{"id":2585,"title":"PROPOSAL FORM ELECTRONIC EQUIPMENT INSURANCE","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/electronic-equipment-insurance/Electronic-Equipment-Insurance-pf2.pdf","sha256":"fe2c4792cba5b51bae8a2403142f6471fa61ea50fec938f3d945c065f05fd07f","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (individual or business) to apply for electronic equipment insurance with Bajaj General Insurance Limited.","notes":["Put a 121 mark wherever applicable.","Answer all questions completely; if space is insufficient, enclose annexure.","Attach copies of relevant documents as requested.","Use original bills and documents for claims.","Keep policy details updated for faster service.","The form includes multiple questionnaires depending on the insurance coverage desired.","Signatures of proposer, witness, authorized representative (if any), and agent are required.","The form includes a prohibition of rebates notice as per Insurance Act 1938."],"title":"PROPOSAL FORM ELECTRONIC EQUIPMENT INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details and Equipment Information","fields":[{"help":"Enter full name and complete address of the proposer","type":"text","label":"Name and address of proposer","options":[],"required":true,"pdf_field":""},{"help":"Specify the nature of your business","type":"text","label":"Type of business","options":[],"required":true,"pdf_field":""},{"help":"Enter telephone number","type":"phone","label":"Tel. No.","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E-mail","options":[],"required":false,"pdf_field":""},{"help":"Provide full address including building and storey details","type":"text","label":"Location of equipment to be insured (address of building storey)","options":[],"required":true,"pdf_field":""},{"help":"Select the building structure type","type":"choice","label":"Structure of building","options":["Steel skeleton","Brick work","Wood","Concrete"],"required":true,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"PAN No.","options":[],"required":false,"pdf_field":""},{"help":"Provide bank name, account number, IFSC code for premium and claim payments","type":"text","label":"Bank Details","options":[],"required":false,"pdf_field":""},{"help":"Provide e-lA number if available","type":"text","label":"Electronic-Insurance Account: Please provide e-lA No. to deposit your insurance policy","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you want to open e-lA account","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide PID or Policy number if existing customer","type":"text","label":"If Yes. Please provide PID No / Policy No","options":[],"required":false,"pdf_field":""},{"help":"Tick if applicable","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":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has any of the equipment to be insured previously been covered by other insurance companies?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify items and insurance companies if applicable","type":"text","label":"If yes, which items of the specification and by which companies","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Period of insurance to expire at midnight of previous date of next year?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is all the equipment to be insured new?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify old items if any","type":"text","label":"If not, which items of the list are old?","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is the equipment maintained in accordance with the manufacturers Instructions?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Have operators been trained with manufacturer?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are dangerous materials used in the vicinity?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick all that apply","type":"checkbox","label":"If so specify (Acids, Prepared or sensitized papers, Dyes, Test solutions, Developers, Explosives, Isotopes, others)","options":["Acids","Prepared or sensitized papers","Dyes","Test solutions","Developers","Explosives","Isotopes","others"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Valid maintenance contract in force?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach copy of maintenance contract if applicable","type":"checkbox","label":"If yes, copy to be enclosed","options":[],"required":false,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Enter place of execution","type":"text","label":"Executed at","options":[],"required":false,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Questionnaire for Electronic Data Processing (EDP) Systems","fields":[{"help":"Enter full name and address","type":"text","label":"Name and address of proposer","options":[],"required":true,"pdf_field":""},{"help":"Specify business type","type":"text","label":"Type of business","options":[],"required":true,"pdf_field":""},{"help":"Enter monthly rent if rented","type":"amount","label":"If the system is rented state monthly rent Rs.","options":[],"required":false,"pdf_field":""},{"help":"Specify operational hours","type":"text","label":"Operational hours per day in shifts","options":[],"required":false,"pdf_field":""},{"help":"Provide manufacturer or lessor details","type":"text","label":"Name and address of manufacturer and/or lessor","options":[],"required":false,"pdf_field":""},{"help":"Describe lease contract liability provisions and attach copy if available","type":"text","label":"What are the provisions of your lease contract regarding your liability in the case of damage to the EDP system? Please furnish copy of lease contract if available","options":[],"required":false,"pdf_field":""},{"help":"Enter value in basement","type":"amount","label":"Total value of plant located in basement Rs.","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the air conditioning plant automatically shut off by limit switches, if the normal control facility fails?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is the air-conditioning plant also equipped with an independent signaling device in the case of disturbance or failure? (optical, acoustic signal)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are adequate loss prevention measures initiated immediately, even if the above protective devices are actuated outside operational hours?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Describe air conditioning method if not standard","type":"text","label":"Air-conditioning - If not, how is air conditioning effected","options":[],"required":false,"pdf_field":""},{"help":"Tick all that apply","type":"checkbox","label":"Risk aggravating circumstances as in the storage rooms (Steam & water lines, Vibrations, Acid atmosphere)","options":["Steam & water lines","Vibrations","Acid atmosphere"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Exclusion of Fire & Allied Perils as per Standard Fire & Special Perils Policy","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Enter place of execution","type":"text","label":"Executed at","options":[],"required":false,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Questionnaire for Increased Cost of Working","fields":[{"help":"Enter full name and address","type":"text","label":"Name and address of proposer","options":[],"required":true,"pdf_field":""},{"help":"Specify business type","type":"text","label":"Type of business","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is it possible in the event of failure to utilize other EDP system so as to obviate using an outside system?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Describe special agreements if any","type":"text","label":"If so, please specify","options":[],"required":false,"pdf_field":""},{"help":"Describe special conditions if any","type":"text","label":"If so, please specify","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has the system already been used?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify frequency of use","type":"text","label":"If so, how often?","options":[],"required":false,"pdf_field":""},{"help":"Specify causes of failure","type":"text","label":"Causes","options":[],"required":false,"pdf_field":""},{"help":"Specify maximum duration of failure","type":"text","label":"Max. duration","options":[],"required":false,"pdf_field":""},{"help":"Specify maximum cost incurred","type":"amount","label":"Max. cost incurred","options":[],"required":false,"pdf_field":""},{"help":"Enter indemnity period in weeks","type":"amount","label":"Indemnity period per occurrence Rs. weeks","options":[],"required":false,"pdf_field":""},{"help":"Enter limit per occurrence","type":"amount","label":"Limit per occurrence (a x b) Rs.","options":[],"required":false,"pdf_field":""},{"help":"Enter aggregate indemnity limit","type":"amount","label":"Aggregate indemnity limit during the period of insurance Rs.","options":[],"required":false,"pdf_field":""},{"help":"Enter personnel expenses","type":"amount","label":"Personnel expenses Rs.","options":[],"required":false,"pdf_field":""},{"help":"Enter transportation expenses","type":"amount","label":"Transportation of material Rs.","options":[],"required":false,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Enter place of execution","type":"text","label":"Executed at","options":[],"required":false,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration - Physical Proposal Form","fields":[{"help":"Select Yes or No","type":"choice","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Agent to confirm explanation to proposer","type":"text","label":"Declaration: The content of this form and its particulars have been explained by me in vernacular to the proposer","options":[],"required":true,"pdf_field":""},{"help":"Proposer to sign","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":false,"pdf_field":""},{"help":"Enter witness name","type":"text","label":"Name of Witness","options":[],"required":false,"pdf_field":""},{"help":"Witness to sign","type":"signature","label":"Signature of Witness","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Disability Declaration: Any Physical deformity or handicap (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide disability details and certificate info","type":"text","label":"If Yes, Please provide details","options":[],"required":false,"pdf_field":""},{"help":"If proposer is disabled, name of authorized representative","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Authorized representative to sign","type":"signature","label":"Signature of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Enter agent license number","type":"text","label":"IRDAI COR No./ License No. (Advisor/Corporate Agent/Broker/Relationship Officer)","options":[],"required":true,"pdf_field":""},{"help":"Agent to sign","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"Agent or IMD signature and code","type":"text","label":"Agent / IMD (SP/DP/ BQP) signature and their code","options":[],"required":false,"pdf_field":""},{"help":"Enter SP/BQP/DP/PoS name","type":"text","label":"SP/ BQP /DP/ PoS Name","options":[],"required":false,"pdf_field":""},{"help":"Enter SP/BQP/DP/PoS CoR number","type":"text","label":"SP/ BQP /DP/ PoS CoR No.","options":[],"required":false,"pdf_field":""},{"help":"SP/BQP/DP/PoS to sign","type":"signature","label":"SP/ BQP /DP/ PoS Signature","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer and agent"}],"deadlines":[],"applies_to":"Electronic Equipment Insurance","attachments":["Copy of valid maintenance contract (if applicable)","Copy of lease contract (if available)"],"declarations":["Statements made in this proposal are true and complete to the best of the proposer's knowledge.","The proposal forms the basis and part of any policy issued.","Insurers are liable only according to policy terms and no other claims will be lodged.","Information will be treated in strict confidence.","No person shall offer or accept rebates except as allowed by insurer's published prospectus.","Non-disclosure of material facts may render the policy null and void and premiums forfeited.","Consent is given for identity/address verification through specified government portals.","Premiums are declared to be paid from legally acquired sources.","Consent is given to share personal information with group companies for services.","It is mandatory to keep policy contact and bank details updated for faster service.","Agent declares having explained the form contents to the proposer in vernacular language."],"dropped_labels":43},"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/2585-proposal-form-electronic-equipment-insurance"}