{"id":2568,"title":"FLEXI LOCKER SHIELD PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/Flexi-Locker-Shield/Flexi-Locker-Shield-pf.pdf","sha256":"d19f919bda8893309f52502427044858ee7314e3298bc0b2a31bc77598210a17","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or groups to apply for insurance coverage under the Flexi Locker Shield policy offered by Bajaj General Insurance Ltd. The proposer (individual or group representative) fills this form to provide details for policy issuance.","notes":["Answer all questions fully and accurately.","Attach separate sheet if space is insufficient.","Policy liability starts only after acceptance of proposal and payment of premium.","Use block letters where applicable.","Certified explanation required if form filled by someone other than proposer.","Prohibition of rebates under Insurance Act 1938 Section 41 applies."],"title":"FLEXI LOCKER SHIELD PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Individual Proposal Details","fields":[{"help":"","type":"text","label":"Name of the Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"Provide any one 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":"Include country and area code if applicable","type":"phone","label":"Telephone Number","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No 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":"Provide policy details 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":"","type":"text","label":"Occupation/Profession","options":[],"required":true,"pdf_field":""},{"help":"Select the sections and optional extensions you want to cover","type":"choice","label":"Coverage Available under the Policy : SECTION UNDER POLICY SECTION 1   – Accidental Damage Cover for Locker and/ or Contents (Mandatory Section) SECTION 2   – Burglary & Robbery Cover for Locker and/ or Contents (Optional Section) SECTION 3   – Breakdown Cover for Locker (Optional Section) OPTIONAL EXTENSIONS UNDER POLICY 1. Terrorism Cover 2. Floater Cover","options":["SECTION 1 – Accidental Damage Cover for Locker and/or Contents (Mandatory Section)","SECTION 2 – Burglary & Robbery Cover for Locker and/or Contents (Optional Section)","SECTION 3 – Breakdown Cover for Locker (Optional Section)","Terrorism Cover","Floater Cover"],"required":true,"pdf_field":""},{"help":"Select the constitution type of the proposer","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":null,"pdf_field":""},{"help":"Provide DARPAN Portal Registration if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":false,"pdf_field":""},{"help":"Select Yes to exclude these perils, No to include","type":"yes-no","label":"Do you want to exclude the following perils (choose not to be covered for) under Section 1. – Yes / No - Storms, typhoons, cyclones, tempest, tornados, hurricanes, floods and inundation - Earthquake - Lightning and thunderstorm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes to include Theft Cover","type":"yes-no","label":"Do you want to opt for Theft Cover under Section 2 - Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select any optional extensions you want to add","type":"choice","label":"Below extensions can be opted on payment of additional premium","options":["Terrorism Cover","Floater Cover","Infidelity of Employee","Lock Replacement Cover","Documents and Money Cover under Section 1/ Section 2","Inconvenience Benefit","Personal Injury Cover under Section 2"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has any company/Insurer in respect of insurance Declined your Proposal?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Cancelled or refused to renew your policy?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of past claims if any","type":"table","label":"Past Claims Experience, if any YES NO ( If Yes please provide details below ) Date of Occurrence Details of Loss Amount of Loss Name of Insurer and Policy Number","options":[],"required":false,"pdf_field":""},{"help":"Select the cover period; if up to 365 days, specify number of days","type":"choice","label":"Cover Period","options":["Up to 365 Days","1 Year","2 Years","3 Years","4 Years","5 Years"],"required":true,"pdf_field":""},{"help":"Fill details of locker and/or contents coverage including sections, deductible, co-pay and sum insured","type":"table","label":"Please select from below coverage options For covering Locker and/or contents individually: Asset Type (Please select the desired) Locker Details & Invoice Details Please select the desired Section Deductible Co-Pay Sum Insured Locker SECTION 1 – Accidental Damage Cover for Locker (Mandatory Section) SECTION 2 – Burglary & Robbery Cover for Locker (Optional Section) SECTION 3 – Breakdown Cover for Locker (Optional Section) Asset Type (Please select the desired) Description of Contents Choose Basis of Sum Insured Please select the desired Section Deductible Co-Pay Sum Insured Content Named / Unnamed Basis Indemnity / Benefit SECTION 1 – Accidental Damage Cover for Contents (Mandatory Section) Indemnity / Benefit SECTION 2 – Burglary & Robbery Cover for or Contents (Optional Section)","options":[],"required":true,"pdf_field":""},{"help":"Provide details if opting for floater cover for multiple lockers","type":"text","label":"For covering Locker and/or contents on floater basis","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Group Proposal Details","fields":[{"help":"Full incorporated name or firm name as applicable","type":"text","label":"Name of the Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"PAN/TAN Number","options":[],"required":true,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Telephone Number","options":[],"required":true,"pdf_field":""},{"help":"Provide group details","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":"Select Yes or No","type":"yes-no","label":"Is the group being formed with the sole purpose of obtaining Insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain relationship if group 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":"Select Yes or No","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":"Select 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","options":["Group Manager","Members"],"required":false,"pdf_field":""},{"help":"Enter 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":"Enter expected number of persons 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":"Select sections and optional extensions for group policy","type":"choice","label":"Coverage Available under the Policy : SECTION UNDER POLICY SECTION 1   – Accidental Damage Cover for Locker and/ or Contents (Mandatory Section) SECTION 2   – Burglary & Robbery Cover for Locker and/ or Contents (Optional Section) SECTION 3   – Breakdown Cover for Locker (Optional Section) OPTIONAL EXTENSIONS UNDER POLICY 1. Terrorism Cover 2. Floater Cover 3. Infidelity of Employee 4. Lock Replacement Cover 5. Documents and Money Cover under Section 1/ Section 2 6. Inconvenience Benefit 7. Personal Injury Cover under Section 2","options":["SECTION 1 – Accidental Damage Cover for Locker and/or Contents (Mandatory Section)","SECTION 2 – Burglary & Robbery Cover for Locker and/or Contents (Optional Section)","SECTION 3 – Breakdown Cover for Locker (Optional Section)","Terrorism Cover","Floater Cover","Infidelity of Employee","Lock Replacement Cover","Documents and Money Cover under Section 1/ Section 2","Inconvenience Benefit","Personal Injury Cover under Section 2"],"required":true,"pdf_field":""},{"help":"Fill details of insured assets and coverage","type":"table","label":"DETAILS OF INSURED ASSETS Sr. No. Coverage Details under the Policy Locker / Contents Details Individual / Floater Section Name Indemnity/ Benefit Sum Insured/ AOA:AOY Limit Extension Name Indemnity/ Benefit Sum Insured/ AOA:AOY Limit Other Covers (If Any) Deductible, Co-pay & Special Conditions","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has any company/Insurer in respect of Insurance Declined your Proposal?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Cancelled or refused to renew your policy?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide past claims details if any","type":"table","label":"Past Claims Experience, if any YES NO ( If Yes please provide details below ) Date of Occurrence Details of loss Amount of loss Rs. Name of the Insurer & Policy Number","options":[],"required":false,"pdf_field":""}],"filled_by":"group proposer"},{"title":"Declarations and Consents","fields":[{"help":"Agree to this declaration","type":"checkbox","label":"I/We, the undersigned hereby declare and warrant that the above statements are true, accurate and complete. I/We desire to have an insurance policy as described herein with the Company and I/We agree that this proposal and declarations hereto shall be the basis of contract between me/us and the Company and I/We agree to accept a Policy subject to the conditions prescribed by the Company.","options":[],"required":true,"pdf_field":""},{"help":"Agree to this condition","type":"checkbox","label":"I/We agree that the Policy shall become null and void, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material particular in the proposal form/personal statement, declaration and connected documents, or any material information has been withheld by me/us or anyone acting on my/our behalf to obtain any benefit under this Policy.","options":[],"required":true,"pdf_field":""},{"help":"Agree to this condition","type":"checkbox","label":"I/We agree that the issuance of Policy shall be subject to realisation of premium cheque.","options":[],"required":true,"pdf_field":""},{"help":"Consent to data sharing","type":"checkbox","label":"I/We hereby give voluntary consent to BGIL/Company to share my/our personal information and data provided in this proposal form with its group companies or any other person in connection with the Insurance Policy or otherwise, including for providing products and services of group companies that may be of interest to me/us, to be used in accordance with their respective privacy policies and subject to appropriate measures being in place to safeguard my/our personal information.","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature (Proposer)","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Name of proposer","type":"text","label":"Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Insurance proposal for Flexi Locker Shield policy covering lockers and/or contents with various optional sections and extensions","attachments":["Separate sheet if insufficient space to provide relevant information","Locker Details & Invoice Details (for coverage options)"],"declarations":["The statements made in the proposal are true, accurate and complete and form the basis of the contract.","Policy will be void if any untrue or incorrect statement or non-disclosure is made.","Policy issuance is subject to realization of premium cheque.","Consent is given to share personal information with group companies and others as per privacy policies.","AML declarations including PEP status, CKYC consent, and premium source confirmation must be agreed to."],"dropped_labels":4},"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/2568-flexi-locker-shield-proposal-form"}