Follow the steps to effectively complete your proposal form

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by entering your full name in the designated field for the proposer.
3. Provide your residential address, including city and state.
4. Input your telephone numbers, both residential and mobile, for contact purposes.
5. Enter your email address in the provided field.
6. State your gross monthly income in the specified area.
7. Select your preferred plan by ticking the box next to one of the available options.
8. If applicable, list any additional members to be covered under the policy, including spouse and children, indicating the number of children.
9. Complete the section regarding the details of the person to be insured, including their full name, date of birth, age, and profession.
10. Disclose any existing disability or deformity for the person to be insured.
11. If applicable, provide details of any other policies you hold, indicating the company name, sum insured, and policy number.
12. Indicate whether any insurance company has declined to issue or renew a policy for any insured persons and provide relevant details.
13. Fill in the assignee details if applicable, including their relation to you and the percentage of sum insured.
14. Read the declaration carefully and authorize Bajaj Allianz to pay any claim to the assignee by signing in the designated section.
15. Date the application using the format DD/MM/YY.
16. If you are an agent, provide your declaration, agent's name, signature, and date.
17. Finally, review all entered information for accuracy, and once confirmed, save the changes, download, print, or share the completed form.

Complete your proposal form online today to secure your coverage with Bajaj Allianz.