{"id":2485,"title":"Bajaj General Individual 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-Individual-pf.pdf","sha256":"a70e466821441dda1acf70de73855e3946a1f6ad35e128ced800aac23aaf5a47","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals to apply for the Bajaj General Individual Cyber Safe Insurance Policy by providing personal, family, and risk-related information.","notes":["Answer all questions fully and accurately to avoid claim rejection or policy avoidance.","If insufficient space, attach a separate sheet with additional information.","Insurance cover starts only after proposal acceptance and premium payment.","Signature on behalf of proposer is required only if proposal is filled by someone else.","Use block letters where applicable.","Comply with Insurance Act 1938 Section 41 regarding prohibition of rebates."],"title":"Bajaj General Individual Cyber Safe Insurance Policy (Proposal Form)","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Name of the Proposer ( in full )","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Gender: Male Female","options":["Male","Female"],"required":true,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"Date of Birth:","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status: Married Single","options":["Married","Single"],"required":true,"pdf_field":""},{"help":"Full postal address including State and Pin Code","type":"text","label":"Address for Communication","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Education Qualification: Post Graduate & Doctorate Graduate and Graduate Students Non-Graduates","options":["Post Graduate & Doctorate","Graduate and Graduate Students","Non-Graduates"],"required":true,"pdf_field":""},{"help":"Specify start and end dates of insurance coverage","type":"date","label":"Period of Insurance: From: To:","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Family Floater: Yes/ No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"List family members with their name, age, and relationship to proposer","type":"table","label":"If 9 is opted, Details of family Members to be covered Sr. No. Name Age Relationship with Proposer","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Valid email address","type":"email","label":"E mail ID","options":[],"required":true,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile Number","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"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":"Provide DARPAN registration number if applicable","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":"proposer"},{"title":"Insurance Cover Options and Details","fields":[{"help":"","type":"choice","label":"Please select Basis of Limit for the opted covers : a. Independent Sum Insured for each Cover Option b. Aggregate Policy Limit with Sub Limit for each opted Cover","options":["Independent Sum Insured for each Cover Option","Aggregate Policy Limit with Sub Limit for each opted Cover"],"required":true,"pdf_field":""},{"help":"Specify amount in INR","type":"amount","label":"If “b” is opted, Kindly specify Aggregate Policy Limit You want to opt","options":[],"required":false,"pdf_field":""},{"help":"For each cover option, select Yes/No and specify sum insured, deductible, sub limits, and territorial limit","type":"table","label":"Cover Options Opt for Insured Event Sum Insured (in ₹) Deductible (in ₹) Sub Limits of Aggregate Policy Limit (in %) Territorial Limit","options":[],"required":true,"pdf_field":""},{"help":"Specify amount per day and maximum days if opted","type":"text","label":"Extensions: 1. Loss of Professional Income Yes / No Rs. __ per Day up to a Maximum of ____ Days","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"2. Connected Vehicle Cover Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify amount in INR if opted","type":"text","label":"3. Liability Arising out of Underage Children Yes / No INR. _____","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Past Incidents and Security Details","fields":[{"help":"","type":"yes-no","label":"Have you been a victim of any of the proposed covers in the past? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of past incidents","type":"text","label":"If answer to above question is yes, please give details","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Did you report the occurrence of the incident to the Police Authorities? Yes No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you aware at the time of proposal of any prior act, event or circumstances which is likely to give rise to a claim under any of the above insuring clauses? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you presently insured against cyber risk? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide policy details","type":"text","label":"If answer to above question is yes, give details of existing policy/policies if any","options":[],"required":false,"pdf_field":""},{"help":"Any other relevant information","type":"text","label":"Additional Information (If Any)","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any company/Insurer in respect of Insurance Declined your Proposal? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Cancelled or refused to renew your policy? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Accepted your proposal on special terms and conditions? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Level of Authentications used Multi-factor Authentication Single factor Authentication No Authentication","options":["Multi-factor Authentication","Single factor Authentication","No Authentication"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Antivirus Availability Paid Antivirus Free Antivirus No Antivirus","options":["Paid Antivirus","Free Antivirus","No Antivirus"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Print your name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Required only if proposal is filled by someone else","type":"signature","label":"Signature (on behalf of the Proposer) *","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Individual Cyber Safe Insurance Policy proposals","attachments":["Attach separate sheet if insufficient space to provide relevant information"],"declarations":["The statements made in this proposal are true, accurate and complete and form the basis of the insurance contract.","The policy will be void if any untrue or incorrect statement, misrepresentation, or non-disclosure is made.","Policy issuance is subject to realization of premium cheque.","Consent is given to share personal information with group companies for insurance and related services.","AML declarations and consents regarding Politically Exposed Persons, CKYC verification, and premium source are agreed to as applicable."],"dropped_labels":1},"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/2485-bajaj-general-individual-cyber-safe-insurance-policy-proposal-form"}