{"id":2484,"title":"Bajaj General Cyber Protect Premium – DIGITAL BUSINESS AND DATA PROTECTION INSURANCE 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-Protect-pf.pdf","sha256":"3dea48704ac7bed6df052c9fe70f03fdff041288ada24e2ee26d2e1da94f492e","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for digital business and data protection insurance to be filled by the policyholder applying for coverage.","notes":["Use additional sheets if space is insufficient and indicate question number.","This is a claims made policy proposal form.","Keep policy contact and bank details updated for faster service.","Signatory must be Chairman, Chief Executive or Managing Director."],"title":"Bajaj General Cyber Protect Premium – DIGITAL BUSINESS AND DATA PROTECTION INSURANCE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Constitution Details","fields":[{"help":"","type":"yes-no","label":"Partnership Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Limited Liability/Partnership Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes, provide DARPAN Portal Registration details","type":"yes-no","label":"NGO/NPO- Provide DARPAN Portal Registration, if applicable","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Company","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Trust","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Society","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Section 8 Company","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Proprietorship Firm","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify other constitution type if applicable","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""}],"filled_by":""},{"title":"General Information","fields":[{"help":"Full legal name of the policyholder","type":"text","label":"Name of Policyholder","options":[],"required":true,"pdf_field":"Name of policyholder"},{"help":"Complete address of the principal office","type":"text","label":"Address of Principal Office","options":[],"required":true,"pdf_field":"Address O principal office"},{"help":"Country where the policyholder is incorporated","type":"text","label":"Country of incorporation of the Policyholder","options":[],"required":true,"pdf_field":"Country of incorpation ofthe policyholder"},{"help":"Date when the policyholder was established","type":"date","label":"Date of establishment","options":[],"required":true,"pdf_field":"Date Of Establichment"},{"help":"Official website URL of the policyholder","type":"text","label":"Website address","options":[],"required":false,"pdf_field":"Website address"}],"filled_by":"policyholder"},{"title":"Business Information","fields":[{"help":"Describe the main business activities of the company","type":"text","label":"Please provide a clear description of the business activities","options":[],"required":true,"pdf_field":"text 501"}],"filled_by":"policyholder"},{"title":"Insurance Programme","fields":[{"help":"Current retention amount","type":"amount","label":"Current Retention - Standard Cyber Covers","options":[],"required":false,"pdf_field":"Current RetentionStandard Cyber Covers.0"}],"filled_by":"policyholder"},{"title":"Policies and Procedures","fields":[{"help":"Answer yes or no; if no, provide details","type":"yes-no","label":"Has data security and information technology risk in general been added to your company risk register?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Answer yes or no; if no, provide details","type":"yes-no","label":"Do you have a written data protection/information security policy?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Describe guidance provided by policy or practices","type":"text","label":"Does the policy (or in the absence of a policy do you) provide guidance on: Responsibilities of the Information Security Officer or equivalent, Network security (access rights, passwords, encryption etc), Mobile device security (inc. laptops, smart phones and memory devices), Use and storage of personally identifiable information & notification in case of a breach, Employee’s use of social networking websites, Use of unsecured WiFi networks, Data backup procedures (please comment on how often backup takes place and whether this is offsite)","options":[],"required":false,"pdf_field":"text 502"},{"help":"Answer yes or no; if no, provide details","type":"yes-no","label":"Are all employees trained and/or made aware of the requirements of the policy?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Answer yes or no; please briefly describe","type":"yes-no","label":"Are the security standards set by the policy tested, has this involved a qualified security assessor?","options":["YES","NO"],"required":true,"pdf_field":"Comments"},{"help":"Answer yes or no; if yes, specify frequency","type":"yes-no","label":"Is the policy reviewed and updated on a regular basis?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If you comply with any industry standards e.g. ISO 27001, please briefly describe","type":"yes-no","label":"Do you maintain up to date (generally accepted) data security techniques?","options":["YES","NO"],"required":true,"pdf_field":"Comments_2"}],"filled_by":"policyholder"},{"title":"Payment Card Information","fields":[{"help":"","type":"yes-no","label":"Do you collect credit/debit or any other type of payment information?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide any comments related to payment information","type":"text","label":"Comments","options":[],"required":false,"pdf_field":"Comments_3"},{"help":"If yes, provide details","type":"yes-no","label":"Do you process payments on behalf of any other individual or organisation?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you fully compliant with the applicable Payment Card Industry Data Security Standards (PCI DSS)?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is compliance self certified?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Name of certifying body if not self-certified","type":"text","label":"If no, who carries out certification","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Third Party Service Providers","fields":[{"help":"If yes, provide details","type":"yes-no","label":"Does the firm use any third-party service providers to remotely host any activities (e.g web site maintenance, data backup, payment services etc)?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Describe due diligence process","type":"text","label":"Describe the due diligence carried out by or on behalf of the firm to ensure the service provider’s security arrangements are adequate.","options":[],"required":false,"pdf_field":"Comments_4"},{"help":"If yes, provide details","type":"yes-no","label":"Does the contract ensure that the third party service provider has a contractual liability for any losses suffered by the insured for the failure of the service provide to adequately protect the insured’s data?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Specify liability limit if applicable","type":"text","label":"Is this liability limited, if so at what level?","options":[],"required":false,"pdf_field":"Comments_5"}],"filled_by":"policyholder"},{"title":"Crisis Management","fields":[{"help":"","type":"yes-no","label":"Do you have a written crisis management plan that address breaches of data and network security?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Specify review frequency","type":"text","label":"How often is this reviewed and updated?","options":[],"required":false,"pdf_field":"Comments_6"},{"help":"If yes, provide details","type":"yes-no","label":"Have you identified third party service providers to help you with crisis management and response?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Historical Losses and Incidents","fields":[{"help":"If yes, provide details","type":"yes-no","label":"Has a regulator or recognised industry body ever investigated you in respect of personally identifiable information or requested information from you in this regard?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If yes, provide details","type":"yes-no","label":"Have you been the subject of a targeted attack on your computer system?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If yes, provide details","type":"yes-no","label":"Has your computer network/system been suspended or interrupted (voluntarily or otherwise) for any reason (e.g targeted or generalised attack, loss of data etc)?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Specify duration","type":"text","label":"How long did the suspension or interruption last?","options":[],"required":false,"pdf_field":""},{"help":"If yes, provide details","type":"yes-no","label":"Was there a loss of profits or an increase of costs associated with the suspension or interruption?","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Discovery Period Opted","fields":[{"help":"Select one discovery period option","type":"choice","label":"Discovery Period Opted","options":["60 Days","90 Days","120 Days","180 Days","365 Days"],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Waiting Period Under Business Interruption Loss","fields":[{"help":"Select one waiting period option","type":"choice","label":"Waiting Period Under Business Interruption Loss","options":["6 hours","12 hours","18 hours","24 hours","36 hours"],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Warranty Statement","fields":[{"help":"If yes, provide details","type":"yes-no","label":"Are you aware, after inquiry of any facts or circumstances that may give rise to a claim under the proposed policy?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Retroactive Date Coverage","fields":[{"help":"","type":"yes-no","label":"Do you wish to limit the prior acts coverage by adding a retroactive date to the policy?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Enter the retroactive date if applicable","type":"date","label":"If YES, please provide Retroactive Date","options":[],"required":false,"pdf_field":"Retroactive Date"}],"filled_by":"policyholder"},{"title":"Declarations and Signature","fields":[{"help":"Signature of Chairman, Chief Executive or Managing Director","type":"signature","label":"Signed","options":[],"required":true,"pdf_field":"Signed"},{"help":"Name of the company","type":"text","label":"Company","options":[],"required":true,"pdf_field":"Company"},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":"Date"}],"filled_by":"Chairman/Chief Executive/Managing Director"},{"title":"Additional Declarations","fields":[{"help":"PEP means Politically Exposed Persons as defined","type":"yes-no","label":"Are you or any of the proposal applicants a PEP* or a close relative of PEP*? If yes, please share the details","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Cyber Protect Digital Business and Data Protection Insurance (Premium and Standard)","attachments":["Additional sheets if insufficient space to answer questions","DARPAN Portal Registration (if applicable)"],"declarations":["You must disclose fully and faithfully all facts that may affect the insurance cover.","Completion and signature of this proposal does not bind the proposer or insurer to a contract.","Material facts must be disclosed and any changes informed before policy inception.","Information provided may be shared with third parties related to the insurance cover.","Premium must be paid from legally acquired sources.","Consent is given for KYC verification through specified portals.","Consent is given for sharing personal data with group companies.","Policy must be signed by Chairman, Chief Executive or Managing Director.","No rebates or inducements are allowed as per Insurance Act 1938 Section 41."],"dropped_labels":14},"pdf_fields":[{"name":"Name of policyholder","page":3,"type":"text","label":"1 European Union"},{"name":"Address O principal office","page":3,"type":"text","label":"1 European Union"},{"name":"Country of incorpation ofthe policyholder","page":3,"type":"text","label":"1 European Union"},{"name":"Date Of Establichment","page":3,"type":"text","label":"1 European Union"},{"name":"Website address","page":3,"type":"text","label":"1 European Union"},{"name":"text 501","page":3,"type":"text","label":"1 European Union"},{"name":"INDIAEmployee Numbers.0","page":3,"type":"text","label":"INDIA_Employee Numbers"},{"name":"INDIAEmployee Numbers.1","page":3,"type":"text","label":"INDIA_Employee Numbers"},{"name":"INDIAEmployee Numbers.2","page":3,"type":"text","label":"INDIA_Employee Numbers"},{"name":"INDIAEmployee Numbers.3","page":3,"type":"text","label":"INDIA_Employee Numbers"},{"name":"Turnover.0","page":3,"type":"text","label":"USA_Employee Numbers"},{"name":"Turnover.1","page":3,"type":"text","label":"USA_Employee Numbers"},{"name":"Turnover.2","page":3,"type":"text","label":"USA_Employee Numbers"},{"name":"Turnover.3","page":3,"type":"text","label":"USA_Employee Numbers"},{"name":"Turnover from web based trading.0.0","page":3,"type":"text","label":"EU1_Employee Numbers"},{"name":"Turnover from web based trading.0.1","page":3,"type":"text","label":"EU1_Employee Numbers"},{"name":"Turnover from web based trading.0.2","page":3,"type":"text","label":"EU1_Employee Numbers"},{"name":"Turnover from web based trading.0.3","page":3,"type":"text","label":"EU1_Employee Numbers"},{"name":"Estimate of customer numbers.0.0","page":3,"type":"text","label":"ROW2_Employee Numbers"},{"name":"Estimate of customer numbers.0.1","page":3,"type":"text","label":"ROW2_Employee Numbers"},{"name":"Estimate of customer numbers.0.2","page":3,"type":"text","label":"ROW2_Employee Numbers"},{"name":"Estimate of customer numbers.0.3","page":3,"type":"text","label":"ROW2_Employee Numbers"},{"name":"Total Assets.0","page":3,"type":"text","label":"ROW2_Employee Numbers"},{"name":"Total Assets.1","page":3,"type":"text","label":"ROW2_Employee Numbers"},{"name":"Total Assets.2","page":3,"type":"text","label":"ROW2_Employee Numbers"},{"name":"Total Assets.3","page":3,"type":"text","label":"ROW2_Employee Numbers"},{"name":"Limit Re questedStandard Cyber Covers.0","page":4,"type":"text","label":"Limit Re- quested_Standard Cyber Covers"},{"name":"Deductible RequestedStandard Cyber Covers.0","page":4,"type":"text","label":"Deductible Requested_Standard Cyber Covers"},{"name":"Current In surerStandard Cyber Covers.0","page":4,"type":"text","label":"Current In- surer_Standard Cyber Covers"},{"name":"Current Premi umStandard Cyber Covers.0","page":4,"type":"text","label":"Current Premi- um_Standard Cyber Covers"},{"name":"Current RetentionStandard Cyber Covers.0","page":4,"type":"text","label":"Current Retention_Standard Cyber Covers"},{"name":"Limit Re questedStandard Cyber Covers.1","page":4,"type":"text","label":"Limit Re- quested_Standard Cyber Covers"},{"name":"Deductible RequestedStandard Cyber Covers.1","page":4,"type":"text","label":"Deductible Requested_Standard Cyber Covers"},{"name":"Current In surerStandard Cyber Covers.1","page":4,"type":"text","label":"Current In- surer_Standard Cyber Covers"},{"name":"Current Premi umStandard Cyber Covers.1","page":4,"type":"text","label":"Current Premi- um_Standard Cyber Covers"},{"name":"Current RetentionStandard Cyber Covers.1","page":4,"type":"text","label":"Current Retention_Standard Cyber Covers"},{"name":"Group 01","page":4,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 01","page":4,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text 502","page":4,"type":"text","label":"1 European Union"},{"name":"Group 02","page":4,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 02","page":4,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text503","page":4,"type":"text","label":"1 European Union"},{"name":"text550","page":4,"type":"text","label":"1 European Union"},{"name":"Comments","page":5,"type":"text","label":"Comments_"},{"name":"Group 04","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 04","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 05","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 05","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Comments_2","page":5,"type":"text","label":"Comments_"},{"name":"Comments_3","page":5,"type":"text","label":"Comments_"},{"name":"Group 06","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 06","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Comments_4","page":5,"type":"text","label":"Comments_"},{"name":"Group 07","page":5,"type":"radiobutton"},{"name":"Group 07","page":5,"type":"radiobutton"},{"name":"Group 08","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 08","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Comments_5","page":5,"type":"text","label":"Comments_"},{"name":"Group 09","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 09","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Comments_6","page":5,"type":"text","label":"Comments_"},{"name":"Comments_7","page":5,"type":"text","label":"Comments_"},{"name":"Group 10","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 10","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 11","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 11","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text504","page":5,"type":"text","label":"1 European Union"},{"name":"Group 12","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 12","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text507","page":5,"type":"text","label":"1 European Union"},{"name":"Group 14","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 14","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text505","page":5,"type":"text","label":"1 European Union"},{"name":"Group 15","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 15","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text506","page":5,"type":"text","label":"1 European Union"},{"name":"Group16","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group16","page":5,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 17","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 17","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text508","page":6,"type":"text","label":"1 European Union"},{"name":"Group 18","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 18","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text509","page":6,"type":"text","label":"1 European Union"},{"name":"Group 19","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 19","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text510","page":6,"type":"text","label":"1 European Union"},{"name":"Group 20","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 20","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text511","page":6,"type":"text","label":"1 European Union"},{"name":"text512","page":6,"type":"text","label":"1 European Union"},{"name":"Group 21","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 21","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text513","page":6,"type":"text","label":"1 European Union"},{"name":"Group 22","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 22","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text514","page":6,"type":"text","label":"1 European Union"},{"name":"Group 23","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 23","page":6,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text515","page":7,"type":"text","label":"1 European Union"},{"name":"Group 24","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 24","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text516","page":7,"type":"text","label":"1 European Union"},{"name":"Group 25","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 25","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text517","page":7,"type":"text","label":"1 European Union"},{"name":"Group 26","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 26","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text518","page":7,"type":"text","label":"1 European Union"},{"name":"Group 27","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 27","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text519","page":7,"type":"text","label":"1 European Union"},{"name":"Group 28","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 28","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text520","page":7,"type":"text","label":"1 European Union"},{"name":"text521","page":7,"type":"text","label":"1 European Union"},{"name":"Group 29","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 29","page":7,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text522","page":7,"type":"text","label":"1 European Union"},{"name":"Group 31","page":7,"type":"radiobutton","options":["Choice1","Choice1","Choice1","Choice1","Choice1"]},{"name":"Group 31","page":7,"type":"radiobutton","options":["Choice1","Choice1","Choice1","Choice1","Choice1"]},{"name":"Group 31","page":7,"type":"radiobutton","options":["Choice1","Choice1","Choice1","Choice1","Choice1"]},{"name":"Group 31","page":7,"type":"radiobutton","options":["Choice1","Choice1","Choice1","Choice1","Choice1"]},{"name":"Group 31","page":7,"type":"radiobutton","options":["Choice1","Choice1","Choice1","Choice1","Choice1"]},{"name":"Group 32","page":8,"type":"radiobutton","options":["Choice1","Choice1","Choice1","Choice1","Choice1"]},{"name":"Group 32","page":8,"type":"radiobutton","options":["Choice1","Choice1","Choice1","Choice1","Choice1"]},{"name":"Group 32","page":8,"type":"radiobutton","options":["Choice1","Choice1","Choice1","Choice1","Choice1"]},{"name":"Group 32","page":8,"type":"radiobutton","options":["Choice1","Choice1","Choice1","Choice1","Choice1"]},{"name":"Group 32","page":8,"type":"radiobutton","options":["Choice1","Choice1","Choice1","Choice1","Choice1"]},{"name":"Group 33","page":8,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 33","page":8,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"text523","page":8,"type":"text","label":"1 European Union"},{"name":"Group 34","page":8,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Group 34","page":8,"type":"radiobutton","options":["Choice1","Choice1"]},{"name":"Retroactive Date","page":8,"type":"text","label":"undefined"},{"name":"Group 35","page":8,"type":"radiobutton"},{"name":"Signed","page":8,"type":"text","label":"Signed"},{"name":"Company","page":8,"type":"text","label":"Company"},{"name":"Date","page":8,"type":"text","label":"Date"},{"name":"Group15001","page":9,"type":"radiobutton"},{"name":"Group15001","page":9,"type":"radiobutton"},{"name":"Group15002","page":9,"type":"radiobutton"},{"name":"Group15002","page":9,"type":"radiobutton"}],"fillable_pdf":true,"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/2484-bajaj-general-cyber-protect-premium-digital-business-and-data-protection-insuran"}