{"id":2573,"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-pf2.pdf","sha256":"f067458c0addbcea736a8a308ca9421ef174e0ba8e0ec2256369cbe4b43ded10","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 liability of the Company does not commence until this proposal has been accepted and premium paid.","Use separate sheet for full particulars of any accidents.","Value of Boiler and/or Pressure Plant older than 20 years must be indicated separately.","The term 'Boiler' includes fittings, integral super heaters and integral economisers but excludes steam or feed water piping unless specifically listed.","Keep policy updated with contact and bank details for faster service.","Original documents may be required for claims processing.","Section 41 of Insurance Act 1938 prohibits rebates.","The form must be signed by proposer and witnessed.","If proposer has disability, authorised representative may sign with consent."],"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":"Mark YES or NO; if NO, provide name as per Aadhaar Card","type":"choice","label":"Is your name mentioned above same as per your Aadhaar Card YES NO If No, Please mention the Name as per Aadhaar Card","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Enter Aadhaar Card number","type":"text","label":"Aadhaar Card No.","options":[],"required":null,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"PAN Number","options":[],"required":null,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Insurance Period and Bank Details","fields":[{"help":"Enter name as per bank records","type":"text","label":"Name as pr Bank","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name Of Bank","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"Tick to accept","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":"Enter 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":"Select Yes or No","type":"choice","label":"Do you want to open e-lA account: Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Are you an exisiting customer of Bajaj General? Yes No","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":"Tick to confirm","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":"Constitution Details","fields":[{"help":"Mark Yes or No","type":"yes-no","label":"Partnership Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Mark Yes or No","type":"yes-no","label":"Limited Liability/Partnership Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Mark Yes or No and provide DARPAN registration if Yes","type":"yes-no","label":"NGO/NPO- Provide DARPAN Portal Registration, if applicable","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Mark Yes or No","type":"yes-no","label":"Company","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Mark Yes or No","type":"yes-no","label":"Trust","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Mark Yes or No","type":"yes-no","label":"Society","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Mark Yes or No","type":"yes-no","label":"Section 8 Company","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Mark Yes or No","type":"yes-no","label":"Proprietorship Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify other constitution if applicable","type":"text","label":"Others (Please specify)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Boiler and Pressure Plant Details","fields":[{"help":"Describe surrounding property","type":"text","label":"B) SURROUNDING PROPERTY OF THE INSURED INCLUDING PROPERTY HELD IN TRUST OR COMMISSION","options":[],"required":null,"pdf_field":""},{"help":"Provide details of legal liabilities","type":"text","label":"C) LEGAL LIABILITIES TO THIRD PARTIES a) Personal Injury b) Property Damage","options":[],"required":null,"pdf_field":""},{"help":"Mark Yes or No for each item and provide Limits of Indemnity if Yes","type":"choice","label":"D) On payment of additional premium do you wish to cover the following? a) Express freight (excluding airfreight), Overtime and Holiday rates of wages. b) Airfreight. c) Owner's Surrounding Property. d) Third Party Liability (i) Any one Accident (ii) Any one Year e) Additional Customs Duty.","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Boiler Specific Questions","fields":[{"help":"Provide evaporative capacity per hour","type":"text","label":"b) If so, what is the evaporative capacity per hour","options":[],"required":null,"pdf_field":""},{"help":"Specify fuel type","type":"text","label":"State how Boiler is fired, e.g. Oil, Gas Coal or Pulverized fuel.","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"a) Do you wish to include the main steam piping? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select radius","type":"choice","label":"b) If so, state whether cover required within 20 meters or 100 meters radius of the Boiler","options":["20 m","100 m"],"required":null,"pdf_field":""},{"help":"Describe defects if any","type":"text","label":"b) Give particulars of any defects","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Inspection and Safety Details","fields":[{"help":"List items inspected periodically","type":"text","label":"a) Which items of Plant are subject to periodical inspection?","options":[],"required":null,"pdf_field":""},{"help":"Provide inspector details and inspection frequency","type":"text","label":"b) By whom are they inspected, and at what intervals?","options":[],"required":null,"pdf_field":""},{"help":"Provide last inspection date and approval details","type":"text","label":"c) Date of last inspection, working pressure approved, and period of such approval (attach copy of last report)","options":[],"required":null,"pdf_field":""},{"help":"Provide maximum load","type":"text","label":"a) What is the maximum load on safety valve per square inch?","options":[],"required":null,"pdf_field":""},{"help":"Provide working pressure","type":"text","label":"b) What is the working pressure?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Boiler Attendant Details","fields":[{"help":"Select Yes or No","type":"choice","label":"a) Are the Boiler Attendant solely employed on the Boiler Plant? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide qualifications","type":"text","label":"b) What are their qualification?","options":[],"required":null,"pdf_field":""},{"help":"Specify proportion of time","type":"text","label":"c) What proportion of their time is given to other duties, if not solely employed on the Boiler Plant?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Insurance History","fields":[{"help":"Provide insurer name and expiry date","type":"text","label":"b) If so, state name of Insurer, and date policy expires.","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"a) Has the Boiler Plant at any time been insured by you? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide insurer name and expiry date","type":"text","label":"b) If so, state name of Insurer, and date of policy expired?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Accident and Other Boiler Details","fields":[{"help":"Select Yes or No","type":"choice","label":"a) Have you ever had an accident to your Boiler Plant? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide accident details on separate sheet if Yes","type":"text","label":"b) If so, give full particulars on separate sheet.","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Have your any Boiler Plant in use other than that specified in the schedule? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"a) Are any of the Boilers shown in the proposal automatically controlled? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify which boilers are automatically controlled","type":"text","label":"b) If so, which ones?","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"a) Is any of the automatically controlled Boilers not under continuous supervision by person competent to operate it? Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify which boilers are not under continuous supervision","type":"text","label":"b) If so which ones","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is Boiler under regular and frequent supervision whilst working? Yes No","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Consent","fields":[{"help":"Sign the form","type":"signature","label":"Proposer's Signature","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Politically Exposed Persons declaration","type":"choice","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Acknowledge importance of updated details","type":"checkbox","label":"It is mandatory to keep your policy with updated contact (Mobile No., Email ID and PAN Card) and bank account details","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Witness and Disability Declaration","fields":[{"help":"Proposer signs here","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of signature","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter witness name","type":"text","label":"Name of Witness","options":[],"required":null,"pdf_field":""},{"help":"Witness signs here","type":"signature","label":"Signature of Witness","options":[],"required":null,"pdf_field":""},{"help":"Date of witness signature","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of witness signature","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Declare any disability","type":"choice","label":"Any Physical deformity or handicap Yes No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide disability details and certificate","type":"text","label":"If Yes. Please provide details (Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability)","options":[],"required":null,"pdf_field":""},{"help":"If proposer is disabled, authorised representative name","type":"text","label":"Name of Authorised Representative","options":[],"required":null,"pdf_field":""},{"help":"Authorised representative signs here","type":"signature","label":"Signature of Authorised representative","options":[],"required":null,"pdf_field":""},{"help":"Date of authorised representative signature","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of authorised representative signature","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"witness / authorised representative"},{"title":"Agent / Intermediary Declaration","fields":[{"help":"Agent signs here","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"Date of agent signature","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of agent signature","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter SP/BQP/DP/PoS name","type":"text","label":"SP/BQP/DP/PoS Name","options":[],"required":null,"pdf_field":""},{"help":"Enter SP/BQP/DP/PoS CoR number","type":"text","label":"SP/BQP/DP/PoS CoR No.","options":[],"required":null,"pdf_field":""},{"help":"SP/BQP/DP/PoS signature","type":"signature","label":"SP/BQP/DP/PoS Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"agent / intermediary"}],"deadlines":[],"applies_to":"Boiler Pressure Plant Insurance","attachments":["Copy of last inspection report","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability (if applicable)","Any other documents as may be required for claims processing"],"declarations":["The statements and particulars given are true and complete and form the basis of the contract.","Consent to share information within group entities.","No rebate of commission or premium is allowed as per Section 41 of Insurance Act 1938.","Consent to verify identity/address proof through specified portals.","Premium paid from legally acquired sources and future premiums will be paid similarly.","Consent to share personal information with group companies for products and services.","Agent declares having explained the form contents and consequences of untrue statements or non-disclosure.","Proposer confirms understanding of the form content and particulars.","Agent confirms explanation of the proposal form in vernacular language if required."],"dropped_labels":15},"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/2573-proposal-and-questionnaire-for-boiler-pressure-plant-insurance"}