{"id":2564,"title":"HOUSEHOLDERS 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/commercial-pf/Householders-Package-Policy-Proposal-Form.pdf","sha256":"5287c2dfceb269a3c349b79c24c3d7b652f9163621aa52de605f5dc9da70ca00","pages":12,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for householders insurance policy to be filled by the proposer (person seeking insurance). It collects details about the proposer, property, coverage, and declarations to issue an insurance policy.","notes":["Answer all questions fully and accurately; attach separate sheets if needed.","Use block letters where applicable.","Valuation certificate required for jewellery items over Rs.5000.","Electronic equipment older than 10 years are not covered.","Sum insured for personal accident cover is restricted as per age and relationship.","Policy period for long term policies shall not exceed 10 years.","Keep policy updated with contact and bank details for faster service.","Prohibition on rebates as per Insurance Act 1938 Section 41.","Attach all relevant and supporting documents as required.","Agent/intermediary must explain the form contents in vernacular if required."],"title":"HOUSEHOLDERS INSURANCE POLICY PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter full name of the proposer","type":"text","label":"Name of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Address","options":[],"required":true,"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":false,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name Of Bank","options":[],"required":false,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No.","options":[],"required":false,"pdf_field":""},{"help":"Enter IFSC code of the bank branch","type":"text","label":"IFSCCode","options":[],"required":false,"pdf_field":""},{"help":"Tick to accept payment through this bank account","type":"checkbox","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["accept"],"required":false,"pdf_field":""},{"help":"Provide e-lA number if available","type":"text","label":"Electronic-Insurance Account: Please provide e-lA No. to deposite 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":"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":"Communication Details","fields":[{"help":"Provide communication details such as phone, email","type":"text","label":"Communication Details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Occupation","fields":[{"help":"Enter occupation","type":"text","label":"Occupation","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Proposed","fields":[{"help":"Specify coverage details","type":"text","label":"Coverage Proposed","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Period of Insurance","fields":[{"help":"Start date of insurance period","type":"date","label":"From","options":[],"required":true,"pdf_field":""},{"help":"End date of insurance period","type":"date","label":"To","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Select the constitution type","type":"choice","label":"Constitution Details","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":false,"pdf_field":""},{"help":"Provide DARPAN registration details if applicable","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Fire & Allied Perils and Other Cover Details","fields":[{"help":"Select Yes or No","type":"choice","label":"Would you wish to avail cover on first loss basis? (Burglary and Robbery)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Would you wish to avail cover on first loss basis? (Jewellery and Precious Stones)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter limit up to Rs.5,00,000","type":"amount","label":"Limit of indemnity required for public liability","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration of Assignment","fields":[{"help":"Sign here","type":"signature","label":"Proposers Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Warranty","fields":[{"help":"Agree to declaration and warranty","type":"checkbox","label":"Declarations and Warranty","options":["I/We declare that the statements are true and complete and agree to terms"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Template for Householder policy - Working out Sum insured for Contents","fields":[{"help":"List electronic equipment with details; equipment older than 10 years not covered","type":"table","label":"Items covered under Electronic Equipment Section (Description, Make, Year, Model, Value, Bill/Valuation certificate details)","options":[],"required":false,"pdf_field":""},{"help":"List breakdown items like refrigerator, washing machine, etc.","type":"table","label":"Items covered under Breakdown Section (Item, Description, Make, Year, Model, Value)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details about Proposer and Policy Period","fields":[{"help":"Enter full name","type":"text","label":"Name of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Address of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Provide email address","type":"email","label":"Email","options":[],"required":false,"pdf_field":""},{"help":"Start date","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee name","type":"text","label":"Nominee Name","options":[],"required":false,"pdf_field":""},{"help":"Provide relationship of nominee","type":"text","label":"Relationship with the insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Covers Opted","fields":[{"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 existing policy details","type":"text","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Select cover type","type":"choice","label":"Cover/s required","options":["Home Building Only","Home Contents Only","Home Building and Home Contents"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Location of Home Building","fields":[{"help":"Provide full address and pin code","type":"text","label":"Location of Home Building - full postal address with Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Select building type","type":"choice","label":"Is it in a multi-storey building or is it a standalone house?","options":["Multi-storey building","Standalone house"],"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":"choice","label":"Is there a basement to Your house?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Home Building","fields":[{"help":"Enter amount required to construct home building","type":"amount","label":"Sum Insured (SI) for Home Building","options":[],"required":true,"pdf_field":""},{"help":"Enter carpet area in square meters","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":true,"pdf_field":""},{"help":"Enter prevailing rate of construction cost","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date","options":[],"required":true,"pdf_field":""},{"help":"Calculated sum insured for residential structure","type":"amount","label":"SI for residential structure of Your Home including fittings and fixtures","options":[],"required":true,"pdf_field":""},{"help":"Sum insured for additional structures on site","type":"amount","label":"SI for additional structures","options":[],"required":false,"pdf_field":""},{"help":"Select age category","type":"choice","label":"Age of Home Building","options":["Less than 5 years","5-10 years","10-20 years","Above 20 years"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Home Contents","fields":[{"help":"Provide sum insured for furniture, electrical/electronic, others","type":"table","label":"Item wise Sum Insured for General Contents","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Covers","fields":[{"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","type":"choice","label":"Do You require 'Cover for Valuable Contents on Agreed Value Basis'?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach list of valuable items and sum insured","type":"attachment","label":"If Yes, please attach list of items and Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Valuation certificate attached?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional/Add-on Covers","fields":[{"help":"Specify add-on cover name","type":"text","label":"Name of Add-on cover","options":[],"required":false,"pdf_field":""},{"help":"Specify sum insured for add-on cover","type":"amount","label":"Sum insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Details","fields":[{"help":"Select payment mode","type":"choice","label":"Mode of Payment","options":["Cash","Cheque","Online","Other"],"required":true,"pdf_field":""},{"help":"Provide payment details","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Insured","fields":[{"help":"Agree to declaration","type":"checkbox","label":"Declaration by Insured","options":["I/We declare that the statements are true and agree to terms"],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration - Physical Proposal Form","fields":[{"help":"Select Yes or No","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 here","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter date","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter witness name","type":"text","label":"Name of Witness","options":[],"required":false,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"Signature of Witness","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Disability Declaration: Any Physical deformity or handicap","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide disability details and certificate","type":"text","label":"If Yes, please provide details","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorised representative","type":"signature","label":"Signature of Authorised Representative","options":[],"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 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":""}],"filled_by":"agent"},{"title":"Agent / IMD Signature and Code","fields":[{"help":"Enter SP/BQP/DP/PoS name","type":"text","label":"SP/BQP/DP/PoS Name","options":[],"required":false,"pdf_field":""},{"help":"Enter SP/BQP/DP/PoS CoR number","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":"Householders Insurance Policy","attachments":["Separate sheet if insufficient space for information","Valuation certificate for jewellery/precious stones valued over Rs.5000","List of items and sum insured for valuable contents on agreed value basis","Disability Certificate issued by Medical Board appointed by Government"],"declarations":["The statements made in the proposal form are true and complete to the best of the proposer's knowledge.","The proposal and declarations form the basis of the insurance contract.","The proposer agrees to pay premium as estimated.","The proposer undertakes to exercise reasonable precautions for safety of the property.","The company may share information within group entities.","The liability of the company starts only after acceptance of proposal and payment of full premium.","No person shall offer or accept rebates on premium except as allowed by insurer's published prospectus.","The proposer declares premium is paid from legally acquired sources.","The proposer consents to verification of identity/address through specified portals.","The proposer consents to sharing personal information with group companies.","The agent declares having explained the proposal form contents to the proposer."],"dropped_labels":35},"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/2564-householders-insurance-policy-proposal-form"}