{"id":2570,"title":"PROPOSAL AND QUESTIONNAIRE FOR BOILER PRESSURE PLANT INSURANCE","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/boilers-and-pressure-plant-insurance/Boiler-and-Pressure-Plant-pf.pdf","sha256":"899e8ec542448a3667adc4adbb8bad1d0ba79c20d49cce1a3532a360f0337535","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is a proposal and questionnaire for Boiler Pressure Plant Insurance to be filled by the insured person or entity seeking insurance coverage.","notes":["The term 'Boiler' includes fittings, integral super heaters and integral economisers but excludes steam or feed water piping unless specifically listed.","Value of Boiler and/or Pressure Plant older than 20 years must be indicated separately.","Section 41 of Insurance Act 1938 prohibits rebates and specifies penalties for violations.","Use separate sheet for full particulars of any boiler plant accident.","Attach copy of last inspection report.","Keep policy updated with mobile number, email ID, PAN card and bank details for hassle-free service.","Contact details for updates include app, WhatsApp, call center, email, website, agent or branch."],"title":"PROPOSAL AND QUESTIONNAIRE FOR BOILER PRESSURE PLANT INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Insured Information","fields":[{"help":"","type":"text","label":"a) Name & Address of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"b) Work Address (Site of the Property to be Insured)","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Is your name mentioned above same as per your Aadhaar Card","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If No, Please mention the Name as per Aadhaar Card","options":[],"required":null,"pdf_field":""},{"help":"Enter your 12-digit Aadhaar number","type":"text","label":"Aadhaar Card No.","options":[],"required":null,"pdf_field":""},{"help":"Enter your PAN number","type":"text","label":"PAN Number","options":[],"required":null,"pdf_field":""},{"help":"Enter in DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Insurance Period and Bank Details","fields":[{"help":"Name as per bank records","type":"text","label":"Name as pr Bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name Of Bank","options":[],"required":null,"pdf_field":""},{"help":"Enter your bank account number","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code of your bank branch","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":[],"required":null,"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":null,"pdf_field":""},{"help":"","type":"choice","label":"Do you want to open e-lA account","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Are you an exisiting customer of Bajaj General?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide PID or Policy number if existing customer","type":"text","label":"If Yes. Please provide PID No: /Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"hereby confirm that, there is no change in my existing KYC details that are available from my previous/existing policy.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Sum Insured and Constitution Details","fields":[{"help":"Enter total sum insured amount","type":"amount","label":"Total Sum Insured","options":[],"required":null,"pdf_field":""},{"help":"Mark all applicable constitution types","type":"checkbox","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 registration details if applicable","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Boiler and Pressure Plant Details","fields":[{"help":"Enter maker's name of the boiler or pressure plant","type":"text","label":"Description - Maker's Name","options":[],"required":null,"pdf_field":""},{"help":"Enter year of manufacture","type":"number","label":"Year of Make","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for each boiler or plant","type":"amount","label":"Sum Insured","options":[],"required":null,"pdf_field":""},{"help":"Location of the boiler or plant","type":"text","label":"Location","options":[],"required":null,"pdf_field":""},{"help":"Maker's number and capacity details","type":"text","label":"Maker's No., Capacity","options":[],"required":null,"pdf_field":""},{"help":"Details of surrounding property to be insured","type":"text","label":"B) SURROUNDING PROPERTY OF THE INSURED INCLUDING PROPERTY HELD IN TRUST OR COMMISSION","options":[],"required":null,"pdf_field":""},{"help":"Limit for personal injury liability","type":"amount","label":"C) LEGAL LIABILITIES TO THIRD PARTIES - a) Personal Injury","options":[],"required":null,"pdf_field":""},{"help":"Mark Yes or No for each additional coverage","type":"checkbox","label":"D) On payment of additional premium do you wish to cover the following?","options":["Express freight (excluding airfreight), Overtime and Holiday rates of wages","Airfreight","Owner's Surrounding Property","Third Party Liability - Any one Accident","Third Party Liability - Any one Year","Additional Customs Duty"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"In case of Boiler, state if it is Water tube type?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Inspection and Safety Details","fields":[{"help":"List plant items inspected periodically","type":"text","label":"Which items of Plant are subject to periodical inspection?","options":[],"required":null,"pdf_field":""},{"help":"Name of inspecting authority and inspection frequency","type":"text","label":"By whom are they inspected, and at what intervals?","options":[],"required":null,"pdf_field":""},{"help":"Provide date, pressure and approval period; attach last inspection report","type":"text","label":"Date of last inspection, working pressure approved, and period of such approval (attach copy of last report)","options":[],"required":null,"pdf_field":""},{"help":"Enter maximum load in PSI","type":"number","label":"What is the maximum load on safety valve per square inch?","options":[],"required":null,"pdf_field":""},{"help":"Enter working pressure","type":"number","label":"What is the working pressure?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are the Boiler Attendant solely employed on the Boiler Plant?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide qualifications of boiler attendants","type":"text","label":"What are their qualification?","options":[],"required":null,"pdf_field":""},{"help":"Specify proportion of time for other duties","type":"text","label":"What proportion of their time is given to other duties, if not solely employed on the Boiler Plant?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the Boiler Plant now Insured?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide insurer name and policy expiry date","type":"text","label":"If so, state name of Insurer, and date policy expires.","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the Boiler Plant at any time been insured by you?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide insurer name and expired policy date","type":"text","label":"If so, state name of Insurer, and date of policy expired?","options":[],"required":null,"pdf_field":""},{"help":"If yes, give full particulars on separate sheet","type":"yes-no","label":"Have you ever had an accident to your Boiler Plant?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are any of the Boilers shown in the proposal automatically controlled?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify automatically controlled boilers","type":"text","label":"If so, which ones?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is any of the automatically controlled Boilers not under continuous supervision by person competent to operate it?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify boilers not under continuous supervision","type":"text","label":"If so which ones","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is Boiler under regular and frequent supervision whilst working?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Payment Details","fields":[{"help":"Select mode of payment","type":"choice","label":"Mode of Payment","options":["Cheque","DD","Cash","Other"],"required":null,"pdf_field":""},{"help":"Select who gave the cheque","type":"choice","label":"Cheque - Given by","options":["Spouse","Father","Mother","Son/Daughter","Employer / Employee","Financier"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Consents","fields":[{"help":"Politically Exposed Persons declaration","type":"choice","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Signature of proposer and witness with date and place","type":"signature","label":"Declaration: The content of this form and its particulars have been explained by me in vernacular to the proposer who has understood and confirmed the same.","options":[],"required":true,"pdf_field":""},{"help":"If yes, provide details and disability certificate","type":"yes-no","label":"Disability Declaration: Any Physical deformity or handicap","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured and agent"}],"deadlines":[],"applies_to":"Boiler Pressure Plant Insurance","attachments":["Copy of last inspection report","Full particulars of any boiler plant accident (if applicable)","Disability Certificate issued by the Medical Board appointed by the Government (if applicable)"],"declarations":["The statements and particulars given are true and complete and form the basis of the contract.","Consent to share information within group entities and for KYC verification.","Premiums are paid from legally acquired sources.","Consent to share personal information with group companies for services and products.","Policy must be kept updated with contact and bank details for faster service.","The form content has been explained in vernacular to the proposer who has understood and confirmed it.","Agent confirms having explained the form contents and consequences of untrue statements or non-disclosure."],"dropped_labels":18},"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/2570-proposal-and-questionnaire-for-boiler-pressure-plant-insurance"}