{"id":2576,"title":"CONTRACTORS' PLANT & MACHINERY INSURANCE PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/contractors-plant-machinery-insurance/Contractor-Plant-Machinery-pf.pdf","sha256":"c2e73930b906e1c681fe06a57110bf0016043ff9c9ac9545ff15b4edf502b2b9","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or businesses (proposers) to apply for insurance coverage for contractors' plant and machinery. The proposer fills this form to provide details about themselves, their machinery, and insurance requirements.","notes":["All questions must be answered completely; if space is insufficient, provide details in an annexure.","Use the exact name as per Aadhaar Card unless otherwise specified.","Policyholder must sign or provide thumb impression.","Witness signature and details are required.","If proposer has disability, an authorized representative may sign on their behalf with consent.","Agent or intermediary must declare and sign the form.","Keep policy contact details and bank account updated for faster service.","Original documents may be required for claims processing on demand."],"title":"CONTRACTORS' PLANT & MACHINERY INSURANCE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter your full name as per Aadhaar Card","type":"text","label":"Proposer’s Name","options":[],"required":true,"pdf_field":""},{"help":"Select YES if name matches Aadhaar, else provide correct name","type":"choice","label":"Is your name mentioned above as per your Aadhaar Card? : YES No If No, Please mention the Name as per Aadhaar Card","options":["YES","No"],"required":true,"pdf_field":""},{"help":"Enter your Aadhaar Card number","type":"text","label":"Aadhar Card No.","options":[],"required":true,"pdf_field":""},{"help":"Enter your PAN number","type":"text","label":"PAN Number","options":[],"required":true,"pdf_field":""},{"help":"Enter your date of birth","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Select your gender","type":"choice","label":"Gender :  Male Female Other","options":["Male","Female","Other"],"required":true,"pdf_field":""},{"help":"Describe your trade or business","type":"text","label":"Proposer’s trade of business","options":[],"required":true,"pdf_field":""},{"help":"Enter your postal address","type":"text","label":"Proposer’s postal address","options":[],"required":true,"pdf_field":""},{"help":"Enter your telephone number","type":"phone","label":"Tel. No. :","options":[],"required":false,"pdf_field":""},{"help":"Enter your email address","type":"email","label":"E-mail :","options":[],"required":false,"pdf_field":""},{"help":"Provide the site location of the property to be insured","type":"text","label":"Location of operation (site of property to be insured)","options":[],"required":true,"pdf_field":""},{"help":"Mention nearest railway station and distance from site","type":"text","label":"Nearest railway station and distance","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Machinery and Insurance Details","fields":[{"help":"Answer if the listed machinery is all you use at the location","type":"yes-no","label":"Do the items listed represent the entire machinery used by you at the above location ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if you currently have insurance","type":"yes-no","label":"Are you at present insured ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Name the insurer if currently insured","type":"text","label":"If so, with whom ?","options":[],"required":false,"pdf_field":""},{"help":"Indicate if machinery has defects or damage","type":"yes-no","label":"Are you aware of any defects/damage existing in the machinery ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe any defects or damage","type":"text","label":"If so, give details thereof","options":[],"required":false,"pdf_field":""},{"help":"Answer if other equipment is used on site","type":"yes-no","label":"Do you own or use any equipment other than that described above working on the same site ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"State ownership and if equipment will be hired out","type":"yes-no","label":"Are you the owner of the propose equipment ? If yes, will you be hiring out ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate security of premises","type":"yes-no","label":"Are the premises where the equipment operates well guarded ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe site conditions","type":"text","label":"What is the site condition where the equipment will be utilised ?","options":[],"required":true,"pdf_field":""},{"help":"Indicate if equipment will operate on reclaimed or soft ground","type":"yes-no","label":"Are the equipments likely to operate on reclaimed or soft ground ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate risk of toppling and provide details if yes","type":"yes-no","label":"Are ground conditions such that equipment are exposed to the risk of toppling over ? If so, give details?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate susceptibility to natural calamities and precautions","type":"yes-no","label":"Is the site susceptible to flood, sea damage, storm, cyclone or other natural calamities? If so, give details and safety precautions taken.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer if other contractors' equipment will operate on site","type":"yes-no","label":"Will equipment belonging to other contractors operate on the same site ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if operators are trained and if statutory rules apply","type":"yes-no","label":"Do you have trained and qualified operators? Are there any statutory rules governing the appointment?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"List equipment requiring statutory inspection and certification","type":"text","label":"Which of the equipments are required to be inspected and certified for operation by statutory rules?","options":[],"required":false,"pdf_field":""},{"help":"Indicate if machinery was damaged in last 3 years","type":"yes-no","label":"Has your machinery sustained any damage from breakdown or other cause during last 3 years?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of damage and repair costs","type":"text","label":"If so, give details of damage/s and repairing cost","options":[],"required":false,"pdf_field":""},{"help":"Indicate if periodic inspections are done","type":"yes-no","label":"Are regular periodical inspections of the machinery carried out ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of who inspects and inspection frequency","type":"text","label":"If so, by whom and at what intervals ?","options":[],"required":false,"pdf_field":""},{"help":"Select if you want to cover express freight and related costs","type":"yes-no","label":"On payment of additional premium do you wish to cover : Express freight (excluding air freight), overtime and holiday rates of wages","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want to cover air freight","type":"yes-no","label":"Air Freight","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want to cover owner's surrounding property","type":"yes-no","label":"Owner’s surrounding property","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want to cover clearance and debris removal","type":"yes-no","label":"Clearance & removal of debris","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want to cover additional custom duty","type":"yes-no","label":"Additional custom duty","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you want to cover escalation","type":"yes-no","label":"Escalation","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide limit of indemnity for any one accident","type":"amount","label":"Third Party Liability : (i) For any one accident","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Schedule of Machinery to be Insured","fields":[{"help":"Fill columns: Sr. No., Quantity, Description Type, Model, Capacity of Machine/Serial No., HP / KVA Volts, AMPS, RPM, Maker’s Name and Country of Origin, Year of Make, Sum Insured","type":"table","label":"Schedule of Machinery to be Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Signature","fields":[{"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 or provide thumb impression","type":"signature","label":"Insured Farmer Signature / Thumb Impression","options":[],"required":true,"pdf_field":""},{"help":"Answer if you or close relative is a Politically Exposed Person","type":"choice","label":"Declaration - Physical Proposal Form: Are you or any of the proposal applicants a PEP or a close relative of PEP?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Consent for KYC verification","type":"choice","label":"I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through Central KYC Registry or Goods and Service Tax Portal or Ministry Of Corporate Affairs Portal or National Securities Depository Limited portal for the purpose of undertaking KYC","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Declaration of legal source of premium payment","type":"choice","label":"I/we hereby declare and confirm that the premium has been paid out of legally acquired sources of income and the subsequent premiums if any, will continue to be paid out of legally declared and assessed source of income.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Consent for sharing personal information","type":"choice","label":"I/We hereby give voluntary consent to Bajaj General/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","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Declare if you have any physical deformity or handicap","type":"choice","label":"Disability Declaration : Any Physical deformity or handicap","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of disability with certificate if applicable","type":"text","label":"If Yes. Please provide details","options":[],"required":false,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter name of witness","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"Signature of authorized representative","type":"signature","label":"Signature of Authorised representative","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Agent / Intermediary Declaration","fields":[{"help":"Enter agent or intermediary license number","type":"text","label":"IRDAI COR No./ License No.(Advisor/Corporate Agent/Broker/Relationship Officer)","options":[],"required":true,"pdf_field":""},{"help":"Agent signature","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"Place of agent signature","type":"text","label":"Place (Agent)","options":[],"required":true,"pdf_field":""},{"help":"Name of agent or IMD","type":"text","label":"Agent/IMD Name","options":[],"required":true,"pdf_field":""},{"help":"Agent or IMD code","type":"text","label":"Agent/IMD Code","options":[],"required":true,"pdf_field":""},{"help":"Signature of agent or IMD","type":"signature","label":"Agent/IMD Signature","options":[],"required":true,"pdf_field":""},{"help":"Name of SP/BQP/DP/PoS","type":"text","label":"SP / BQP / DP / PoS Name","options":[],"required":false,"pdf_field":""},{"help":"Code of SP/BQP/DP/PoS","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":"Contractors' Plant and Machinery Insurance","attachments":["Annexure if space is insufficient for answers","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability (if applicable)"],"declarations":["The liability of the Company does not commence until this proposal has been accepted by the Company and premium paid.","No person shall allow or offer any rebate of commission or premium except as allowed in published prospectus or tables.","Any default in complying with rebate provisions may lead to penalty up to ten lakhs rupees.","The proposer confirms all information is true and understands that untrue statements or non-disclosure may void the policy.","Consent is given for KYC verification through specified government portals.","Premiums are paid from legally acquired sources of income.","Consent is given to share personal information with group companies for insurance and related services.","It is mandatory to keep policy contact and bank details updated for faster service.","The proposer confirms provision of all relevant documents required for policy issuance and claims processing.","The content of the form has been explained in vernacular to the proposer who has understood and confirmed the same."],"dropped_labels":16},"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/2576-contractors-plant-and-machinery-insurance-proposal-form"}