{"id":2604,"title":"ANNEXURE ‘B’","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/petro-chemical-tariff/Petro-Chemical-Tariff-pf.pdf","sha256":"66f570a024f7a9eebe5f3a4ae5513722ed3520e0ef70a7e03cec33a4d5227fb4","pages":12,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for insurance under the All India Fire Tariff, to be filled by the proposer seeking property insurance coverage.","notes":["The property proposed for insurance is not covered until the proposal is accepted and premium paid.","Buildings with walls or roofs made of wooden planks, thatched leaves, grass, bamboo, plastic cloth, tarpaulin, etc. are treated as 'Kutcha' construction.","Minimum Sum Insured for stocks on declaration basis is Rs.1 Crore; policy not issued on short period basis.","Stocks in process and stocks stored at Railway sidings are not covered under stock coverage.","Use block letters where applicable.","Attach original documents where required."],"title":"ANNEXURE ‘B’","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Details about Proposer","fields":[{"help":"","type":"text","label":"Name  of Proposer","options":[],"required":null,"pdf_field":""},{"help":"Include full address with phone, fax, and email","type":"text","label":"Address of Proposer including their phone, fax No. and e-mail address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Business of Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Paid up capital of the firm","options":[],"required":null,"pdf_field":""},{"help":"List all parties with insurable interest","type":"text","label":"Policy to be Issued in favour  of (list out all the parties who have insurable interest) including the financial institutions.","options":[],"required":null,"pdf_field":""},{"help":"Provide full postal address with pincode","type":"text","label":"Location of risk to be covered  - full postal address with pincode","options":[],"required":null,"pdf_field":""},{"help":"Start date of insurance period","type":"date","label":"Period of Insurance From","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Would you like to delete any of following covers from the basic cover? a. Flood, Cyclone, group of perils","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Would you like to delete any of following covers from the basic cover? b. Riot, Strike &  Malicious damage, Terrorism","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Cover Options","fields":[{"help":"","type":"yes-no","label":"Would you like to cover Plinth & Foundation along with your buildings","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Add-On Covers Required - Architects consulting & Engineers Fees (in excess of 3% claim amount)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History","fields":[{"help":"Provide details if applicable","type":"text","label":"Whether you have insured the same property with any other Insurance Company with the same type of coverage. (Give details)","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Whether Insurance was declined by any other Company or imposed any Special Conditions (Give details)","options":[],"required":null,"pdf_field":""},{"help":"Enter premium amounts for past 36 months","type":"amount","label":"Premium / Claim details for the past 36 months excluding the expiring policy period - Premium","options":[],"required":null,"pdf_field":""},{"help":"Enter claim amounts for past 36 months","type":"amount","label":"Premium / Claim details for the past 36 months excluding the expiring policy period - Claims","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details about Business Covered at the Insured Location","fields":[{"help":"","type":"yes-no","label":"The Insured property is Residence,Office,Shops,Hotels etc","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Industrial/Manufacturing risks","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Storages outside industrial risks","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Tanks / Gas Holders outside Industrial Manufacturing risks","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Utilities located outside Industrial Manufacturing risks","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Shop and Warehouse Details","fields":[{"help":"Goods include celluloid goods, crackers, explosives, inflammable liquids, etc.","type":"yes-no","label":"If used as Shop please declare whether the goods handled are as per the following list. If yes, whether the stock value will exceed 5% of shops value","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"List goods stored in warehouse/godown","type":"text","label":"If used as warehouse / godown (not located in a manufacturing unit) please give the list of goods stored","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Industrial Manufacturing Unit Details","fields":[{"help":"Describe products manufactured and enclose block plan","type":"text","label":"If used as an Industrial Manufacturing unit give products manufactured at the location proposed.(detailed block plan showing various facilities to be enclosed)","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"If used as an Industrial Manufacturing unit, please state whether the factory is working or silent","options":["Working","Silent"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Fire Protection Devices Installed","fields":[{"help":"","type":"yes-no","label":"Portable Extinguishers","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Small bore hose reels","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Trailer Pumps/Fire engines","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"List various blocks and type of protection for each","type":"yes-no","label":"Hydrant System","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Sprinkler System","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Annual Maintenance contract for the Appliances is in force","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Fixed Water Spray System","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Foam systems","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Fire alarm systems","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Gas flooding systems","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Basis of Insurance and Building Details","fields":[{"help":"","type":"yes-no","label":"Market Value basis","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Reinstatement Value Basis","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether escalation clause is required","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Height in meters","type":"number","label":"Height of Building","options":[],"required":null,"pdf_field":""},{"help":"Select the age category","type":"choice","label":"Age of Building","options":["Less than 5 years","5-10 years","10-20 years","above 20 years"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Building wise values and Stocks Coverage","fields":[{"help":"Provide values for each building including kutcha buildings","type":"table","label":"Building wise values (Please include the kutcha buildings also in this list and give individual values against such buildings)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Total Sum Insured and Premium Details","fields":[{"help":"Provide total sum insured amount","type":"amount","label":"Total Sum Insured (as per relevant serial numbers shown against each)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Voluntary Deductibles and Declaration","fields":[{"help":"","type":"yes-no","label":"Would you like to avail Discount for Voluntary Deductibles","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify deductible amount in Rs.","type":"amount","label":"If the answer is Yes, indicate the choice of Deductible amount","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the Proposer","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consents","fields":[{"help":"PEP means Politically Exposed Persons as defined","type":"yes-no","label":"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":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"property insurance under All India Fire Tariff","attachments":["Detailed block plan showing various facilities (if used as Industrial Manufacturing unit)"],"declarations":["The statements made in this Proposal Form are true to the best of the proposer's knowledge and belief and form the basis of the contract.","Any additions or alterations in the risk after submission must be conveyed to the insurers immediately.","No person shall offer or accept any rebate of commission or premium except as allowed by the insurer's published prospectus or tables.","Consent is given for KYC verification through specified portals.","Premiums are declared to be paid from legally acquired sources.","Consent is given to share personal information with the insurer and its group companies."],"dropped_labels":35},"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/2604-annexure-b"}