{"id":2590,"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-rp.pdf","sha256":"9211c03c8e5f85bd56892e7a931cd9f650ddae5ff23859558cf3b9a38d8590a7","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.","Attach all required documents as specified.","Use original and accurate information to avoid claim rejection or policy avoidance.","The Insurance Act 1938 Section 41 prohibits rebates on commission or premium except as allowed by published prospectuses.","Politically Exposed Persons (PEPs) must be declared with details.","If proposer has disability, authorized representative may sign after confirming understanding.","Agent/intermediary must sign and provide license details.","The form includes confidential and proprietary information; unauthorized use is prohibited."],"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":"Full postal address","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"Full postal address","type":"text","label":"Address of Business Premises Proposed for Insurance","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"House No & Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Landmark / Locality","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Road/Area Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City :","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State :","options":[],"required":true,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code :","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":true,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"E Mail","options":[],"required":false,"pdf_field":""},{"help":"Briefly describe the business nature","type":"text","label":"Nature of Trade of Business","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Construction/Erection and Surroundings","fields":[{"help":"Describe the work planned","type":"text","label":"1. 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":"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":true,"pdf_field":""},{"help":"Select one","type":"choice","label":"3. Project is","options":["Extension of existing work","A new venture"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"4. 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":"Explain if delay may occur","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":"","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","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":"Select Yes or No","type":"choice","label":"Existing Customer","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide previous policy or PID number","type":"text","label":"If Yes. Please provide PID No: / Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Tick to confirm","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 no change in KYC"],"required":true,"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":"Select Yes or No","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 applicable constitution type","type":"choice","label":"If Yes Specify Constitution","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO - Provide DARPAN Portal Registration, if applicable","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":false,"pdf_field":""},{"help":"Provide DARPAN portal registration if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Project and Business Details","fields":[{"help":"Specify number of years","type":"number","label":"If so, for how many years? (please specify)","options":[],"required":false,"pdf_field":""},{"help":"Explain one-off loss if applicable","type":"text","label":"If Yes please specify","options":[],"required":false,"pdf_field":""},{"help":"Explain loss of profits if applicable","type":"text","label":"If Yes please specify","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Power Supply Details","fields":[{"help":"Answer only if electricity can be drawn from public power network","type":"yes-no","label":"i. Is the additional expenditure caused by using external power supply to be insured?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Explain additional expenditure","type":"text","label":"If Yes please specify","options":[],"required":false,"pdf_field":""},{"help":"Specify power requirements","type":"text","label":"ii. Power requirements of the plant (kW, kWh p.a.)","options":[],"required":true,"pdf_field":""},{"help":"Specify percentage","type":"number","label":"iii. 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":"iv. Costs of kWh of power - own plant","options":[],"required":true,"pdf_field":""},{"help":"Specify kW capacity from external source","type":"number","label":"v. To what extent (kW) may electricity be drawn from an external source?","options":[],"required":true,"pdf_field":""},{"help":"Specify demand charge and period; attach contract copy","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":true,"pdf_field":""},{"help":"Specify annual demand charges","type":"amount","label":"vii. Annual maximum demand charges?","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Project Timeline and Penalties","fields":[{"help":"Explain how period can be reduced","type":"text","label":"If so, by which means?","options":[],"required":false,"pdf_field":""},{"help":"Additional remarks","type":"text","label":"Remarks","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Signature","fields":[{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration - Physical Proposal Form","fields":[{"help":"Politically Exposed Persons status","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 legal source of premium payment","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":"Declaration by Witness and Disability Declaration","fields":[{"help":"Proposer signs here","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Date of proposer signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of proposer signature","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Witness name","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"Witness signs here","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":"Declare any disability","type":"yes-no","label":"Any Physical deformity or handicap","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide disability details and certificate","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":"If proposer is disabled, name of authorized representative","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Authorized representative signature","type":"signature","label":"Signature of Authorised representative","options":[],"required":false,"pdf_field":""},{"help":"Date of authorized representative signature","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Place of authorized representative signature","type":"text","label":"Place","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer and witness"},{"title":"Agent / Intermediary Declaration","fields":[{"help":"Agent license number","type":"text","label":"IRDAI COR No./ License No.(Advisor/Corporate Agent/Broker/Relationship Officer)","options":[],"required":true,"pdf_field":""},{"help":"Agent signs here","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 or intermediary"}],"deadlines":[],"applies_to":"Advance Loss of Profit (EAR) insurance proposals","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 and no material information is withheld.","The proposer agrees to accept the policy subject to terms, exceptions, and conditions prescribed or endorsed.","The proposer confirms consent for KYC verification through specified government portals.","The proposer declares that premiums are paid from legally acquired sources.","The proposer confirms understanding of the form content as explained in vernacular.","The insurance advisor declares that the form contents and questions have been explained to the proposer.","Non-disclosure or untrue statements may lead to policy being null and void and forfeiture of premiums."],"dropped_labels":22},"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/2590-advance-loss-of-profit-ear-proposal-form"}