{"id":2608,"title":"BAJAJ GENERAL INSURANCE LIMITED, BHARAT LAGHU UDYAM SURAKSHA POLICY PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/Bharat-Laghu-Udyam-Suraksha/Bharat-Laghu-Udyam-Suraksha-PF.pdf","sha256":"f86f34c92932108b4757154e91ddc2189beb997db2f4231222d0f16f53f4cdc0","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for insurance coverage of enterprises with insurable assets valued between Rs. 5 Crore and Rs. 50 Crore against Fire and Allied Perils. It is filled by the proposer (policyholder).","notes":["Read the Prospectus/Key Features Document/Policy Wordings before filling the proposal form.","The property is not covered until the proposal is accepted and premium is paid.","Use detailed block plan for industrial manufacturing units wherever applicable.","Kutcha construction means buildings with walls/roofs made of wooden planks, thatched leaves, grass, bamboo, plastic cloth, asphalt, canvas, tarpaulin, etc.","Pucca construction means buildings other than Kutcha.","Keep policy updated with mobile number, email ID, PAN card, and bank account details for hassle-free service.","Agent/intermediary must explain the form contents in vernacular if required."],"title":"BAJAJ GENERAL INSURANCE LIMITED, BHARAT LAGHU UDYAM SURAKSHA POLICY PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Name of Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of Proposer","options":[],"required":null,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Telephone No ( Landline)","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E-Mail","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) includin the financial institutions","options":[],"required":null,"pdf_field":""},{"help":"Start date of policy period","type":"date","label":"Period of Insurance: From","options":[],"required":null,"pdf_field":""},{"help":"Name as per bank records","type":"text","label":"Bank Details - Name as pr Bank","options":[],"required":null,"pdf_field":""},{"help":"Consent to use given bank account for payments","type":"yes-no","label":"* I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide e-lA number if available","type":"text","label":"Electronic-Insurance Account: Please provide e-lA No. to deposite your insurance policy.","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Do you want to open e-lA account","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Are you an exisiting customer of BGIL?","options":["Yes","No"],"required":null,"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":"","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":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"","type":"yes-no","label":"Partnership Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Limited Liability/Partnership Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide DARPAN registration if applicable","type":"yes-no","label":"NGO/NPO - Provide DARPAN Portal Registration, if applicable","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Company","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Trust","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Society","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Section 8 Company","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Proprietorship Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify other constitution type if applicable","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Business and Location of Business","fields":[{"help":"Describe the business activity","type":"text","label":"Business of Proposer","options":[],"required":null,"pdf_field":""},{"help":"Columns: SL No., Address, Pin code, Occupancy, Age of Unit, Floor (GF/MF/Higher Floor)","type":"table","label":"Location of risk/business to be covered - full postal address with Pin Code","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 (Please tick in the space below): Offices, 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":"Storage outside Industrial/ manufacturing 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":""},{"help":"","type":"yes-no","label":"Boundary wall","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"If yes, specify sum insured value stored","type":"yes-no","label":"Basement storage - If yes value stored SI","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Specify other insured property types if any","type":"text","label":"Others (please specify)","options":[],"required":false,"pdf_field":""},{"help":"List goods stored if applicable","type":"text","label":"If used as warehouse / godown (not located in a manufacturing unit) please give the list of goods stored","options":[],"required":false,"pdf_field":""},{"help":"Describe products manufactured and enclose block plan if applicable","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 wherever applicable)","options":[],"required":false,"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":""},{"help":"Tick all applicable fire protection devices installed","type":"checkbox","label":"Fire Protection devices installed (Please Tick the correct answer in the box below.)","options":["Portable Extinguishers","Small bore hose reels","Trailer Pumps/Fire engines","Hydrant System","Sprinkler System","Fixed Water Spray System","Fire Alarm System","Foam System","Gas Flooding System","Others, please specify"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Indicate whether AMC (Annual Maintenance contract) for the Fire Protection Appliances is in force","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Number of Floors","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Age of the Building","options":["Less than 5 years","5-10 years","10-20 years","Above 20 years"],"required":null,"pdf_field":""},{"help":"Specify distance in appropriate units","type":"text","label":"Distance between the risk to be covered and nearest Fire Brigade","options":[],"required":null,"pdf_field":""},{"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":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Whether Insurance was declined by any other Company (Give details)","options":[],"required":false,"pdf_field":""},{"help":"Provide premium and claim details year-wise for past 36 months","type":"table","label":"Premium / Claim details for the past 36 months excluding the expiring policy period - Year and Premium ₹","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured and Other details of Insured Property","fields":[{"help":"Describe building and structures insured","type":"text","label":"Building including plinth, Basement - Description of Block and additional structures","options":[],"required":null,"pdf_field":""},{"help":"If yes, provide details below","type":"choice","label":"Do You want to opt for Floater Cover? : Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide location addresses if opting for floater cover","type":"text","label":"Floater Cover (for stocks at various locations) - Location (Postal Address with Pin Code)","options":[],"required":false,"pdf_field":""},{"help":"If yes, provide details below","type":"choice","label":"Do You want to opt for Declaration Policy?: Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide amount if opting for declaration policy","type":"amount","label":"Stocks which fluctuate in value to be covered on (monthly) declaration basis: Amount","options":[],"required":false,"pdf_field":""},{"help":"Specify payment mode","type":"text","label":"Mode of Payment","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Payment Details - Amount","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Insured","fields":[{"help":"Agree to declaration","type":"checkbox","label":"I/ We hereby declare that the value insurable assets is more than ' 5 Crore but less than ' 50 Crore and the statements made by me / Us in this Proposal Form are true to the best of my / our knowledge and belief and I / We hereby agree that this declaration shall form the basis of the contract between me/Us and the.","options":[],"required":true,"pdf_field":""},{"help":"Agree to notify insurer of changes","type":"checkbox","label":"If any additions or alterations are carried out in the risk proposed after the submission of this proposal form then the same should be conveyed to the insurers immediately","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration - Physical Proposal Form","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?","options":["Yes","No"],"required":true,"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":"Agree to keep contact and bank details updated","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":[],"required":true,"pdf_field":""},{"help":"Agent/intermediary declaration","type":"checkbox","label":"Declaration : The content of this form and its particulars have been explained by me in vernacular to the proposer who has understood and confirmed the same.","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name of Witness","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Witness","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"If yes, provide details and disability certificate","type":"yes-no","label":"Disability Declaration: Any Physical deformity or handicap","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Disability Certificate issued by Medical Board appointed by Government","type":"text","label":"If Yes. Please provide details","options":[],"required":false,"pdf_field":""},{"help":"Authorised representative details if proposer is disabled","type":"text","label":"I _____ authorised representative of Mr./Miss/Mrs. ___ hereby giving consent on the behalf of the proposer due to his/her disability , that he/she has understood the content of this form and its particulars and confirmed the same","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Authorised representative","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":false,"pdf_field":""},{"help":"Confirm submission of required documents","type":"checkbox","label":"Claim Docs - I/we hereby confirm that I/we have provided all relevant and supporting documents sought by the company, required for the issuance of the policy. Any document(s) as may be required, for claims processing, shall be submitted by me on demand by the company.","options":[],"required":true,"pdf_field":""},{"help":"Agent license number","type":"text","label":"IRDAI COR No./ License No.(Advisor/Corporate Agent/Broker/Relationship Officer)","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Enterprises with total value of insurable assets at a location exceeding Rs. 5 Crore but not exceeding Rs. 50 Crore, for Fire and Allied Perils coverage.","attachments":["Detailed block plan showing various facilities to be enclosed wherever applicable"],"declarations":["The value of insurable assets is more than Rs. 5 Crore but less than Rs. 50 Crore and the statements made in this Proposal Form are true to the best of the proposer's knowledge and belief.","Any additions or alterations in the risk after submission of this proposal form must be conveyed to the insurer immediately.","No person shall offer or accept any rebate of commission or premium except as allowed by the insurer's published prospectuses or tables.","Consent to verify identity/address proof through various government portals for KYC purposes.","Premiums have been and will be paid from legally acquired sources of income.","Voluntary consent to share personal information with group companies or others for insurance and related services.","Policyholder must keep contact and bank details updated for faster service.","Agent/intermediary declares that the proposal form contents have been explained to the proposer in vernacular and that untrue statements or non-disclosure may lead to policy variation or cancellation.","Confirmation that all relevant documents for policy issuance have been provided and further documents for claims will be submitted on demand."],"dropped_labels":13},"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/2608-bajaj-general-insurance-limited-bharat-laghu-udyam-suraksha-policy-proposal-form"}