{"id":2613,"title":"PROPOSAL FORM BAJAJ GENERAL INSURANCE LIMITED. BHARAT GRIHARAKSHA POLICY","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/Bharat-Griha-Raksha/Bharat-Griha-Raksha-Proposal-form.pdf","sha256":"bff0c371c0b8356617a587f3c642cc30a3da4ebda59239caf00ef6413aa23ce2","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) to apply for insurance coverage for their home building and/or home contents against fire and allied perils.","notes":["Answer all questions in BLOCK letters.","Read the Prospectus/Key Features Document/Policy Wordings before filling the form.","The property is not covered until the proposal is accepted and premium paid.","For long term policies, the period shall not exceed 10 years.","Nominee for self (primary insured) must be one of Father, Mother, Son, Daughter; for family members, primary insured is the nominee.","Construction types: Kutcha means walls/roof/floor made of wooden planks, thatched leaves, grass, bamboo, plastic cloth, asphalt, canvas, tarpaulin; Pucca means other construction.","General Contents cover is automatically provided at 20% of Home Building sum insured up to Rs 10 Lakh if both covers are opted.","Use original documents for valuation certificates if required.","Keep policy contact and bank details updated for faster service.","The form includes sections for agent and intermediary signatures and codes.","The form includes a disclaimer about confidentiality and virus protection for email communications."],"title":"PROPOSAL FORM BAJAJ GENERAL INSURANCE LIMITED. BHARAT GRIHARAKSHA POLICY","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Enter full name in BLOCK letters","type":"text","label":"Name of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Address of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Phone No. a. Mobile","options":[],"required":false,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email","options":[],"required":false,"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":true,"pdf_field":""},{"help":"Start date of policy","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""},{"help":"Enter number of years (max 10)","type":"number","label":"No of Years in case of long term policy","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's full name","type":"text","label":"Nominee Details Name","options":[],"required":false,"pdf_field":""},{"help":"Select nominee relation; if 'Others', specify relation and reason","type":"checkbox","label":"Nominee*","options":["Father","Mother","Son","Daughter","Others"],"required":false,"pdf_field":""},{"help":"Enter name of appointee if nominee is minor","type":"text","label":"Appointee (If nominee is minor)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details","fields":[{"help":"Enter name as per bank records","type":"text","label":"Name as pr Bank","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Name of Bank","options":[],"required":false,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account No.","options":[],"required":false,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFSC Code","options":[],"required":false,"pdf_field":""},{"help":"Consent to transact via given bank account","type":"yes-no","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter e-lA number if available","type":"text","label":"Electronic-Insurance Account: Please provide e-lA No. to deposit your insurance policy.","options":[],"required":false,"pdf_field":""},{"help":"Select if you want to open e-lA account","type":"choice","label":"Do you want to open e-lA account","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select if you are an existing customer","type":"choice","label":"Are you an existing customer of Bajaj General ?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter PIO number if existing customer","type":"text","label":"If yes. Please provide PIO No","options":[],"required":false,"pdf_field":""},{"help":"Confirm no change in KYC details","type":"yes-no","label":"I hereby confirm that; there is no change in my existing KYC details that are available from my previous/existing policy.","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Covers Opted","fields":[{"help":"Select if any existing policy for the property","type":"choice","label":"Is there any policy in place for the same property?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of existing policy if any","type":"text","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Select the cover(s) required","type":"checkbox","label":"Cover/s required: (When Home Building and Home Contents are opted for, cover for General Contents of Home for Sum Insured equal to 20% of the Sum Insured for Home Building Cover subject to a maximum of Rs 10 Lakh [Rupees Ten Lakh] is automatically provided). Cover Please tick","options":["Home Building & Home Contents","Home Building Only","Home Contents Only"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Location of Home Building","fields":[{"help":"Enter full postal address including pin code","type":"text","label":"Location of Home Building Full postal address with Pin Code.","options":[],"required":true,"pdf_field":""},{"help":"Enter postal pin code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Select type of building","type":"choice","label":"Is it in a multi-storey building or is it a standalone house?","options":["Multi-storey building","Standalone house"],"required":true,"pdf_field":""},{"help":"Enter floor number if applicable","type":"number","label":"In case of multi-storey building, please provide the floor number of Your house","options":[],"required":false,"pdf_field":""},{"help":"Indicate if house has basement","type":"yes-no","label":"Is there a basement to Your house?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Home Building","fields":[{"help":"Enter sum insured for each additional structure","type":"amount","label":"Additional Structure Sum Insured (in₹)","options":[],"required":false,"pdf_field":""},{"help":"Enter carpet area in square metres","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":true,"pdf_field":""},{"help":"Enter prevailing rate of construction cost per square metre","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date","options":[],"required":true,"pdf_field":""},{"help":"Select age category of home building","type":"choice","label":"Age of Home Building","options":["Less than 5 years","5-10 years","10-20 years","Above 20 years"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Home Contents","fields":[{"help":"Enter sum insured for furniture and fittings","type":"amount","label":"If You want to opt out of in built cover for General Contents as mentioned in (iv) above and want to have higher Sum Insured Or If You have opted for Home Contents Only cover, please provide item wise Sum Insured for General Contents. Item wise Sum Insured for General Contents (in ?): Furniture, Fixtures and Fittings (Home Furnishings)","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured for electrical/electronic items","type":"amount","label":"Electrical/Electronic","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured for other general contents","type":"amount","label":"Others","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured for basement contents if any","type":"amount","label":"In case of Basement, If there are contents in it, please provide the Sum Insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"In-Built Cover (Loss of Rent & Rent for Alternative Accommodation)","fields":[{"help":"Select if loss of rent cover is required","type":"checkbox","label":"Cover for (Please Tick) Loss of Rent","options":["Loss of Rent"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Covers","fields":[{"help":"Select if personal accident cover is required","type":"choice","label":"Do You require 'Personal Accident Cover' for Yourself and Your spouse?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter spouse's name and age if cover opted","type":"text","label":"Name & age of Your spouse","options":[],"required":false,"pdf_field":""},{"help":"Enter your age","type":"number","label":"Your age","options":[],"required":false,"pdf_field":""},{"help":"Select if cover for valuable contents is required","type":"choice","label":"Do You require 'Cover for Valuable Contents on Agreed Value Basis (under Home Contents cover)'?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach list of valuable items and sum insured","type":"attachment","label":"If yes, please attach list of items and Sum insured","options":[],"required":false,"pdf_field":""},{"help":"Indicate if valuation certificate is attached","type":"choice","label":"Valuation certificate attached?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional/Add-on Covers","fields":[{"help":"Enter name of add-on cover","type":"text","label":"Name of Add-on cover","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured for add-on cover","type":"amount","label":"Sum insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Details","fields":[{"help":"Select mode of payment","type":"choice","label":"Mode of Payment","options":[],"required":false,"pdf_field":""},{"help":"Provide payment details","type":"text","label":"Payment Details","options":[],"required":false,"pdf_field":""},{"help":"Enter premium amount","type":"amount","label":"Amount (in)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Claims details","fields":[{"help":"Enter date of any loss in last 3 years","type":"date","label":"Date of Loss","options":[],"required":false,"pdf_field":""},{"help":"Describe cause of loss","type":"text","label":"Cause of Loss","options":[],"required":false,"pdf_field":""},{"help":"Enter claimed amount","type":"amount","label":"Claimed Amount","options":[],"required":false,"pdf_field":""},{"help":"Enter settled amount or specify if claim is outstanding","type":"amount","label":"Settled Amount/please specify if claim is outstanding","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Insured","fields":[{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations – Physical Proposal Form","fields":[{"help":"Declare if politically exposed person or relative","type":"choice","label":"Are you or any of the proposal applicants a PEP* or a close relative of PEP*?","options":["Yes","No"],"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 for the purpose of undertaking KYC verification.","options":["Yes","No"],"required":false,"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":false,"pdf_field":""},{"help":"Consent to share 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.","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Sign after reading declarations","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 signature","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter witness name","type":"text","label":"Name of Witness","options":[],"required":false,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"Signature of Witness","options":[],"required":false,"pdf_field":""},{"help":"Date of witness signature","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Place of witness signature","type":"text","label":"Place","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Disability Declaration","fields":[{"help":"Declare if any physical disability","type":"yes-no","label":"Any Physical deformity or handicap?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details and attach Disability Certificate issued by Medical Board","type":"text","label":"If yes. Please provide details","options":[],"required":false,"pdf_field":""},{"help":"Enter name of authorised representative if applicable","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Date of declaration","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Place of declaration","type":"text","label":"Place","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorised representative","type":"signature","label":"Signature of Authorised Representative","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer or authorised representative"},{"title":"Agent / IMD Details and Signature","fields":[{"help":"Enter agent or IMD name","type":"text","label":"Agent/IMD Name","options":[],"required":false,"pdf_field":""},{"help":"Enter agent or IMD code","type":"text","label":"Agent/IMD Code","options":[],"required":false,"pdf_field":""},{"help":"Agent or IMD signature","type":"signature","label":"Agent/IMD Signature","options":[],"required":false,"pdf_field":""},{"help":"Enter SP/BQP/DP/PoS name","type":"text","label":"SP / BQP / DP / PoS Name","options":[],"required":false,"pdf_field":""},{"help":"Enter SP/BQP/DP/PoS CoR number","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 or intermediary"}],"deadlines":[],"applies_to":"Home Building and/or Home Contents insurance under Bharat Griha Raksha Policy","attachments":["List of items and Sum insured for Valuable Contents (if opting for agreed value basis cover)","Valuation Certificate (if Sum Insured for Valuable Contents exceeds 5 Lakh or individual item value exceeds 1 Lakh)","Disability Certificate issued by the Medical Board appointed by the Government (if applicable)"],"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 immediately to the insurer.","No person shall offer or accept any rebate of premium except as allowed by the insurer's published prospectus or tables.","Premiums must be paid from legally acquired sources of income.","Consent is given for KYC verification through specified government portals.","Consent is given to share personal information with group companies for insurance and related services.","The proposer confirms understanding of the form's content and particulars, including in vernacular if explained.","If any untrue statement or non-disclosure of material fact is found, the policy may be void and premiums forfeited."],"dropped_labels":16},"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/2613-proposal-form-bajaj-general-insurance-limited-bharat-griharaksha-policy"}