{"id":2787,"title":"BUSINESS SURAKSHA-LAGHU (RETAIL) PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/business-suraksha-laghu-retail/proposal-forms/business-suraksha-laghu-retail-proposal-form.pdf","sha256":"c763467aa394d1bd0cb3f977067bb2b14f596f207def03f6b8467003c03a1145","pages":16,"collected":"2026-10-17","instructions":{"about":"This form is used by business owners or proposers to apply for the Business Suraksha-Laghu (Retail) insurance policy. The proposer fills it to provide details about their business, insured property, and coverage requirements.","notes":["Read prospectus/key features document/policy wordings before completing the form.","Answer all questions; attach separate signed and dated sheet if needed.","Cover commences only after acceptance and premium receipt.","Use block letters where applicable.","Original bills and documents may be required for claims.","Policyholder may receive policy documents electronically unless physical copy is requested.","Insurance is a contract of utmost good faith requiring full disclosure.","Anti-money laundering and anti-financial crime compliance is mandatory.","Section 41 of Insurance Act, 1938 prohibits rebates as inducement for insurance."],"title":"BUSINESS SURAKSHA-LAGHU (RETAIL) PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer and Policy Period Details","fields":[{"help":"","type":"text","label":"Policy Issuing Office Address & Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary/Agent Name & Code (if any)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"POSP PAN (if applicable)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"1. Name of Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"2A. Present Address of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"2B. Permanent address of the proposer (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"3. Telephone No (Landline)","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"4. Mobile No","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"5. Email","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"6. CKYC Number (if available)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"7. Contact person details, if not an individual a. Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"8. 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 insurance coverage","type":"date","label":"9. Period of Insurance From","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposer Status and Disability","fields":[{"help":"Tick all that apply","type":"checkbox","label":"10. I am (please tick all that are applicable)","options":["High Net Worth Individual/s","Non-Residential Indian/s","Politically Exposed Person","Non-Governmental Organisation","Non-Profit Organisation"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If you are an NGO/NPO, please provide Niti Ayog – Darpan Portal Registration Number","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"11. If you are Differently Abled, please tick on the checkbox to provide confirmation","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If Yes above, specify impairment type","type":"text","label":"i. Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes above, specify percentage","type":"number","label":"ii. Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes above, provide UDID number","type":"text","label":"iii. UDID Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Business and Location Details","fields":[{"help":"","type":"text","label":"12 Business of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Provide address, pin code, occupancy, age of unit, floor (GF/MF/Higher Floor) for each location","type":"table","label":"13 Location of risk/business to be covered - full postal address with Pin Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section 1 - Fire and Allied Perils","fields":[{"help":"Sum insured value for basement storage if applicable","type":"amount","label":"If yes value stored SI: ₹","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"15. If used as warehouse / godown (not located in a manufacturing unit) please give the list of goods stored","options":[],"required":false,"pdf_field":""},{"help":"Attach detailed block plan if applicable","type":"text","label":"16. If used as an Industrial Manufacturing unit give products manufactured at the location proposed","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"17. If used as an Industrial Manufacturing unit, please state whether the factory is working or silent","options":["Working","Silent"],"required":false,"pdf_field":""},{"help":"Tick all fire protection devices installed","type":"checkbox","label":"18. Fire Protection devices installed (Please tick all that apply)","options":["Portable Extinguishers","Small bore hose reels","Trailer Pumps/Fire engines","Hydrant System","Sprinkler System","Fixed Water Spray System","Foam System","Fire Alarm System","Gas Flooding System","Others (please specify)"],"required":false,"pdf_field":""},{"help":"Specify other fire protection devices","type":"text","label":"Others (please specify)","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"19. Indicate whether AMC (Annual Maintenance contract) for the Fire Protection Appliances is in force","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Kutcha or Pucca for each: Walls, Floor, Roof","type":"choice","label":"20. Construction Details - a. Please state material used (Walls, Floor, Roof)","options":["Kutcha","Pucca"],"required":true,"pdf_field":""},{"help":"Specify distance","type":"text","label":"21. Distance between the risk to be covered and nearest Fire Brigade","options":[],"required":false,"pdf_field":""},{"help":"Provide year-wise premium and claim amounts","type":"table","label":"22. Premium / Claim details for the past 36 Months for Fire and Allied perils Section excluding the expiring policy period","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured and Other Details of Insured Property","fields":[{"help":"Provide sum insured amounts for each category","type":"table","label":"23. Description of Block Building including plinth, Basement and additional structures, Plant & Machinery, Furniture & Fixtures, Fittings and other equipment, Raw Material, Stock in Process, Finished Stock, Other Contents (Please specify), Total","options":[],"required":true,"pdf_field":""},{"help":"Indicate if floater cover is desired","type":"choice","label":"I. Do You want to opt for Floater Cover? Yes/No (strike off what is not applicable). If yes, give details below","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"List locations and sum insured for floater cover","type":"table","label":"24. Floater Cover (for stocks at various locations) - Location (Postal Address with Pin Code), Sum Insured (in ₹)","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"i) Maximum value at any one location: ₹","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"ii) Whether stocks stored in open: Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if declaration policy is desired","type":"choice","label":"II. Do You want to opt for Declaration Policy? Yes/No (strike off what is not applicable). If yes, give details below","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"25. Stocks which fluctuate in value to be covered on (monthly) declaration basis: Amount (₹)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Covers (Add-ons)","fields":[{"help":"Tick Yes or No for each add-on cover","type":"checkbox","label":"Details of additional covers (add-ons) offered with the policy","options":["Involuntary Betterment","Additional Custom Duty","Brands and Label","Escalation","Immediate Repair Clause","Loss Of Rent Clause","Insurance Of Additional Expenses Of Rent For An Alternative Accommodation","Deterioration Of Stocks In Cold Storage Premises","Accidental Damage"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section II: Fire Loss of Profit","fields":[{"help":"Tick all that apply and provide sum insured","type":"checkbox","label":"Tick Description Sum Insured in Rs.","options":["Net Profit","Standing Charges or Fixed Charges","Wages- if required separately"],"required":false,"pdf_field":""},{"help":"Provide total gross profit sum insured","type":"amount","label":"Gross Profit (TOTAL)","options":[],"required":false,"pdf_field":""},{"help":"List critical equipment and lead time","type":"text","label":"a. Critical Equipment’s & their Lead time","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Please mention the type of Process","options":["Continuous","Non-Continuous"],"required":false,"pdf_field":""},{"help":"Tick all extensions desired and provide details for Customers and Suppliers Premises (No. and Dependence %)","type":"checkbox","label":"b. Please select Extension/s that you wish to opt","options":["Auditor Fees","Customers Premises","Suppliers Premises","Loss due to accidental failure of public electricity/gas/water supply"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section III: Burglary","fields":[{"help":"Attach separate sheet if required","type":"text","label":"Please provide a description of all valuables in the insured premises, excluding jewellery, electronic equipment, Television, domestic appliance and the like","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"a. Please specify if Watch & ward facility is available for 24 hours","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"b. Please provide details of any other security facilities available at the premises","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"c. Do you wish to avail cover on first loss basis?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"","type":"number","label":"If YES, please specify the % of First Loss basis (Min 25%)","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"d. Please mention the First Loss Sum insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section IV: Machinery Breakdown","fields":[{"help":"Attach separate sheet if required","type":"table","label":"Please provide in respect of all Machineries which you wish to insure, the following information: Description, Type of item along with serial number, Year of manufacture, Reinstatement Value (Rs)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section V: Electronic Equipment","fields":[{"help":"Attach separate sheet if required. Equipment older than 10 years not covered","type":"table","label":"Please provide in respect of all the Electronic Equipment’s that you wish to insure the following: Description, Type of item along with serial number, Year of manufacture, Reinstatement Value (Rs)","options":[],"required":false,"pdf_field":""},{"help":"If YES, please enclose a copy","type":"choice","label":"a. Is a valid maintenance contract in force for the items insured above?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If YES, fill a separate EEI proposal form","type":"choice","label":"b. Do you wish to include External Data Media and/or Increased Cost of working covers?","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section VI: All Risks","fields":[{"help":"Provide details of all items to be insured under All Risks","type":"table","label":"Description, Make, Sr. No., Year of manufacture, Sum insured Rs.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section VII: Accident Suraksha","fields":[{"help":"Sum assured limits apply as per note; attach details for each insured member","type":"table","label":"Please provide following information for each of the insured members: Name of the insured person, Date of Birth, Occupation, Relationship with Proposer, Details of existing infirmity or disability, Name of Nominee, Relationship with the Insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section VIII: Liability","fields":[{"help":"","type":"amount","label":"A. Tenant Liability: Please specify the Limit of Indemnity required for Tenant Liability (Max Rs.10,00,000)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section IX: Baggage","fields":[{"help":"Provide item-wise details and total value","type":"table","label":"Please provide details in relation to accompanied baggage, clothing, personal effects, medicines and all other articles generally carried during travel within India: Description of item, Value (Rs)","options":[],"required":false,"pdf_field":""},{"help":"Total value of all articles","type":"amount","label":"Total","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section X: Plate Glass","fields":[{"help":"","type":"table","label":"Please provide a description of the Plate Glass which you wish to insure and its value: Description, Size, Value in Rs.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section XII: Money Insurance","fields":[{"help":"","type":"text","label":"Description","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured in Rs.","options":[],"required":false},{"help":"","type":"amount","label":"Money in Transit (Annual Turnover)","options":[],"required":false},{"help":"","type":"amount","label":"Money at Counter","options":[],"required":false},{"help":"","type":"amount","label":"Money in safe","options":[],"required":false},{"help":"","type":"amount","label":"Per Carrying Limit","options":[],"required":false},{"help":"","type":"text","label":"Location for Money in safe","options":[],"required":false},{"help":"","type":"text","label":"From where to where","options":[],"required":false},{"help":"","type":"text","label":"Mode of Transport","options":[],"required":false}],"filled_by":"proposer"},{"title":"Section XIII: Fidelity Guarantee","fields":[{"help":"","type":"text","label":"Please note only Permanent employees are covered. Attach separate list of No of employees to be covered, their names & designation","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Any One Person Limit","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Any One-Accident Limit","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Any one Year Limit","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Expiring policy details","options":[],"required":false}],"filled_by":"proposer"},{"title":"Section XIV: Pedal Cycle","fields":[{"help":"Maximum sum insured restricted to Rs.5000","type":"table","label":"Please provide in respect of all pedal cycles that you wish to insure: Name of the manufacturer, Year of production, Frame no., Value including accessories (Rs)","options":[],"required":false,"pdf_field":""},{"help":"Total value of pedal cycles","type":"amount","label":"Total","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section XV: Neon Sign / Glow Sign","fields":[{"help":"","type":"table","label":"Please provide the details as follows: Location/Height, Size, Type/Age, Value (Rs)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History and Premium Details","fields":[{"help":"","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":"","type":"text","label":"Whether Insurance was declined by any other Company (Give details)","options":[],"required":false,"pdf_field":""},{"help":"Provide year-wise premium and claim details for each section","type":"table","label":"Premium and Claim details (past 36 months excluding the expiring policy period) for each Section","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"PREMIUM DETAILS - Mode of Payment","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"Amount in (₹)","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"PAN (If premium is 1 Lac and Above.)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"GSTIN (If more than one GSTIN, kindly attach an annexure with details)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank and Nominee Details","fields":[{"help":"","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"IFS Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of Nominee","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the proposer","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address of Nominee - Present address","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Permanent address (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Details of Nominee - Name of Account holder","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"IFSC Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Authorized person details (in case nominee is a minor)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Insured","fields":[{"help":"","type":"signature","label":"Proposer’s Signature","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Intermediary Use Only","fields":[{"help":"","type":"text","label":"Name of Insurance Agent/POSP/Specified Person of the Corporate Agent/Authorized Person of the Broker/IMF","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Intermediary’s Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Intermediary’s Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary"}],"deadlines":[],"applies_to":"Business Suraksha-Laghu (Retail) insurance policy proposal","attachments":["Separate signed and dated sheet if additional space is needed for answers","Detailed block plan for industrial manufacturing unit if applicable","Copy of valid maintenance contract for electronic equipment if applicable","Separate EEI proposal form if External Data Media and/or Increased Cost of working covers are opted","Separate list of permanent employees for Fidelity Guarantee cover","Annexure with GSTIN details if more than one GSTIN"],"declarations":["All statements and information provided are complete and accurate with no relevant information withheld.","Misrepresentation or suppression of material facts may render the policy void and premium forfeited.","Policyholder and related persons will assist the insurer with records and information to address anti-financial crime practices.","Premium is paid from legitimate sources in compliance with Prevention of Money Laundering Act, 2002.","Consent to receive policy and service communications electronically and for processing of personal data as per privacy policy.","Consent for insurer to access CKYC records for verification and communication.","Policyholder undertakes to inform insurer of any changes in CKYC records.","Insurance agent/intermediary declares that product features and proposal contents have been explained to the proposer."],"dropped_labels":15},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"grievance","channel":"email","value":"GCIcare@generalicentral.com","label":"HELPLINE Email","level":1,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"atrix given below.\nLEVEL 1\nYou Can Call On Our HELPLINE\n1800-220-233 / 1860-500-3333 / 022-67837800\nOR\nSEND US AN EMAIL\nGCIcare@generalicentral.com\nOur senior citizen policyholders can avail priority support by choosing the valid option from the helpline menu or writ","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-220-233 / 1860-500-3333 / 022-67837800","label":"HELPLINE","level":1,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"may have. You can escalate your concerns as per the\nescalation matrix given below.\nLEVEL 1\nYou Can Call On Our HELPLINE\n1800-220-233 / 1860-500-3333 / 022-67837800\nOR\nSEND US AN EMAIL\nGCIcare@generalicentral.com\nOur senior citizen policyholders can avail priority support by choosing","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Generali Central Insurance Company Ltd.\nUnit No. 301, 3rd Floor Part, Building No. 8,\nMindspace IT/ITES SEZ, MIDC Industrial Area,\nAiravali, Navi Mumbai,\nThane District – 400 708.","label":"Corporate Grievance Redressal Officer (GRO) Address","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mishra\nADDRESS\nGenerali Central Insurance Company Ltd.\nUnit No. 301, 3\nrd\nFloor Part, Building No. 8,\nMindspace IT/ITES SEZ, MIDC Industrial Area,\nAiravali, Navi Mumbai,\nThane District – 400 708.\nLEVEL 3\nIf you are still not satisfied with the solution provided, you can email\nour CEO’s office.\nEMAIL OUR CEO’s OFF","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"GCIGRO@generalicentral.com","label":"Corporate Grievance Redressal Officer (GRO) Email","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"solution provided to you does not meet your expectations,\nyou can write directly to our Corporate GRO.\nSEND US AN EMAIL\nGCIGRO@generalicentral.com\nOR\nCALL US ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mish","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"+91-79001 97777","label":"Corporate Grievance Redressal Officer (GRO) Phone","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"ur expectations,\nyou can write directly to our Corporate GRO.\nSEND US AN EMAIL\nGCIGRO@generalicentral.com\nOR\nCALL US ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mishra\nADDRESS\nGenerali Central In","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/generali-central-insurance/2787-business-suraksha-laghu-retail-proposal-form"}