{"id":2589,"title":"PARAMETRIC 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/Parametric-Insurance/Proposal-Form.pdf","sha256":"e669504f00f807c02adbd6218296a8d66230abb9bd1f22fa522dff9ac590227c","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or groups to apply for parametric insurance coverage from Bajaj General Insurance Limited. The proposer (individual, company, or group manager) fills it out to provide details about the insured group and coverage parameters.","notes":["If proposer is a company, provide full incorporated name; if proprietorship or partnership, provide full names accordingly.","Use separate sheet if space is insufficient to provide information.","Certified signature required if proposal is filled by someone other than proposer.","Prohibition of rebates under Insurance Act 1938 Section 41 applies; violations may lead to fines up to ten lakh rupees."],"title":"PARAMETRIC INSURANCE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Full incorporated name if company; full name of proprietorship or partnership with partners' names","type":"text","label":"Name of the Proposer ( in full )","options":[],"required":true,"pdf_field":""},{"help":"Provide PAN or TAN number","type":"text","label":"PAN/TAN Number","options":[],"required":true,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"Contact phone number","type":"phone","label":"Telephone Number","options":[],"required":false,"pdf_field":""},{"help":"Email address","type":"email","label":"E mail ID","options":[],"required":false,"pdf_field":""},{"help":"Describe the group or institution whose members are insured","type":"text","label":"Please mention detail of the Group/ Association/ Institution/ Corporate Body whose members are being covered under the Policy?","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the group being formed with the sole purpose of obtaining Insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"State of the proposer or group","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Postal PIN code","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Group Constitution Details","fields":[{"help":"Check if applicable","type":"checkbox","label":"Partnership Firm","options":["Yes"],"required":false,"pdf_field":""},{"help":"Check if applicable","type":"checkbox","label":"Limited Liability/Partnership Firm","options":["Yes"],"required":false,"pdf_field":""},{"help":"Check if applicable and provide DARPAN details","type":"checkbox","label":"NGO/NPO- Provide DARPAN Portal Registration, if applicable","options":["Yes"],"required":false,"pdf_field":""},{"help":"Check if applicable","type":"checkbox","label":"Company","options":["Yes"],"required":false,"pdf_field":""},{"help":"Check if applicable","type":"checkbox","label":"Trust","options":["Yes"],"required":false,"pdf_field":""},{"help":"Check if applicable","type":"checkbox","label":"Society","options":["Yes"],"required":false,"pdf_field":""},{"help":"Check if applicable","type":"checkbox","label":"Section 8 Company","options":["Yes"],"required":false,"pdf_field":""},{"help":"Check if applicable","type":"checkbox","label":"Proprietorship Firm","options":["Yes"],"required":false,"pdf_field":""},{"help":"Specify other constitution type if any","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""},{"help":"Provide details of constitution if applicable","type":"text","label":"Constitution Details","options":[],"required":false,"pdf_field":""},{"help":"Provide DARPAN portal registration details if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Group and Coverage Information","fields":[{"help":"Explain relationship if group not formed solely for insurance","type":"text","label":"If answer to Question 6 is “No” please mention the relationship between the members and the group manager for services other than Insurance","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Please state whether all members of the Group/ Association/ Institution/ Corporate Body are proposed for Insurance?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"If answer to Question 8 is “Yes” kindly specify who shall bear the premium?","options":["Group Manager","Members of Group"],"required":false,"pdf_field":""},{"help":"Initial number of persons covered","type":"number","label":"Please mention the total number of persons to be covered initially:","options":[],"required":true,"pdf_field":""},{"help":"Expected number of persons covered during policy period","type":"number","label":"Please mention the expected no of persons to be covered during the policy period?","options":[],"required":false,"pdf_field":""},{"help":"Fill table with columns: Sr. No., Type of Coverage/Parameter, Strike, Exit, Unit Value, Notional Payment per unit of deviation, Deductible, Sum Insured, Policy Period, Index Risk Period, Index Phase Period","type":"table","label":"Coverage Details: (Individual / Group)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History and Claims","fields":[{"help":"","type":"yes-no","label":"Has any company/Insurer in respect of Insurance Declined your Proposal?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Date of past claim occurrence","type":"date","label":"Date of Occurrence","options":[],"required":false,"pdf_field":""},{"help":"Describe the loss","type":"text","label":"Details of loss","options":[],"required":false,"pdf_field":""},{"help":"Amount claimed in rupees","type":"amount","label":"Amount of loss Rs.","options":[],"required":false,"pdf_field":""},{"help":"Name of insurer and policy number for past claims","type":"text","label":"Name of the Insurer & Policy Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consents","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Signature of proposer","type":"signature","label":"*Signature (Proposer)","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Name of proposer signing","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"To be signed if proposal filled by someone else","type":"checkbox","label":"Certified that that the contents of the proposal form and documents have been fully explained to the Proposer and that he/they have fully understood the significance of the proposed contract.","options":["Yes"],"required":true,"pdf_field":""},{"help":"Date of certification","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Signature of person filling form if not proposer","type":"signature","label":"**Signature (on behalf of the Proposer)","options":[],"required":false,"pdf_field":""},{"help":"Place of signing by authorized person","type":"text","label":"Place","options":[],"required":false,"pdf_field":""},{"help":"Name of authorized person signing","type":"text","label":"Name","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"AML Declarations and Consents","fields":[{"help":"Provide details if applicable","type":"text","label":"Declaration for Politically Exposed Person (PEP) to be added in proposal form: Are you or any of the proposal applicants a PEP* or a close relative of PEP*? If yes, please share the details","options":[],"required":false,"pdf_field":""},{"help":"Consent for KYC verification","type":"checkbox","label":"Consent/Declaration to be added in proposal and claim for CKYC no.: I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through Central KYC Registry or National Securities Depository Limited Portal for the purpose of undertaking KYC verification.","options":["Agree"],"required":false,"pdf_field":""},{"help":"Declaration of legal source of funds","type":"checkbox","label":"Consent/Declaration to be added in proposal for Premium paid from own funds: 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":["Agree"],"required":false,"pdf_field":""},{"help":"Agreement to maintain beneficiary details","type":"checkbox","label":"Consent/Declaration to be added in proposal: I/we hereby agree and ensure to maintain details of all the beneficiaries covered under the policy and shall share the same with the Company as and when required.","options":["Agree"],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Parametric Insurance policies","attachments":["Separate sheet if insufficient space to provide relevant information"],"declarations":["The statements in this proposal are true, accurate and complete and form the basis of the insurance contract.","The policy will be void if any untrue or incorrect statement, misrepresentation, or non-disclosure is made.","Policy issuance is subject to realization of premium cheque.","Consent is given to share personal information with group companies or others for insurance and related services.","Declarations and consents related to AML, PEP status, KYC verification, and legal source of premium funds are required."],"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/2589-parametric-insurance-proposal-form"}