{"id":2569,"title":"Flexi Secure Plus 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-secure-plus/Flexi-Secure-Plus-Proposal-Form.pdf","sha256":"98f69184a27a8261ecf8460f39b8787820303096ec230a93fbb82268dd03fb04","pages":12,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or groups proposing to purchase the Flexi Secure Plus insurance policy from Bajaj General Insurance Ltd. The proposer fills this form to provide personal, occupational, and coverage details required for underwriting the insurance policy.","notes":["Read the Prospectus/Key Features Document/Policy Wordings before filling the form.","Insurance coverage starts only after proposal acceptance and premium payment.","Provide all mandatory information and attach additional sheets if space is insufficient.","Use original and accurate documents as required.","Nominee for self must be a close family member or specify relation and reason if others.","If proposer has disability, authorized representative must sign consent.","Intermediary certification required if proposer did not fill the form.","Declarations related to AML and PEP status must be completed as applicable."],"title":"Flexi Secure Plus Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Full Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Policy to be issued in favour of (List of all the parties who have insurable interest)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"Fill location and occupancy details","type":"table","label":"Address of Premises/ Location Proposed for Insurance with ongoing occupancy in that location (applicable only for business cover)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation/Business","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Tel. Nos.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E-mail ID","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":"Provide PAN or TAN number","type":"text","label":"PAN/TAN No.","options":[],"required":false,"pdf_field":""},{"help":"Provide only if policy opted on aggregate limit basis","type":"amount","label":"Aggregate Limit for all covers under the policy","options":[],"required":false,"pdf_field":""},{"help":"Provide details of previous policy if any","type":"text","label":"Previous Policy Details","options":[],"required":false,"pdf_field":""},{"help":"Select policy type","type":"choice","label":"Policy opted on: individual basis / Group Basis","options":["individual basis","Group Basis"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Group Policy Additional Details","fields":[{"help":"Provide group details","type":"text","label":"Detail of the Group/ Association/ Institution/ Corporate Body whose members are being covered under the Policy","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the group being formed with the sole purpose of obtaining Insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify premium payer","type":"choice","label":"Who shall bear the premium? Group Manager / Members of Group","options":["Group Manager","Members of Group"],"required":false,"pdf_field":""},{"help":"Provide initial number of persons covered","type":"number","label":"Total number of persons to be covered initially","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer (if group policy)"},{"title":"Coverage Proposed","fields":[{"help":"Select at least any 2 of the 8 mandatory covers","type":"checkbox","label":"Please tick the relevant Coverage Sections you require","options":["Income Protection","Loan Protection","EMI Protection","Business Interruption","Breakdown of Business Equipment","Cyber Frauds","Home Protect","Family Emergency","Trip Cancellation/ Trip Interruption","Event Cancellation","Loss of Wallet","Locker Shield","ATM Withdrawal Robbery","Personal Liability","Baggage Insurance"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 1: Income Protection (Salaried Persons)","fields":[{"help":"If yes, select reasons: Merger & acquisition, Cost cutting and downsizing, Closure of establishment","type":"yes-no","label":"Do you want to opt for coverage due to commercial reasons? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If yes, select reasons: Illness, Injury","type":"yes-no","label":"Do you want to opt for coverage due to medical reasons? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If yes, provide details","type":"yes-no","label":"Are you aware about any impending job loss arising out of commercial or medical reasons? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sections 2 & 3: Loan Protection & EMI Protection","fields":[{"help":"If yes, select reasons: Merger & acquisition, Cost cutting and downsizing, Closure of establishment","type":"yes-no","label":"Do you want to opt for coverage due to commercial reasons? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If yes, select reasons: Permanent Total Disability, Accidental Death","type":"yes-no","label":"Do you want to opt for coverage due to medical reasons? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If yes, provide details","type":"yes-no","label":"Are you aware about any impending job loss arising out of commercial or medical reasons? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If yes, specify event and details","type":"yes-no","label":"Are you opting for coverage due to any other insured event? (Applicable only for group policies)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 6: Cyber Fraud","fields":[{"help":"","type":"choice","label":"Please select the cover option","options":["Unauthorized and Fraudulent Transaction","Online Shopping","Online Sales"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 7: Home Protect","fields":[{"help":"","type":"text","label":"Address of the Home Building","options":[],"required":true,"pdf_field":""},{"help":"If yes, provide details","type":"yes-no","label":"Is the Home Building or Home Contents covered under any other insurance? (Yes/No)","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 12: Locker Shield","fields":[{"help":"","type":"text","label":"Describe the locker (Brand Name, Make, Type)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address of the insured premises where the locker is located","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the locker permanently situated at the insured premises? (Yes/No)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"What type of access control mechanism does the locker have? (e.g., physical lock, digital lock)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 15: Locker Shield Other Details","fields":[{"help":"","type":"text","label":"Other relevant details applicable to the opted cover (if any)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nomination Details","fields":[{"help":"Fill nominee details; nominee for self must be Father, Mother, Son, Daughter, Spouse or Others (specify relation and reason)","type":"table","label":"Nominee Details: Name, DOB (dd/mm/yyyy), Age, Relation, Nominee/Appointee (if nominee is minor)","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you want to open e-IA account? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide bank details for refund and policy servicing","type":"text","label":"Bank Account detail: Name as per Bank Account, Name of the Bank, Bank Account No., IFSC Code, Account Type, Mobile No., Email Address","options":[],"required":true,"pdf_field":""},{"help":"If yes, provide details and attach Disability Certificate issued by Government Medical Board","type":"yes-no","label":"Disability Declaration: Any Physical deformity or handicap? (Yes/No)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide PID No. or Policy No.","type":"yes-no","label":"Existing Customer: Are you an existing customer of BGIL? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signature","fields":[{"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":""},{"help":"Sign if applicable","type":"signature","label":"Signature of the Loan Borrower","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Intermediary/Officer Certification (if proposal not filled by proposer)","fields":[{"help":"","type":"text","label":"Name of the Intermediary/Officer of the Company","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Code Number/Employee Number","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place and Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Intermediary/Officer of the Company","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary/officer"},{"title":"AML Declarations","fields":[{"help":"Declare if you or close relative is a PEP and provide details if yes","type":"yes-no","label":"Declaration for Politically Exposed Person (PEP) status","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Flexi Secure Plus insurance policy proposal","attachments":["Loan Amortization Chart (if applicable)","Disability Certificate issued by the Medical Board appointed by the Government (if applicable)"],"declarations":["The information provided is complete, true, and accurate to the best of the proposer's knowledge.","The proposal form and declaration form the basis of the insurance contract.","Failure to provide true information may result in claim rejection and policy avoidance.","The proposer agrees to inform the company of any changes after submission.","The contract is effective only upon company acceptance and full premium payment.","The proposer consents to policy terms and conditions being available on the company website.","Consultancy services provided do not guarantee employment or cover treatment expenses.","The proposer agrees to cooperate with consultancy services and not misuse them.","The proposer consents to KYC verification through specified government portals.","Premiums are paid from legally acquired sources of income."],"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/2569-flexi-secure-plus-proposal-form"}