{"id":2795,"title":"GC BHARAT LAGHU UDYAM SURAKSHA PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/gc-bharat-laghu-udyam-suraksha/proposal-forms/gc-bharat-laghu-udyam-suraksha-proposal-form.pdf","sha256":"5bbeb26b87ea5ed64271d36d5e020dbf4da4c0211c8e981037fc2f10ef26ff99","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by enterprises to apply for insurance coverage under the GC Bharat Laghu Udyam Suraksha policy, which covers insurable assets against Fire and Allied Perils. The proposer (enterprise owner or authorized representative) fills this form.","notes":["Read the Prospectus/Key Features Document/Policy Wordings before filling the form.","Property is not covered until proposal is accepted and premium paid.","Use block letters where applicable.","Attach original documents where required.","Fill request for authorization form to receive claim/refund payments directly via NEFT if premium paid is more than Rs 10,000.","Physical copy of policy document available on request; otherwise digital copy will be sent.","Section 41 of Insurance Act prohibits rebates; violation punishable with fine up to ten lakh rupees."],"title":"GC BHARAT LAGHU UDYAM SURAKSHA PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer and Policy Period Details","fields":[{"help":"","type":"text","label":"Name of Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Present Address of Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Permanent Address of Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"CKYC Number (if available)","options":[],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"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":"If Yes, provide Type of Impairment, Percentage of Impairment, UDID Number","type":"choice","label":"If you are Differently Abled, please tick on the checkbox to provide confirmation.","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If Differently Abled is Yes","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Differently Abled is Yes","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Differently Abled is Yes","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy to be Issued in favour of (list out all the parties who have insurable interest) including the financial institutions","options":[],"required":null,"pdf_field":""},{"help":"Start date of policy","type":"date","label":"Period of Insurance From","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Business and Location of Business","fields":[{"help":"","type":"text","label":"Business of Proposer","options":[],"required":null,"pdf_field":""},{"help":"Fill address, pin code, occupancy, age of unit, floor (GF/MF/Higher Floor) for each location","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":"text","label":"Others (please specify)","options":[],"required":false,"pdf_field":""},{"help":"","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":"Attach detailed block plan showing various facilities if applicable","type":"text","label":"If used as an Industrial Manufacturing unit give products manufactured at the location proposed","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":false,"pdf_field":""},{"help":"If 'Others' above is ticked","type":"text","label":"Others (please specify)","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Indicate whether AMC (Annual Maintenance contract) for the Fire Protection Appliances is in force","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Number of Floors","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Distance between the risk to be covered and nearest Fire Brigade","options":[],"required":false,"pdf_field":""},{"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":"Fill year-wise premium and claim amounts for last 3 years","type":"table","label":"Premium / Claim details for the past 36 months excluding the expiring policy period","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Standard Add-ons","fields":[{"help":"If Yes, provide details below","type":"choice","label":"Do You want to opt for Floater Cover? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"List locations and sum insured for each","type":"table","label":"Floater Cover (for stocks at various locations) - Location (Postal Address with Pin Code) and Sum Insured (in ₹)","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Maximum value at any one location: ₹","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Whether stocks stored in open (Yes/No)","options":["Yes","No"],"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":false,"pdf_field":""},{"help":"","type":"amount","label":"Stocks which fluctuate in value to be covered on (monthly) declaration basis: Amount (₹)","options":[],"required":false,"pdf_field":""},{"help":"List add-on covers and sum insured","type":"table","label":"Details of additional covers (add-ons) offered with the policy: Annexure - Please tick Sum Insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium and Payment Details","fields":[{"help":"","type":"text","label":"Mode of Payment","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Payment Details","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Amount in (₹)","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":null,"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 Details of Proposer for Refund or Claim Purpose","fields":[{"help":"","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"IFS Code","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E-Mail ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of Nominee - Present address","options":[],"required":null,"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":"IFS 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":"Sign to confirm declarations","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":"Questionnaire Annexure","fields":[{"help":"","type":"choice","label":"Is Watchmen on Duty (Round the Clock) available at your Storage Facility?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Are you following standard housekeeping practices at premises to be covered?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Please confirm whether your premises has conductive wiring in place?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Enterprises with total insurable assets at a location exceeding ₹5 Crore but not exceeding ₹50 Crore, for Fire and Allied Perils coverage.","attachments":["Detailed block plan showing various facilities (where applicable)","Annexure for additional covers/add-ons","Annexure with GSTIN details if more than one GSTIN"],"declarations":["All statements and information provided are complete and accurate and form the basis of the insurance contract.","Misrepresentation or suppression of material facts may render the policy void and premium forfeited.","The insured agrees to assist the insurer with records and information to address anti-financial crime practices.","Premiums are paid from legitimate sources and insurer may verify source of funds and reject or terminate policy if otherwise.","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.","Agreement to abide by insurer's privacy policy and acceptance that insurer may reject proposal or terminate contract if named on sanctions list.","KYC records are current and valid and proposer will inform insurer of any changes."],"dropped_labels":9},"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/2795-gc-bharat-laghu-udyam-suraksha-proposal-form"}