{"id":2509,"title":"Digital Suraksha Group 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/Digital-Suraksha-Group-Insurance-Policy/Digital-Suraksha-Group-Insurance-PF.pdf","sha256":"71f26db9bbeeb598ec5586c59b1f29dd675ec3aef9cd816d13ae97e27a37de56","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (group or corporate entity) to apply for the Digital Suraksha Group Insurance Policy from Bajaj General Insurance Limited.","notes":["If insufficient space, attach separate sheets with relevant information.","Proposal form must be filled fully and accurately to avoid claim rejection or policy avoidance.","This form is also used for renewal proposals.","Intermediary/officer certification is required only if the proposer did not fill the form themselves.","Use original documents and provide accurate details.","Insurance Act 1938 Section 41 prohibits rebates or inducements related to insurance premiums or commissions."],"title":"Digital Suraksha Group Insurance Policy (Proposal Form)","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Full incorporated name if company; full name and partners if partnership; proprietor name if proprietorship firm.","type":"text","label":"Name of the Proposer (in full)","options":[],"required":null,"pdf_field":""},{"help":"Provide PAN or TAN number of the proposer.","type":"text","label":"PAN/TAN Number","options":[],"required":null,"pdf_field":""},{"help":"Full postal address for communication.","type":"text","label":"Address for Communication","options":[],"required":null,"pdf_field":""},{"help":"Contact telephone number.","type":"phone","label":"Telephone Number","options":[],"required":null,"pdf_field":""},{"help":"Brief description of the business of the proposer.","type":"text","label":"Description of Proposers Business","options":[],"required":null,"pdf_field":""},{"help":"Details of the group or association whose members will be insured.","type":"text","label":"Please mention detail of the Group/ Association/ Institution/ Corporate Body whose members are being covered under the Policy?","options":[],"required":null,"pdf_field":""},{"help":"State of the proposer or group.","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal pin code.","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Email address of the proposer.","type":"email","label":"E mail ID","options":[],"required":null,"pdf_field":""},{"help":"Mobile phone number of the proposer.","type":"phone","label":"Mobile Number","options":[],"required":null,"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":"If yes, provide DARPAN 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":"proposer"},{"title":"Group and Coverage Details","fields":[{"help":"","type":"yes-no","label":"Is the group being formed with the sole purpose of obtaining Insurance?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe relationship if group formed for other purposes.","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":"Initial number of persons to be insured.","type":"number","label":"Please mention the total number of persons to be covered initially","options":[],"required":null,"pdf_field":""},{"help":"Expected total number of persons to be insured during policy period.","type":"number","label":"Please mention the expected no of persons to be covered during the policy period?","options":[],"required":null,"pdf_field":""},{"help":"Indicate if cover in switch mode is required.","type":"yes-no","label":"Cover required in Switch Mode during Cover Period?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Please specify, percentage of group members proposed to be insured under the Policy, with age above 60","options":["Up to 10%","11% to 25%","Greater than 25%"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Please specify, percentage of group members proposed to be insured under the Policy, having antivirus enabled devices","options":["Up to 30%","31% to 70%","Greater than 70%"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Please specify, percentage of group members proposed to be insured under the Policy, using multi-factor authentication","options":["Up to 30%","31% to 70%","Greater than 70%"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Please specify frequency of use of Public Wi-Fi by members of the group, proposed to be insured under the Policy","options":["Less than 5%","5% to 15%","Greater than 15%"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Please specify percentage of group members using only devices owned by self or family members for doing financial transactions","options":["Up to 50%","51% to 75%","Greater than 75%"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Please specify average time spent on the internet by members of the group proposed to be insured under the Policy","options":["Less than 1 hour","1-2 hours","2-4 hours","4-6 hours","Above 6 hours"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured Beneficiary Details","fields":[{"help":"Provide Name, Contact Details, Unique Id (PAN/AADHAR/CUST ID/Loan Account No. etc.), Cover Opted, Cover Period*, Extension Opted for each beneficiary.","type":"table","label":"Details for each Insured Beneficiary to be covered under the policy (attach extra sheet if multiple)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Information and Past Insurance Details","fields":[{"help":"Any other relevant information.","type":"text","label":"Additional Information","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any company/Insurer in respect of Insurance Declined your Proposal?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Cancelled or refused to renew your policy?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide number of claims and total claim amount in past.","type":"text","label":"Past Claim Experience (please specify no of claims and aggregate claim amount)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Signature","fields":[{"help":"Date of signing the proposal.","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of signing the proposal.","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of the proposer or authorized signatory.","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Tick if you agree to the explanation in vernacular language.","type":"checkbox","label":"The salient features of the policy, terms and conditions of this proposal have been explained to me/us in vernacular language, and I/We agree to the same. (Please tick in case same is agreed).","options":["Agree"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Intermediary/Officer Certification (if applicable)","fields":[{"help":"Name of the intermediary or company officer.","type":"text","label":"Name of the Intermediary/Officer of the Company","options":[],"required":null,"pdf_field":""},{"help":"Code or employee number of intermediary/officer.","type":"text","label":"Code Number/Employee Number","options":[],"required":null,"pdf_field":""},{"help":"Place and date of certification.","type":"text","label":"Place and Date","options":[],"required":null,"pdf_field":""},{"help":"Signature of intermediary/officer certifying the proposal.","type":"signature","label":"Signature of Intermediary/Officer of the Company","options":[],"required":null,"pdf_field":""}],"filled_by":"intermediary/officer"}],"deadlines":[],"applies_to":"Digital Suraksha Group Insurance Policy","attachments":["Separate sheet if insufficient space to provide relevant information","Extra sheet for details of multiple Insured Beneficiaries"],"declarations":["The information provided is true and complete to the best of the proposer's knowledge and forms the basis of the insurance policy.","The proposer is authorized to propose on behalf of all persons to be insured.","If any information is found incorrect, untrue, suppressed or misleading, the company may reject claims, cancel the policy and forfeit premium.","The proposer agrees to inform the company immediately of any changes in the proposal or risk after submission.","The proposer agrees to accept the standard terms and conditions of the policy as issued by the company.","The contract of insurance is effective only upon company acceptance and receipt of full premium.","The proposal form is also deemed to be a renewal proposal form.","The proposer authorizes the company to display standard terms and conditions on its website for access.","The salient features and terms have been explained in vernacular language and agreed to by the proposer."],"dropped_labels":0},"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/2509-digital-suraksha-group-insurance-policy-proposal-form"}