{"id":2583,"title":"ADVANCE LOSS OF PROFIT (CAR) PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/Advance-Loss-of-Profit-car-pf-rp.pdf","sha256":"cef40e9edc1e7ed2f89741f78560986bd43e44ee1cae158cdff2b52d70af280c","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for Advance Loss of Profit insurance under a CAR (Contractors' All Risks) policy, to be filled by the proposer (policy applicant) seeking insurance coverage for construction/erection projects.","notes":["If space is insufficient for any answer, continue on a separate sheet and attach it.","Attach site layout plan and phase diagram as required.","Attach copy of contract for maximum demand charge per kW if applicable.","Use legally acquired sources of income for premium payments.","Keep policy contact and bank details updated via app, WhatsApp, call center, email, website, agent or branch.","The form must be signed by proposer and witness; if proposer is disabled, an authorised representative may sign.","The form includes a prohibition on rebates under Insurance Act 1938 Section 41.","Agent/intermediary must sign and provide license details."],"title":"ADVANCE LOSS OF PROFIT (CAR) PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Customer Details","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Middle Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Last Name","options":[],"required":null,"pdf_field":""},{"help":"Include House No & Name, Landmark / Locality, Road/Area Name, City, State, Pin Code","type":"text","label":"Address for Communication","options":[],"required":null,"pdf_field":""},{"help":"Include House No & Name, Landmark / Locality, Road/Area Name, City, State, Pin Code","type":"text","label":"Address of Business Premises Proposed for Insurance","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E Mail","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nature of Trade of Business","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Project and Construction Details","fields":[{"help":"","type":"text","label":"1. Brief description of the construction/erection work to be carried out","options":[],"required":null,"pdf_field":""},{"help":"Attach site layout plan","type":"text","label":"2. Brief description of any existing plant or surrounding property in proposer’s possession or care, custody or control on the above site(s) or adjacent to it (them). Please attach site layout plan","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"3. Project is","options":["Extension or renovation of existing work","A new venture"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"4. Can damage to existing structures and/or surrounding property, caused by the construction work, delay in completion of the business to be insured?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If Yes please specify","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"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":"","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"Indian Financial System Code","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":""}],"filled_by":"proposer"},{"title":"Existing Customer Details","fields":[{"help":"","type":"yes-no","label":"Are you an exisiting customer of Bajaj General?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If Yes. Please provide PID No: / Policy No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"I 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":""},{"help":"","type":"text","label":"Electronic-Insurance Account: Please provide e-IA No. to deposite your insurance policy.","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you want to open e-IA account:","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"","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":""}],"filled_by":"proposer"},{"title":"Business Interruption and Profit Details","fields":[{"help":"","type":"yes-no","label":"5. Can damage to existing structures and/or surrounding property, caused by the construction work, lead to business interruptions and are these to be insured?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"number","label":"If so, for how many years? (please specify)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If Yes please specify","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If Yes please specify","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"ii. Power requirements of the plant (kW, kWh p.a.)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"iii. Percentage of the requirements met by the plant’s own power generation equipment?","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"iv. Costs of kWh of power","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"v. To what extent (kW) may electricity be drawn from an external source?","options":[],"required":null,"pdf_field":""},{"help":"Attach copy of contract","type":"text","label":"vi. What is the maximum demand charge per kW and within which period is it due? (Please attach copy of contract)","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"vii. Annual maximum demand charges?","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Project Timeline and Penalties","fields":[{"help":"","type":"text","label":"If so, by which means?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Remarks","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Signature","fields":[{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"","type":"choice","label":"Mode of Payment :","options":["Cheque","DD","Cash","Other"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cheque - Given by :","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Relationship to Proposer","fields":[{"help":"","type":"checkbox","label":"Spouse","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Father","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Mother","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Son/Daughter","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Employer / Employee","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Financier","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration - Physical Proposal Form","fields":[{"help":"PEP means Politically Exposed Persons as defined","type":"yes-no","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":"","type":"text","label":"If yes, please share the details","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","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":null,"pdf_field":""},{"help":"","type":"yes-no","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":null,"pdf_field":""},{"help":"","type":"yes-no","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, 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":["Yes","No"],"required":null,"pdf_field":""},{"help":"You can update via app, WhatsApp, call center, email, website, agent or branch","type":"yes-no","label":"It is mandatory to keep your policy with updated contact (Mobile No., Email ID and PAN Card) and bank account details, to process any of your service requests faster and hassle-free in future.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"checkbox","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":"","type":"signature","label":"Signature of Proposer:","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date :","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place :","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name of Witness :","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Witness :","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place :","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Disability Declaration","fields":[{"help":"","type":"yes-no","label":"Any Physical deformity or handicap","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","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 fills this","type":"text","label":"Name of Authorised Representative","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Authorised representative","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer or authorised representative"},{"title":"Claim Documents Confirmation","fields":[{"help":"","type":"checkbox","label":"I/we hereby confirm that I/we have provided all relevant and supporting documents sought by the company, required for the issuance of the policy. Any document(s) as may be required, for claims processing, shall be submitted by me on demand by the company.","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Agent / Intermediary Declaration","fields":[{"help":"","type":"text","label":"IRDAI COR No./ License No.(Advisor/Corporate Agent/Broker/Relationship Officer)","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Agent/IMD Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Agent/IMD Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Agent/IMD Signature","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"SP / BQP / DP / PoS Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"SP / BQP / DP / PoS CoR No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"SP / BQP / DP / PoS Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Advance Loss of Profit insurance under CAR policies","attachments":["site layout plan","phase diagram of construction giving the phasing of the work (date of arrival on site, erection, testing, commissioning, handover) regarding all plant sections and major items","copy of contract for maximum demand charge per kW"],"declarations":["The proposer declares that all statements are true and complete and no material information is withheld.","The declaration and answers form the basis of the insurance contract and untrue statements may void the policy.","The proposer consents to KYC verification through specified government portals.","The proposer confirms premiums are paid from legally acquired sources.","The proposer consents to sharing personal data 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 understanding of the form content as explained in vernacular.","The proposer confirms provision of all relevant documents for policy issuance and claims.","The agent declares having explained the form contents to the proposer and understands the consequences of untrue statements or non-disclosure."],"dropped_labels":21},"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/2583-advance-loss-of-profit-car-proposal-form"}