{"id":2514,"title":"BAJAJ GENERAL PROFESSIONAL PROTECT INSURANCE FOR MEDIA PROFESSIONALS : 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-pw/Bajaj-General-Professional-Protect-Media-Proposal-Form-Commercial.pdf","sha256":"ee0f3eb2ed52eb19c6f9efd058f37d5b1f24474e6a9118360582552ff6e15bc7","pages":13,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for professional indemnity insurance for media professionals, to be filled by the policyholder or their authorized representative.","notes":["All questions must be answered to enable a quotation to be given.","Use additional sheets if space is insufficient and indicate question number.","This is a claims made policy; coverage applies only to claims made and notified during the policy period.","Disclosure of all relevant facts is mandatory before entering into or renewing the contract.","The form must be signed by a Partner, Director or Principal.","Certified that the contents have been fully explained to the proposer and understood.","Insurance Act 1938 Section 41 prohibits rebates as inducements to take or renew insurance."],"title":"BAJAJ GENERAL PROFESSIONAL PROTECT INSURANCE FOR MEDIA PROFESSIONALS : PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"General Information","fields":[{"help":"","type":"text","label":"Name of Policyholder","options":[],"required":null,"pdf_field":""},{"help":"Full address including street, city, state, and postal code","type":"text","label":"Address of Principal Office","options":[],"required":null,"pdf_field":""},{"help":"Date when the firm was established","type":"date","label":"Date of Establishment","options":[],"required":null,"pdf_field":""},{"help":"Official website URL","type":"text","label":"Website Address","options":[],"required":null,"pdf_field":""},{"help":"Provide DARPAN Portal Registration details if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":null,"pdf_field":""},{"help":"List all additional entities with years","type":"text","label":"Please list all additional business entities (whether or not currently trading, including year of establishment and year of cessation if applicable)","options":[],"required":null,"pdf_field":""},{"help":"Provide addresses of all other offices","type":"text","label":"Please list addresses of all other offices currently trading","options":[],"required":null,"pdf_field":""},{"help":"If Yes, supply details","type":"yes-no","label":"Is/are the firm(s) or any principal, partner or director a member of a consortium, joint venture, single project partnership or group practice? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of consortium, joint venture, partnership or group practice","type":"text","label":"If Yes, please supply details","options":[],"required":null,"pdf_field":""},{"help":"If Yes, supply details","type":"yes-no","label":"Does the firm(s) or any principal, partner or director carry out any work on behalf of any other business in which they have a controlling or financial interest (other than as a shareholder in a public quoted company)? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of work on behalf of other business","type":"text","label":"If Yes, please supply details","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Staff and Partners","fields":[{"help":"Provide full details for each principal, partner or director","type":"table","label":"Please give details of any principal, partners or directors: Name, Date of Birth, Relevant Qualifications, Year became Partner/Director","options":[],"required":null,"pdf_field":""},{"help":"Provide counts for each category","type":"table","label":"Please give details of number of permanent staff in current business: Full Time, Part Time, Principal/Partners/Directors, Professionally Qualified, All Others","options":[],"required":null,"pdf_field":""},{"help":"If Yes, answer the following questions","type":"yes-no","label":"Does the firm(s) use specialist designers, consultants or sub-contractors? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Percentage value","type":"number","label":"Please state what proportion of the firm(s) business involves the subcontracting of work to others (%)","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) insist that the specialist designers / Consultants / sub-contractors maintain their own PI cover? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe services","type":"text","label":"What services does the firm(s) use the specialist designers/ consultants/ sub-contractors for?","options":[],"required":null,"pdf_field":""},{"help":"Describe selection and management procedures","type":"text","label":"How does the firm(s) select and manage the specialist designers/ consultants/ sub-contractors?","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Professional Services","fields":[{"help":"Provide income breakdown by year and territory","type":"table","label":"Please state your total gross income for the last 5 years, plus an estimate for the current and forthcoming year: Year Ending, In Territory where domiciled, In USA/Canada or elsewhere for clients whose address is in USA/Canada, Elsewhere, Total (INR)","options":[],"required":null,"pdf_field":""},{"help":"Provide INR amounts for each category and total","type":"table","label":"Please give the percentage split of total gross fees / turnover received in the last complete financial year for various categories (e.g. Advertising – TV, Broadcasting – TV, Publishing, etc.)","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the work split above represent the make up of the firm(s) over the past three years? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If Yes, provide explanation","type":"yes-no","label":"Are any substantial changes in the percentage amounts shown above anticipated during the next 12 months? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain anticipated changes","type":"text","label":"If Yes, please provide an explanation","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Broadcasting Section","fields":[{"help":"Provide percentage for each category","type":"table","label":"Please provide a percentage split of your broadcasting programmes: Consumer Programmes, Current Affairs / News, Documentaries, Films, Investigative / Exposes, Light Entertainment (Inc. Sports / Comedy), Live / Unscripted, Religious/ Political, Other (please specify)","options":[],"required":null,"pdf_field":""},{"help":"Percentage value","type":"number","label":"What percentage of your broadcasts are via the Internet?","options":[],"required":null,"pdf_field":""},{"help":"Percentage value","type":"number","label":"What is the percentage of programmes produced by a third party?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are all News broadcasts sourced from a third party? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) ensure that a delay device is used for all live/ unscripted broadcasts? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) always refer potentially contentious material to lawyers prior to broadcasting? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Publishing Section","fields":[{"help":"Provide percentage for each category","type":"table","label":"Please provide a percentage split of your publications / distributed material: Advertising, Autobiographies / Biographies, Business / Trade, Children’s, Financial, Lifestyle, Local Newspapers, Medical / Technical / Scientific, National Newspapers, Religious/ Political, Other (please state publication type)","options":[],"required":null,"pdf_field":""},{"help":"Percentage value","type":"number","label":"What percentage (approximately) of your turnover comes from advertising revenue?","options":[],"required":null,"pdf_field":""},{"help":"Percentage value","type":"number","label":"What percentage of your turnover comes from contract publishing?","options":[],"required":null,"pdf_field":""},{"help":"Percentage value","type":"number","label":"What percentage of your publications are via the Internet?","options":[],"required":null,"pdf_field":""},{"help":"Provide details for each publication","type":"table","label":"Please complete the table below: Name of Publication, Publishing Format (e.g. magazine, book, newspaper), Approx. Annual Circulation (weekly, monthly), Territories Where Distributed","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) have procedures in place for checking the accuracy, originality and content of work – including title clearance? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) have procedures in place to ensure all intellectual property rights have been acquired prior to publication? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) always refer potentially contentious material to lawyers prior to publication? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"General Section","fields":[{"help":"Provide details for each contract","type":"table","label":"Please give details of the 3 largest mailshots / direct marketing contracts undertaken in the past 3 years or anticipated if a new practice: Name of Client, Business of Client, Size of Mailing, Total Contract Value INR, Income to You INR","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) always work to a written specification for each contract including campaign details, volume, quality, timing and sign-off procedures? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details for each contract","type":"table","label":"Please give details of the 3 largest promotional contracts undertaken in the past 3 years or anticipated if a new practice: Name of Client, Nature of the Contract, Total Contract Value INR, Income to You INR","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) always obtain final client sign off before going to print? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If Yes, explain procedures in place to prevent any intellectual property infringement","type":"yes-no","label":"Does the firm(s) engage in the design of logos or trade marks? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe procedures","type":"text","label":"If Yes, please explain procedures in place to prevent any intellectual property infringement","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) engage in the distribution and/or redemption of coupons, rebates or other promotional games tickets? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If Yes, provide explanation","type":"yes-no","label":"Are any substantial changes in the percentage amounts shown above anticipated during the next 12 months? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain anticipated changes","type":"text","label":"If Yes, please provide an explanation","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Risk Management","fields":[{"help":"If No, answer the following","type":"yes-no","label":"Does the firm(s) always use standard written contract conditions? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Percentage value","type":"number","label":"What percentage of contracts are in the non-standard form (%)","options":[],"required":null,"pdf_field":""},{"help":"Describe procedures","type":"text","label":"What are the procedures for the sign-off / approval of a non-standard contract?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"In respect of all contracts the firm(s) enters into, do they always include: an outline of the scope of services to be provided? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Limitation of liabilities? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Direct, Consequential and Economic Loss Exclusion? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Force Majeure? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Guarantees? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Warranty Disclaimers? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Hold Harmless Agreement? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Arbitration Agreement? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the client always sign the contract? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) have standard procedures for the regular review of ongoing contracts internally and with the client? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) provide advice or services which fall outside of the scope of the contract? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Does the firm always require satisfactory references or only when engaging senior employees? (Always / Senior appointments only)","options":["Always","Senior appointments only"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is any employee allowed to sign cheques on his/her signature alone for values exceeding? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If Other, please specify","type":"choice","label":"How frequently are checks carried out on all entries in the cash book with paying-in books, receipts, counterfoils and vouchers, and reconciled with bank statements? (Weekly / Monthly / Quarterly / Other)","options":["Weekly","Monthly","Quarterly","Other"],"required":null,"pdf_field":""},{"help":"Provide amounts in INR for each limit and sub-limit","type":"table","label":"Please state Limits of Indemnity for which a quotation is required or local currency equivalent: Limit of Liability (all Claims in the aggregate, including Defence Costs), Sub Limits (Emergency Costs Advancement, Legal Representation Costs, Lost Documents)","options":[],"required":null,"pdf_field":""},{"help":"Provide start and end dates of policy period","type":"date","label":"Policy Period : Risk Inception Date (DD/MM/YYYY), Risk End Date (DD/MM/YYYY)","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Claims Information","fields":[{"help":"If Yes, supply details","type":"yes-no","label":"Has the firm(s) sustained any loss through the fraud or dishonesty of any person? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of loss through fraud or dishonesty","type":"text","label":"If Yes, please supply details","options":[],"required":null,"pdf_field":""},{"help":"If Yes, supply details","type":"yes-no","label":"Is the firm(s) aware of any allegation or occurrence of fraud or dishonesty at any time committed by any past or present partner, director or principal or employee? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of allegation or occurrence","type":"text","label":"If Yes, please supply details","options":[],"required":null,"pdf_field":""},{"help":"If Yes, supply details","type":"yes-no","label":"After enquiry, have any Professional Liability claims ever been made against the firm(s) and/or predecessors of the firm(s) and/or your current and/or retired partners, directors or principals, either individually or otherwise for any negligence, errors, omission, breach of professional duty or the like, whether successful or not? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide claim details","type":"table","label":"If Yes, please supply details: Date of Claim, Claimant, Details of Claim including any payments made or reserves held","options":[],"required":null,"pdf_field":""},{"help":"If Yes, supply details","type":"yes-no","label":"After enquiry, are any of the partners, directors or principals aware of any pending claims and/or circumstances existing which may give rise to a Professional Liability claim against the firm(s) and/or predecessors of the firm(s) and/or your current and/or retired partners/directors/principal? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of pending claims or circumstances","type":"table","label":"If Yes, please supply details: Date of Circumstance, Claimant, Details of Circumstance","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Previous Insurance","fields":[{"help":"If Yes, supply details","type":"yes-no","label":"Has the firm(s) previously been insured for Professional Liability insurance? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details for each previous policy","type":"table","label":"If Yes, please supply details: Renewal Date, Limit of Liability, Premium, Excess, Insurer","options":[],"required":null,"pdf_field":""},{"help":"If Yes, supply details","type":"yes-no","label":"In respect of Professional Liability insurance, has any Insurer ever declined a proposal, declined to pay a claim, refused renewal, cancelled such insurance or imposed special conditions? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Details of insurer actions","type":"text","label":"If Yes, please supply details","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declarations and Consent","fields":[{"help":"PEP means Politically Exposed Persons","type":"yes-no","label":"Are you or any of the proposal applicants a PEP* or a close relative of PEP*? (Yes/No)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of PEP status","type":"text","label":"If yes, please share the details","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Partner / Director / Principal","options":[],"required":true,"pdf_field":""},{"help":"Print name of signatory","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Name of policyholder","type":"text","label":"Policyholder","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Professional Indemnity Insurance for Media Professionals","attachments":["Additional sheets if insufficient space to answer questions","Income breakdown in the Tax Form at the back of the proposal form if income is derived from overseas offices"],"declarations":["The statements made in the proposal form are true, accurate and complete.","The proposal and declarations form the basis of the insurance contract.","The policy shall be void if any untrue or incorrect statement, misrepresentation, non-disclosure or withholding of material information is made.","Policy issuance is subject to realization of premium cheque.","Consent is given for KYC verification through specified portals.","Premiums are declared to be paid from legally acquired sources.","Consent is given to share personal information with group companies for services."],"dropped_labels":8},"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/2514-bajaj-general-professional-protect-insurance-for-media-professionals-proposal-fo"}