{"id":2481,"title":"BAJAJ GENERAL GROUP CYBER SAFE INSURANCE POLICY: PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/commercial-general/Cyber-Safe-Group-pf.pdf","sha256":"4d5ebc551be5ce0d49aee50c1b4191fb5ab0912f47f3307d9d3bc084d3eb8816","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (individual or entity) to apply for the Bajaj General Group Cyber Safe Insurance Policy by providing details about themselves, their business, and the group members to be insured.","notes":["If proposer is a company, provide full incorporated name; if proprietorship or partnership, provide appropriate names.","Attach extra sheets if details of insured beneficiaries exceed space provided.","Keep policy contact and bank details updated for faster service.","The proposal form is also deemed to be a renewal proposal form.","The salient features and terms have been explained in vernacular language if agreed by proposer.","Use original and accurate information; any false information may lead to policy cancellation.","The form includes a disclaimer about confidentiality and virus protection for email communications."],"title":"BAJAJ GENERAL GROUP CYBER SAFE INSURANCE POLICY: PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Full incorporated name if a company; proprietorship or partnership firm name as applicable","type":"text","label":"Name of the Proposer ( in full)","options":[],"required":true,"pdf_field":""},{"help":"Provide your PAN or TAN number","type":"text","label":"PAN/TAN Number","options":[],"required":true,"pdf_field":""},{"help":"Provide a valid email address","type":"email","label":"E-mail ID","options":[],"required":true,"pdf_field":""},{"help":"Provide a valid mobile number","type":"phone","label":"Mobile Number","options":[],"required":true,"pdf_field":""},{"help":"Provide bank name, account number, IFSC code and name as per bank","type":"text","label":"Bank Details","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide e-lA number if available","type":"text","label":"Electronic-Insurance Account: Please provide e-lA No. to deposite your insurance policy.","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Do you want to open e-lA account:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Are you an exisiting customer of BGIL?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide PID or Policy number if existing customer","type":"text","label":"If Yes. Please provide PID No / Policy No","options":[],"required":false,"pdf_field":""},{"help":"","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":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Select the constitution type of the proposer","type":"choice","label":"If Yes Specify Constitution","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":"Business and Group Details","fields":[{"help":"Provide telephone number","type":"phone","label":"Telephone Number","options":[],"required":false,"pdf_field":""},{"help":"Describe the nature of your business","type":"text","label":"Description of Proposers Business","options":[],"required":true,"pdf_field":""},{"help":"Provide details of the group or association","type":"text","label":"Please mention detail of the Group/ Association/ Institution/ Corporate Body whose members are being covered under the Policy?","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the group being formed with the sole purpose of obtaining Insurance?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain relationship if group not solely for insurance","type":"text","label":"If answer to Question 7 is No please mention the relationship between the members and the group manager for services other than Insurance","options":[],"required":false,"pdf_field":""},{"help":"Provide initial number of persons to be insured","type":"number","label":"Please mention the total number of persons to be covered initially:","options":[],"required":true,"pdf_field":""},{"help":"Provide expected total number of persons during policy period","type":"number","label":"Please mention the expected no of persons to be covered during the policy period?","options":[],"required":true,"pdf_field":""},{"help":"List each insured beneficiary with their details; attach extra sheets if needed","type":"table","label":"Please provide below details for each Insured Beneficiary to be covered under the policy.(Please attach extra sheet for details of multiple Insured Beneficiaries) Sr.No, Insured Beneficiary Name, Address, Contact No, E-Mail, Plan Opted","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History","fields":[{"help":"","type":"yes-no","label":"Has any company/Insurer in respect of Insurance Declined your Proposal?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Cancelled or refused to renew your policy?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"PEP means Politically Exposed Person","type":"yes-no","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","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 or National Securities Depository limited portal for the purpose of undertaking KYC","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","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":true,"pdf_field":""},{"help":"","type":"yes-no","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":"You can update details via app, WhatsApp, call center, email, website, agent or branch","type":"checkbox","label":"It is mandatory to keep your policy with updated contact (Mobile No., Email ID and PAN Card) and bank account details, to process any of your service requests faster and hassle-free in future.","options":[],"required":null,"pdf_field":""},{"help":"Sign and date the form","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Provide witness name and signature","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"If yes, provide details and disability certificate","type":"yes-no","label":"Disability Declaration: Any Physical deformity or handicap","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Authorised Representative","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Agent/Intermediary Declaration","fields":[{"help":"Provide agent license number","type":"text","label":"IRDAI COR No./ License No.(Advisor/Corporate Agent/Broker/Relationship Officer)","options":[],"required":true,"pdf_field":""},{"help":"Agent must sign and date","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"Agent/IMD signature and code","type":"signature","label":"Agent / IMD ( SP/DP/ BQP) signature and their code","options":[],"required":false,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Group Cyber Safe Insurance Policy proposals","attachments":["Separate sheet if insufficient space to provide relevant information","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability (if applicable)"],"declarations":["The information provided in this proposal form is true and complete to the best of the proposer's knowledge and forms the basis of the insurance contract.","The company may reject claims or cancel the policy if any information is found incorrect, untrue, suppressed or misleading.","The proposer agrees to inform the company immediately of any changes after submission of this proposal.","The insurance contract is effective only upon company acceptance and receipt of full premium.","The proposer consents to verification of identity/address through specified government portals for KYC.","The premium is paid from legally acquired sources and future premiums will be similarly paid.","The proposer consents to sharing personal information with group companies for services and products.","The agent/intermediary declares that the proposal form contents have been explained to the proposer in vernacular language.","No person shall offer or accept rebates other than those allowed by the insurer's published prospectus or tables.","Failure to comply with rebate provisions is punishable with a fine up to ten lakh rupees."],"dropped_labels":4},"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/2481-bajaj-general-group-cyber-safe-insurance-policy-proposal-form"}