{"id":2612,"title":"MARINE HULL PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/MARINE-HULL-PROPOSAL-FORM.pdf","sha256":"b53a1f892ebc47b2eacf50d2c5692bb06187ef149fbaf7100837666ac4b2b17f","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by proposers (owners or operators of marine vessels) to apply for marine hull insurance coverage for their vessels.","notes":["Please use block letters to fill the form.","Attach original or certified copies of required documents.","The insurer may require additional documents for claims processing.","Keep your policy updated with current contact and bank details for faster service.","Refer to the annexure for list of requirements to process the proposal form."],"title":"MARINE HULL PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Provide your existing customer ID if applicable","type":"text","label":"In case you are/were in relationship with us, kindly mention your Customer ID:","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of the proposer","type":"text","label":"1. Name of the Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"Provide full postal address for communication","type":"text","label":"2 Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"State of communication address","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Postal PIN code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Provide valid email address","type":"email","label":"E mail ID","options":[],"required":true,"pdf_field":""},{"help":"Provide mobile phone number","type":"phone","label":"Mobile Number","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"4. Are you a member of Customer Loyalty Programme :","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide loyalty number if member","type":"text","label":"If yes, kindly provide you Customer Loyalty number :","options":[],"required":false,"pdf_field":""},{"help":"Start date of insurance coverage","type":"date","label":"5. For what period or voyage is the insurance required? From","options":[],"required":true,"pdf_field":""},{"help":"Provide bank name and address","type":"text","label":"6. Name of Financial Institution / Bank and address:","options":[],"required":true,"pdf_field":""},{"help":"Name as per bank records","type":"text","label":"Bank Details 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":"IFSCCode","options":[],"required":true,"pdf_field":""},{"help":"Tick to accept payment through this bank account","type":"checkbox","label":"* I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":[],"required":true,"pdf_field":""},{"help":"Provide IFSC code for e-Insurance Account","type":"text","label":"Electronic-Insurance Account: IFSCCode","options":[],"required":false,"pdf_field":""},{"help":"Provide e-Insurance Account number","type":"text","label":"Please provide e-lA 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-lA account:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Existin Customer Are you an exisiting customer of BGIL ?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide PID number if existing customer","type":"text","label":"If Yes. Please provide PID No:","options":[],"required":false,"pdf_field":""},{"help":"Provide policy number if existing customer","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Tick to confirm no change in KYC details","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":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Select applicable constitution type","type":"checkbox","label":"Constitution Details","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":null,"pdf_field":""},{"help":"Provide DARPAN registration details if applicable","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Vessel Details","fields":[{"help":"Enter vessel name","type":"text","label":"Name of Vessel","options":[],"required":true,"pdf_field":""},{"help":"Specify vessel type","type":"text","label":"Type of Vessel","options":[],"required":true,"pdf_field":""},{"help":"Enter gross registered tonnage","type":"number","label":"Gross Reg. Tonnage","options":[],"required":true,"pdf_field":""},{"help":"Name of vessel builder","type":"text","label":"Name of Builders","options":[],"required":true,"pdf_field":""},{"help":"Place where vessel was built","type":"text","label":"Place where built","options":[],"required":true,"pdf_field":""},{"help":"Material used to build vessel","type":"text","label":"Material of which built","options":[],"required":true,"pdf_field":""},{"help":"Port where vessel is registered","type":"text","label":"Port of registry","options":[],"required":true,"pdf_field":""},{"help":"Length of vessel","type":"number","label":"Length","options":[],"required":true,"pdf_field":""},{"help":"Breadth of vessel","type":"number","label":"Breadth","options":[],"required":true,"pdf_field":""},{"help":"Purchase price of vessel","type":"amount","label":"Price Paid","options":[],"required":true,"pdf_field":""},{"help":"Attach registration certificate copy","type":"attachment","label":"Please attach copy of Registration Certificate","options":[],"required":true,"pdf_field":""},{"help":"Provide valuation report details","type":"text","label":"Details of Valuation report","options":[],"required":false,"pdf_field":""},{"help":"Current estimated value of vessel","type":"amount","label":"Present Estimated Value","options":[],"required":true,"pdf_field":""},{"help":"Sum insured proposed","type":"amount","label":"Amount Proposed for Insurance","options":[],"required":true,"pdf_field":""},{"help":"Date valuation was done","type":"date","label":"Date of Valuation","options":[],"required":false,"pdf_field":""},{"help":"Total estimated value from report","type":"amount","label":"Estimated value as per report: Total","options":[],"required":false,"pdf_field":""},{"help":"Explain any difference in values","type":"text","label":"1. State the reason for the difference between the estimated value and the amount Proposed for insurance, if any","options":[],"required":false,"pdf_field":""},{"help":"Provide last survey date and surveyor","type":"text","label":"2. When was the vessel last surveyed and by whom?","options":[],"required":false,"pdf_field":""},{"help":"Provide licensing details if applicable","type":"text","label":"3. Is the vessel licensed or approved by any local authority? If so please give full particulars.","options":[],"required":false,"pdf_field":""},{"help":"Tick all applicable equipment present on vessel","type":"checkbox","label":"4. Is the vessel equipped with a) Windlass b) Rubbing Bands c) Fire Fighting Appliances d) Single/ Double bottom e) Collision Bulk heads","options":["a) Windlass","b) Rubbing Bands","c) Fire Fighting Appliances","d) Single/ Double bottom","e) Collision Bulk heads"],"required":false,"pdf_field":""},{"help":"Provide cruising speed in knots","type":"number","label":"5. State the Cruising speed of vessel.","options":[],"required":false,"pdf_field":""},{"help":"Describe any special features of the vessel","type":"text","label":"6. Details of special features if any.","options":[],"required":false,"pdf_field":""},{"help":"Provide classification society details","type":"text","label":"7. Is the vessel classed with a recognised classification society? If so, please state details/ symbols allotted","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Particulars of Engine / Machinery","fields":[{"help":"Engine maker's name","type":"text","label":"Maker's Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Particulars Relating to Employment of the Vessel","fields":[{"help":"Describe vessel usage","type":"text","label":"1. For what purpose is the vessel used?","options":[],"required":true,"pdf_field":""},{"help":"Specify geographical limits for insurance","type":"text","label":"2. For what geographical limits is insurance required?","options":[],"required":true,"pdf_field":""},{"help":"Provide lay-up location and period if applicable","type":"text","label":"3. Will the vessel be laid up during the south West or North East Monsoon? If so a) Where it will be laid up? b) Period for which it will be laid up","options":[],"required":false,"pdf_field":""},{"help":"Yes or No; attach towage conditions if Yes","type":"yes-no","label":"4. Does the vessel ever undertake any tow? If yes, please attach form used by you laying down condition on which towage is accepted.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Particulars of Master & Crew","fields":[{"help":"Provide details of vessel master","type":"text","label":"1. State brief details of the person who will be in-charge of the vessel.","options":[],"required":true,"pdf_field":""},{"help":"Qualifications of master","type":"text","label":"a) His qualifications.","options":[],"required":true,"pdf_field":""},{"help":"Licence type and expiry date","type":"text","label":"b) Type of Licence/ Certificate held and date of its expiry.","options":[],"required":true,"pdf_field":""},{"help":"Duration of employment","type":"text","label":"c) How long has he been in your employment?","options":[],"required":true,"pdf_field":""},{"help":"Yes or No","type":"yes-no","label":"d) Will he live aboard the vessel?","options":[],"required":true,"pdf_field":""},{"help":"Experience and accident history","type":"text","label":"e) His total experience-no. of years and any accident to any of the vessels he handled","options":[],"required":true,"pdf_field":""},{"help":"Number of crew members","type":"number","label":"2. What is the total number of crew on board the vessel?","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"General Information","fields":[{"help":"Yes or No","type":"yes-no","label":"1. a) Do you own any other vessels?","options":[],"required":true,"pdf_field":""},{"help":"Provide accident details if any","type":"text","label":"b) Give the details of accidents that have occurred in the last four years to these vessels.","options":[],"required":false,"pdf_field":""},{"help":"Yes or No","type":"yes-no","label":"c) Does any of these accident related to the vessel proposed for insurance?","options":[],"required":false,"pdf_field":""},{"help":"Answer each question Yes or No","type":"yes-no","label":"2. Has any company or insurer a) Declined to insure you? b) Refused to renew your insurance? c) Increased your premium on renewal? d) Whether any premium due to be paid by you to any other Insurer has been defaulted?","options":[],"required":false,"pdf_field":""},{"help":"Provide number and amount of claims","type":"text","label":"3. Details of claims if any on the proposed vessel No. of Claims: Total Claim amount:","options":[],"required":false,"pdf_field":""},{"help":"Provide previous insurance details and attach documents","type":"text","label":"4. Was the vessel previously insured with any other insurer? a) If so, name of the Insurer and address of issuing office. b) Previous Policy particulars: i) Policy No. ii) Insured Value iii) Conditions iv) Rate charged v) Period of Insurance vi) Whether all instalment premiums were fully paid till expiry of the earlier policy: Please attach last instalment payment receipt. c) If vessel has been previously insured within the past 24 month the name of the Insurer, Period of Cover, Rates, Extent of Cover and special Terms and conditions, if any relating to the insurance cover policy may please be given in brief. Please attach copy of previous policy on proposed vessel.","options":[],"required":false,"pdf_field":""},{"help":"Select all applicable risks to insure","type":"checkbox","label":"5. State the risks against you wish to insure the vessel.","options":["Total loss/ Constructive Total/ Loss Salvage Charges","Sue & Labour Charges","Wider Cover","S.R . C.C. risks"],"required":true,"pdf_field":""},{"help":"Select mode of payment and provide cheque details if applicable","type":"choice","label":"6. Mode of Payment Cheque □ Cheque Date Cheque No. Cash □ Others □","options":["Cheque","Cash","Others"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Proposer's Signature","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Declaration - Physical Proposal Form: 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":"choice","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":"choice","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":"choice","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","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Signature of person explaining the form","type":"signature","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":"Proposer's signature","type":"signature","label":"Signature of Proposer","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":"Declare any disability","type":"choice","label":"Disability Declaration: 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":"Signature of authorised representative if proposer disabled","type":"signature","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":"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":"Agent signature","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":""}],"filled_by":"proposer and agent"},{"title":"Agent / IMD Details","fields":[{"help":"Agent or IMD signature","type":"signature","label":"Agent / IMD (SP/DP/ BQP) signature and their code","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"}],"deadlines":[],"applies_to":"Marine hull insurance proposals for vessels","attachments":["Copy of Registration Certificate","Copy of valuation report","Copy of previous policy on proposed vessel","Last instalment payment receipt"],"declarations":["The proposer declares that all statements and particulars are true and complete and no information has been withheld.","The liability of the company starts only after acceptance of the proposal and payment of premium.","No person shall offer or accept any rebate on premium except as allowed by the insurer's published prospectus.","The proposer consents to KYC verification through specified government portals.","The proposer confirms premium payment is from legally acquired sources.","The proposer consents to sharing personal data with group companies for insurance and related services.","The proposer confirms understanding of the form content as explained in vernacular.","The agent declares having explained the form contents to the proposer and understands the consequences of untrue statements or non-disclosure."],"dropped_labels":18},"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/2612-marine-hull-proposal-form"}