{"id":2586,"title":"ADVANCE LOSS OF PROFIT (EAR) 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-ear-pf-cp.pdf","sha256":"42898827076be5894ee69a8d149831339b6c0b55226eeef9451d3ddb13bebf07","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (potential policyholder) to apply for Advance Loss of Profit (EAR) insurance coverage by providing detailed information about the business, construction/erection work, and related risks.","notes":["Answer all questions fully and accurately; attach separate sheets if space is insufficient.","Use original documents for attachments as required.","Physical deformity or handicap must be declared with supporting government-issued disability certificate.","No rebates or inducements are allowed as per Insurance Act 1938 Section 41.","Signatures of proposer, witness, authorised representative (if applicable), and agent are mandatory.","Attach all required documents to avoid delays in policy issuance."],"title":"ADVANCE LOSS OF PROFIT (EAR) PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Customer Details","fields":[{"help":"","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Middle Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Last Name","options":[],"required":true,"pdf_field":""},{"help":"Include House No & Name, Landmark / Locality, Road/Area Name, City, State, Pin Code","type":"text","label":"Address for Communication","options":[],"required":true,"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":true,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":true,"pdf_field":""},{"help":"Enter email address","type":"email","label":"E Mail","options":[],"required":false,"pdf_field":""},{"help":"Briefly describe the nature of your business","type":"text","label":"Nature of Trade of Business","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Construction/Erection Work and Surroundings","fields":[{"help":"Describe the work planned at the site","type":"text","label":"Brief description of the construction/erection work to be carried out","options":[],"required":true,"pdf_field":""},{"help":"Describe existing plants or property; attach site layout plan","type":"text","label":"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":true,"pdf_field":""},{"help":"Select whether the project is an extension or a new venture","type":"choice","label":"Project is","options":["Extension of existing work","A new venture"],"required":true,"pdf_field":""},{"help":"Indicate if damage to adjacent property may delay business completion","type":"yes-no","label":"May loss or damage to adjacent plants and/or surrounding property, which was caused by the erection work, cause a delay in completion of the business to be insured?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if previous question is Yes","type":"text","label":"If Yes please specify","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details","fields":[{"help":"Name as per bank records","type":"text","label":"Name as pr Bank","options":[],"required":true,"pdf_field":""},{"help":"Bank name","type":"text","label":"Name Of Bank","options":[],"required":true,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Tick to accept payment through this bank account","type":"checkbox","label":"* I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["accept"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Existing Customer Details","fields":[{"help":"Indicate if you are an existing customer","type":"choice","label":"Existing Customer","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide previous policy or PID number if existing customer","type":"text","label":"If Yes. Please provide PID No: / Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Tick to confirm no change in KYC details","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":["confirm"],"required":false,"pdf_field":""},{"help":"Provide e-IA number if available","type":"text","label":"Electronic-Insurance Account: Please provide e-IA No. to deposite your insurance policy.","options":[],"required":false,"pdf_field":""},{"help":"Indicate if you want to open an e-IA account","type":"choice","label":"Do you want to open e-IA account:","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Select the constitution type","type":"choice","label":"If Yes Specify Constitution","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":false,"pdf_field":""},{"help":"Provide DARPAN registration details if applicable","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Project and Business Details","fields":[{"help":"Describe processes and bottlenecks; attach flow sheet","type":"text","label":"Brief description of the process or services, making special mention of bottlenecks. (Please attach flow sheet.)","options":[],"required":true,"pdf_field":""},{"help":"Indicate if method has been used before","type":"yes-no","label":"Has the method of production or services been employed by the proposer previously?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify working hours (per day, week, year, shifts, hours)","type":"text","label":"Intended normal working hours","options":[],"required":true,"pdf_field":""},{"help":"Provide monthly gross profit figures for first year","type":"amount","label":"Anticipated gross profit (annual turnover less costs of supplies of goods, raw material, electricity, water, gas, etc) for first year of operation monthly figures","options":[],"required":true,"pdf_field":""},{"help":"Indicate if indemnity period is longer than 12 months","type":"yes-no","label":"If indemnity period required longer than 12 months","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify number of years if indemnity period longer than 12 months","type":"number","label":"If so, for how many years? (please specify)","options":[],"required":false,"pdf_field":""},{"help":"Indicate if one-off loss may arise from delay","type":"yes-no","label":"In the event that a specific date of completion is not met is any one-off loss likely to arise?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if seasonal events affect profits","type":"yes-no","label":"Are there seasonal events likely to affect the gross profits?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify desired time excess","type":"text","label":"Desired time excess (minimum one week per 6 months of construction/erection period)","options":[],"required":true,"pdf_field":""},{"help":"Specify maximum indemnity period","type":"text","label":"Maximum indemnity period required to be insured","options":[],"required":true,"pdf_field":""},{"help":"Indicate if loss of profits from adjacent plants is to be insured","type":"yes-no","label":"May loss or damage to adjacent plants and/or surrounding property, which was caused by the erection work, lead to any loss of profits there and is this to be insured?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if previous question is Yes","type":"text","label":"If Yes please specify","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Power Supply Details","fields":[{"help":"Specify power requirements in kW and kWh per annum","type":"text","label":"Power requirements of the plant (kW, kWh p.a.)","options":[],"required":true,"pdf_field":""},{"help":"Specify percentage met by own power generation","type":"number","label":"Percentage of the requirements met by the plant’s own power generation equipment?","options":[],"required":true,"pdf_field":""},{"help":"Cost per kWh from own plant","type":"amount","label":"Costs of kWh of power - own plant","options":[],"required":true,"pdf_field":""},{"help":"Maximum kW that can be drawn externally","type":"number","label":"To what extent (kW) may electricity be drawn from an external source?","options":[],"required":true,"pdf_field":""},{"help":"Specify max demand charge per kW and period; attach contract copy","type":"text","label":"What is the maximum demand charge per kW and within which period is it due? (Please attach copy of contract)","options":[],"required":true,"pdf_field":""},{"help":"Specify annual maximum demand charges","type":"amount","label":"Annual maximum demand charges?","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Project Timeline and Penalties","fields":[{"help":"Enter date when EAR cover starts","type":"date","label":"Date of inception of EAR cover","options":[],"required":true,"pdf_field":""},{"help":"Enter date when works start","type":"date","label":"Date of commencement of works","options":[],"required":true,"pdf_field":""},{"help":"Specify duration of testing period","type":"text","label":"Testing period","options":[],"required":true,"pdf_field":""},{"help":"Enter expected completion date","type":"date","label":"Anticipated date of completion (handover following a possible testing period)","options":[],"required":true,"pdf_field":""},{"help":"Enter date when insured business is scheduled to start","type":"date","label":"Scheduled date of commencement of insured business","options":[],"required":true,"pdf_field":""},{"help":"Enter date when full production is expected","type":"date","label":"At which date after completion of testing/commissioning is full production to be reached?","options":[],"required":true,"pdf_field":""},{"help":"Indicate if full production period can be reduced","type":"yes-no","label":"Is it possible to reduce that period?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain how the period can be reduced","type":"text","label":"If so, by which means?","options":[],"required":false,"pdf_field":""},{"help":"Describe allowances for delays","type":"text","label":"What allowance exists for delays due to accidents or otherwise?","options":[],"required":true,"pdf_field":""},{"help":"Attach phase diagram of construction","type":"attachment","label":"Please, attach 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.","options":[],"required":true,"pdf_field":""},{"help":"Provide details of penalty agreements if any","type":"text","label":"Details of any penalty agreements in connection with the contract works","options":[],"required":false,"pdf_field":""},{"help":"Additional remarks","type":"text","label":"Remarks","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Sign to confirm declaration","type":"signature","label":"Declaration - I/WE HEREBY DECLARE AND WARRANT that the above statements are true and complete and that I/We have withheld no information whatsoever which is material for the acceptance of this proposal.","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and agent"},{"title":"Physical Proposal Form Declarations","fields":[{"help":"Indicate if you or relatives are Politically Exposed Persons","type":"yes-no","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":"Provide details if PEP","type":"text","label":"If yes, please share the details","options":[],"required":false,"pdf_field":""},{"help":"Consent for KYC verification","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":true,"pdf_field":""},{"help":"Confirm premium payment source legality","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":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Witness and Disability Declaration","fields":[{"help":"Signature of proposer and witness","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":"Sign here","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"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":"Date of witness signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of witness signature","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Indicate if proposer has any physical deformity or handicap","type":"yes-no","label":"Any Physical deformity or handicap","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide disability details and certificate if applicable","type":"text","label":"If Yes. Please provide details: (Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability)","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorised representative if proposer has disability","type":"signature","label":"I _____________ authorised representative of Mr./Miss/Mrs. ______ _ hereby giving consent on the behalf of the proposer due to his/her disability , that he/she has understood the content of this form and its particulars and confirmed the same","options":[],"required":false,"pdf_field":""},{"help":"Name of authorised representative","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorised representative","type":"signature","label":"Signature of Authorised representative","options":[],"required":false,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Place of signature","type":"text","label":"Place","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer and witness"},{"title":"Agent / Intermediary Declaration","fields":[{"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 signature","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"Date of agent signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of agent signature","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Agent or IMD name","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":"Agent or IMD signature","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":"Advance Loss of Profit (EAR) insurance policies","attachments":["Site layout plan","Flow sheet of process or services","Phase diagram of construction (date of arrival on site, erection, testing, commissioning, handover)","Copy of contract for maximum demand charge"],"declarations":["The proposer declares that all statements are true and complete with no withheld information.","The proposer agrees to accept the policy subject to terms, exceptions, and conditions prescribed or endorsed.","The proposer consents to KYC verification through specified government portals.","The proposer confirms premium payments are from legally acquired sources.","The agent declares having explained the proposal form contents to the proposer in vernacular.","Non-disclosure or untrue statements may lead to policy variation or nullification and forfeiture of premiums."],"dropped_labels":3},"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/2586-advance-loss-of-profit-ear-proposal-form"}