or individual item value exceeds ₹1 Lakh","type":"yes-no","label":"Valuation Certificate attached – Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify if opting for third party liability and provide sum insured if yes","type":"yes-no","label":"Do you want to opt for Third Party Liability – Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Sum insured amount for third party liability","type":"amount","label":"If “Yes” please specify Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Indicate if any insurer declined your proposal","type":"yes-no","label":"Has any company/Insurer in respect of Insurance Declined your Proposal?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if any policy was cancelled or renewal refused","type":"yes-no","label":"Cancelled or refused to renew your policy?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if proposal was accepted on special terms","type":"yes-no","label":"Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Date when loss occurred","type":"date","label":"Date of Occurrence","options":[],"required":false,"pdf_field":""},{"help":"Describe the loss details","type":"text","label":"Details of loss","options":[],"required":false,"pdf_field":""},{"help":"Amount claimed or loss amount","type":"amount","label":"Amount of loss Rs.","options":[],"required":false,"pdf_field":""},{"help":"Name of insurer and policy number for past claims","type":"text","label":"Name of the Insurer & Policy Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consents","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Signature of proposer or authorized signatory","type":"signature","label":"Signature (on behalf of the Proposer)","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Asset insurance under Asset Suraksha – Flexi Guard policy including Named Perils, All Risk, and coverage for curios, works of art and paintings","attachments":["Valuation Certificate (if sum insured exceeds ₹5 Lakh or individual item value exceeds ₹1 Lakh)","Separate sheet for additional information if insufficient space in proposal"],"declarations":["The statements made in the proposal are true, accurate and complete and form the basis of the insurance contract.","The policy shall be void if any untrue or incorrect statement, misrepresentation, or non-disclosure is made.","Policy issuance is subject to realization of premium payment.","Consent is given to share personal information with group companies or others as per privacy policies.","AML declarations and consents including PEP status, CKYC verification, and confirmation of premium paid from legally acquired sources."],"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/2558-asset-suraksha-flexi-guard-proposal-form"}