{"id":2597,"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/Parametric-Insurance-Proposal-Form-Retail.pdf","sha256":"90fcdacef8a0fb9beb8d7ed59ed3396cca56b7ab21cd88153df29f1fc6510d03","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or groups to apply for parametric insurance coverage with Bajaj General Insurance Limited. The proposer (individual, company, or group manager) fills it out to provide details about themselves, the coverage requested, and declarations.","notes":["If proposer is a company, provide full incorporated name; if proprietorship or partnership, provide full names as specified.","Use additional sheets if space is insufficient.","Declarations and consents related to AML and KYC must be completed as applicable.","Signature of proposer is mandatory; if filled by another person, their signature and details are required.","The Insurance Act 1938 Section 41 prohibits rebates and provides penalties for violations."],"title":"PARAMETRIC INSURANCE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Full incorporated name if company; full name if individual or firm","type":"text","label":"1. Name of the Proposer ( in full )","options":[],"required":true,"pdf_field":""},{"help":"Provide your PAN, TAN, or Aadhar number","type":"text","label":"2. PAN/TAN/ Aadhar Number","options":[],"required":true,"pdf_field":""},{"help":"Full postal address for correspondence","type":"text","label":"3. Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"Contact phone number","type":"phone","label":"4. Telephone Number","options":[],"required":false,"pdf_field":""},{"help":"Fill columns: 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, State, Pin Code, E mail ID","type":"table","label":"5. Coverage Details: (Individual / Group)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Select the constitution type of the proposer","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 Portal Registration if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Group Policy Details (if applicable)","fields":[{"help":"Applicable only for group policies","type":"text","label":"6. Please mention detail of the Group/ Association/ Institution/ Corporate Body whose members are being covered under the Policy?","options":[],"required":false,"pdf_field":""},{"help":"Applicable only for group policies","type":"yes-no","label":"7. Is the group being formed with the sole purpose of obtaining Insurance?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Applicable only for group policies","type":"text","label":"8. 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":"Applicable only for group policies","type":"yes-no","label":"9. Please state whether all members of the Group/ Association/ Institution/ Corporate Body are proposed for Insurance?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Applicable only for group policies","type":"choice","label":"10. 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":"Applicable only for group policies","type":"number","label":"11. Please mention the total number of persons to be covered initially:","options":[],"required":false,"pdf_field":""},{"help":"Applicable only for group policies","type":"number","label":"12. Please mention the expected no of persons to be covered during the policy period?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History","fields":[{"help":"","type":"yes-no","label":"13. Has any company/Insurer in respect of Insurance Declined your Proposal?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Cancelled or refused to renew your policy?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"","type":"checkbox","label":"I/We agree that the Policy shall become null and void, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material particular in the proposal form/personal statement, declaration and connected documents, or any material information has been withheld by me/us or anyone acting on my/our behalf to obtain any benefit under this Policy.","options":["Agree"],"required":true,"pdf_field":""},{"help":"","type":"checkbox","label":"I/We agree that the issuance of Policy shall be subject to realisation of premium cheque.","options":["Agree"],"required":true,"pdf_field":""},{"help":"","type":"checkbox","label":"I/We hereby give voluntary consent to BGIL/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":["Agree"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"AML (Anti Money Laundering) Declarations","fields":[{"help":"PEP means individuals with prominent public functions; provide details if yes","type":"yes-no-text","label":"AML DECLARATION FOR RETAIL POLICIES/INDIVIDUAL CUSTOMERS: 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":["Yes","No"],"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":true,"pdf_field":""},{"help":"Confirm premium payment source legality","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":true,"pdf_field":""},{"help":"Same as retail but for juridical persons","type":"yes-no-text","label":"AML DECLARATION FOR JURIDICAL PERSON/NON-INDIVIDUAL CUSTOMER: Declaration for 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":["Yes","No"],"required":false,"pdf_field":""},{"help":"Consent for KYC verification for juridical persons","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 Goods and Service Tax Portal or Ministry Of Corporate Affairs Portal or National Securities Depository Limited portal for the purpose of undertaking KYC.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Confirm premium payment source legality","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":true,"pdf_field":""},{"help":"Consent and agreement to maintain beneficiary details","type":"checkbox","label":"Consent/Declaration to be added in proposal: 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. 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":true,"pdf_field":""},{"help":"Consent for KYC verification at claim stage","type":"checkbox","label":"Consent/Declaration to be added in 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 for the purpose of undertaking KYC","options":["Agree"],"required":true,"pdf_field":""},{"help":"Consent and agreement for juridical and group policies","type":"checkbox","label":"AML DECLARATION FOR JURIDICAL PERSON/NON-INDIVIDUAL CUSTOMER AND GROUP POLICIES: Consent/Declaration to be added in proposal: 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. 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":true,"pdf_field":""},{"help":"Consent for KYC verification at claim stage","type":"checkbox","label":"Consent/Declaration to be added in 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 UIDAI or through any other modes for the purpose of undertaking KYC","options":["Agree"],"required":true,"pdf_field":""},{"help":"Consent for KYC verification","type":"checkbox","label":"Consent/Declaration to be added in proposal: 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 Security Depository Limited portal or through any other modes for the purpose of undertaking KYC.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Confirm premium payment source legality","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":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Signature and Certification","fields":[{"help":"Date of signing the proposal","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Signature of the proposer","type":"signature","label":"*Signature (Proposer)","options":[],"required":true,"pdf_field":""},{"help":"Place where the form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Name of the proposer signing","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Required only if proposal is filled by someone else","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 or agent"}],"deadlines":[],"applies_to":"Parametric Insurance policies for retail, group, or corporate customers","attachments":["Attach a separate sheet if there is insufficient space to provide relevant information"],"declarations":["The statements made in this proposal are true, accurate, and complete and form the basis of the insurance contract.","The policy will be void if any material information is untrue, incorrect, or withheld.","Policy issuance is subject to realization of premium payment.","Consent is given to share personal information with group companies and others for insurance and related services.","Declarations related to AML and KYC compliance are agreed to as applicable.","Premiums are paid from legally acquired sources of income."],"dropped_labels":4},"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/2597-parametric-insurance-proposal-form"}