{"id":2591,"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-cp.pdf","sha256":"ae87f847d8f5344d667c485a5bdffcaf6419ffb1bb65c0c80e2a7a1f6eac317d","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":["Answer all questions fully and accurately; attach separate sheets if needed.","Attach original documents as required.","Use block letters where applicable.","Attach site layout plan and phase diagram as specified.","Attach copy of contract for power demand charges if applicable.","Keep policy details updated for faster service.","The form includes a declaration about prohibition of rebates under Insurance Act 1938 Section 41."],"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":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 of the business premises","type":"text","label":"Address of Business Premises Proposed for Insurance","options":[],"required":true,"pdf_field":""},{"help":"For both communication and business premises addresses","type":"text","label":"House No & Name","options":[],"required":true,"pdf_field":""},{"help":"For both communication and business premises addresses","type":"text","label":"Landmark / Locality","options":[],"required":false,"pdf_field":""},{"help":"For both communication and business premises addresses","type":"text","label":"Road/Area Name","options":[],"required":false,"pdf_field":""},{"help":"For both communication and business premises addresses","type":"text","label":"City :","options":[],"required":true,"pdf_field":""},{"help":"For both communication and business premises addresses","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":"Mobile phone number","type":"phone","label":"Mobile No.","options":[],"required":true,"pdf_field":""},{"help":"Email address","type":"email","label":"E Mail","options":[],"required":false,"pdf_field":""},{"help":"Brief description of business nature","type":"text","label":"Nature of Trade of Business","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Project Details","fields":[{"help":"Describe the construction or erection work","type":"text","label":"Brief description of the construction/erection work to be carried out","options":[],"required":true,"pdf_field":""},{"help":"Describe existing plant 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 one","type":"choice","label":"Project is","options":["Extension or renovation of existing work","A new venture"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"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":true,"pdf_field":""},{"help":"Explain if damage can cause delay","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","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":"yes-no","label":"Are you an exisiting customer of Bajaj General?","options":["Yes","No"],"required":true,"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 to confirm no change in KYC","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":"Select Yes or No","type":"yes-no","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":"Constitution Details","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":true,"pdf_field":""},{"help":"Provide DARPAN registration number if NGO/NPO","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Project and Business Interruption Details","fields":[{"help":"Select Yes or No","type":"yes-no","label":"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":true,"pdf_field":""},{"help":"Describe business activities and bottlenecks","type":"text","label":"Brief description of the intended business or service activities, making special mention of bottlenecks.","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","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)","type":"text","label":"Intended normal working hours","options":[],"required":true,"pdf_field":""},{"help":"Provide monthly gross profit figures","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":"Select Yes or No","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 > 12 months","type":"number","label":"If so, for how many years? (please specify)","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","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":"Select Yes or No","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":"Specify power requirements","type":"text","label":"Power requirements of the plant (kW, kWh p.a.)","options":[],"required":false,"pdf_field":""},{"help":"Specify percentage","type":"number","label":"Percentage of the requirements met by the plant’s own power generation equipment?","options":[],"required":false,"pdf_field":""},{"help":"Specify cost per kWh","type":"amount","label":"Costs of kWh of power","options":[],"required":false,"pdf_field":""},{"help":"Specify kW from external source","type":"number","label":"To what extent (kW) may electricity be drawn from an external source?","options":[],"required":false,"pdf_field":""},{"help":"Specify max demand charge 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":false,"pdf_field":""},{"help":"Specify annual max demand charges","type":"amount","label":"Annual maximum demand charges?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Project Timeline and Penalties","fields":[{"help":"Date when CAR cover starts","type":"date","label":"Date of inception of CAR cover","options":[],"required":true,"pdf_field":""},{"help":"Date when construction/erection works start","type":"date","label":"Date of commencement of works","options":[],"required":true,"pdf_field":""},{"help":"Specify testing period if applicable","type":"text","label":"Testing period (if any)","options":[],"required":false,"pdf_field":""},{"help":"Expected completion and handover date","type":"date","label":"Anticipated date of completion (handover following a possible testing period)","options":[],"required":true,"pdf_field":""},{"help":"Date when insured business starts","type":"date","label":"Scheduled date of commencement of insured business","options":[],"required":true,"pdf_field":""},{"help":"Date full production is expected","type":"date","label":"At which date after completion of the project (and a possible testing period) is full production to be reached?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is it possible to reduce that period?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe allowances for delays","type":"text","label":"What allowance exists for delays due to accidents or otherwise?","options":[],"required":false,"pdf_field":""},{"help":"Attach phase diagram","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 penalty agreement details","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":"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 the form","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Select mode of payment","type":"choice","label":"Mode of Payment :","options":["Cheque","DD","Cash","Other"],"required":true,"pdf_field":""},{"help":"Name of person giving cheque","type":"text","label":"Cheque - Given by :","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration - Physical Proposal Form","fields":[{"help":"Politically Exposed Person 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":""},{"help":"Consent for sharing personal data","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":true,"pdf_field":""},{"help":"Acknowledge importance of updated details","type":"checkbox","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":["acknowledge"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Witness","fields":[{"help":"Proposer's signature","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 signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and witness"},{"title":"Disability Declaration","fields":[{"help":"Declare any physical 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 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 or authorised representative"},{"title":"Agent / Intermediary Declaration","fields":[{"help":"Agent or intermediary 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 signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","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":"CoR number 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":"insurance agent or intermediary"}],"deadlines":[],"applies_to":"Advance Loss of Profit insurance under CAR policies","attachments":["Site layout plan","Phase diagram of construction (date of arrival on site, erection, testing, commissioning, handover)","Copy of contract for maximum demand charge per kW"],"declarations":["The proposer declares that all statements are true and complete and form the basis of the contract.","The proposer agrees that any untrue statement may render the contract null and void.","The proposer confirms premium payment is from legally acquired sources.","The proposer consents to KYC verification through specified government portals.","The proposer consents to sharing personal data with group companies for services.","The proposer acknowledges the importance of keeping contact and bank details updated.","The insurance agent declares having explained the form contents to the proposer in vernacular."],"dropped_labels":1},"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/2591-advance-loss-of-profit-car-proposal-form"}