{"id":2515,"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-Retail.pdf","sha256":"adfcfbf736cf18ac87aecc74b536c860468684958e958f165a339f7e3c6bf95a","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.","Completion and signature of this proposal form does not bind the proposer or insurer to complete a contract.","If insufficient space, use additional sheets 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.","Use original documents where required.","Certified that the contents of the proposal form have been fully explained to the proposer."],"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":true,"pdf_field":""},{"help":"Full address including street, city, state, and postal code","type":"text","label":"Address of Principal Office","options":[],"required":true,"pdf_field":""},{"help":"Date when the firm was established","type":"date","label":"Date of Establishment","options":[],"required":true,"pdf_field":""},{"help":"Official website URL","type":"text","label":"Website Address","options":[],"required":false,"pdf_field":""},{"help":"List all related business entities with relevant 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":false,"pdf_field":""},{"help":"Provide addresses of all other operational offices","type":"text","label":"Please list addresses of all other offices currently trading","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","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?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","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)?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Staff and Partners","fields":[{"help":"List each principal, partner or director with the requested details","type":"table","label":"Please give details of any principal, partners or directors: Name, Date of Birth, Relevant Qualifications, Year became Partner/Director","options":[],"required":true,"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":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) use specialist designers, consultants or sub-contractors?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"If “YES”, please answer the following: (i) Please state what proportion of the firm(s) business involves the subcontracting of work to others?","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"(ii) Does the firm(s) insist that the specialist designers / Consultants / sub-contractors maintain their own PI cover?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Describe the services","type":"text","label":"(iii) What services does the firm(s) use the specialist designers/ consultants/ sub-contractors for?","options":[],"required":false,"pdf_field":""},{"help":"Describe selection and management procedures","type":"text","label":"(iv) How does the firm(s) select and manage the specialist designers/ consultants/ sub-contractors?","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Professional Services","fields":[{"help":"Provide income amounts in INR for each year and category","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","options":[],"required":true,"pdf_field":""},{"help":"Enter 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 – Radio, etc.)","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the work split above represent the make up of the firm(s) over the past three years?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are any substantial changes in the percentage amounts shown above anticipated during the next 12 months?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Explain anticipated changes","type":"text","label":"If “YES”, please provide an explanation","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Broadcasting Section","fields":[{"help":"Enter 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":true,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"What percentage of your broadcasts are via the Internet?","options":[],"required":true,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"What is the percentage of programmes produced by a third party?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are all News broadcasts sourced from a third party?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) ensure that a delay device is used for all live/ unscripted broadcasts?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) always refer potentially contentious material to lawyers prior to broadcasting?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Publishing Section","fields":[{"help":"Enter 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":true,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"What percentage (approximately) of your turnover comes from advertising revenue?","options":[],"required":true,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"What percentage of your turnover comes from contract publishing?","options":[],"required":true,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"What percentage of your publications are via the Internet?","options":[],"required":true,"pdf_field":""},{"help":"Select who reviews publications","type":"choice","label":"Confirmation publications are reviewed by","options":["Outside lawyers","In-House lawyers","Other (please specify)"],"required":true,"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":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) have procedures in place for checking the accuracy, originality and content of work – including title clearance?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) have procedures in place to ensure all intellectual property rights have been acquired prior to publication?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) always refer potentially contentious material to lawyers prior to publication?","options":["YES","NO"],"required":true,"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":true,"pdf_field":""},{"help":"Select Yes or No","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","options":["YES","NO"],"required":true,"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":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) always obtain final client sign off before going to print?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) engage in the design of logos or trade marks?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Describe procedures","type":"text","label":"If “YES”, please explain procedures in place to prevent any intellectual property infringement","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) engage in the distribution and/or redemption of coupons, rebates or other promotional games tickets?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are any substantial changes in the percentage amounts shown above anticipated during the next 12 months?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Explain anticipated changes","type":"text","label":"If “YES”, please provide an explanation","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Risk Management","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) always use standard written contract conditions?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"If “NO”: (i) What percentage of contracts are in the non-standard form?","options":[],"required":false,"pdf_field":""},{"help":"Describe procedures","type":"text","label":"(ii) What are the procedures for the sign-off / approval of a non-standard contract?","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"In respect of all contracts the firm(s) enters into, do they always include: (i) an outline of the scope of services to be provided?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"(ii) Limitation of liabilities?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"(iii) Direct, Consequential and Economic Loss Exclusion?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"(v) Force Majeure?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"(vi) Guarantees?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"(vii) Warranty Disclaimers?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"(viii) Hold Harmless Agreement?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"(ix) Arbitration Agreement?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the client always sign the contract?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) have standard procedures for the regular review of ongoing contracts internally and with the client?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Does the firm(s) provide advice or services which fall outside of the scope of the contract?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select one option","type":"choice","label":"Does the firm always require satisfactory references or only when engaging senior employees?","options":["Always","Senior appointments only"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is any employee allowed to sign cheques on his/her signature alone for values exceeding?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Select frequency or 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 (including the balance of cash and unpresented cheques), independently of employees receiving or banking monies in respect of monies belonging to the firm as well as in trust on behalf of others?","options":["Weekly","Monthly","Quarterly","Other (please specify)"],"required":true,"pdf_field":""},{"help":"Enter amount in INR","type":"amount","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)","options":[],"required":true,"pdf_field":""},{"help":"Enter amount in INR","type":"amount","label":"Sub Limits, which form part of and are not in addition to the Limit of Liability in Item: a) Emergency Costs Advancement in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in INR","type":"amount","label":"b) Legal Representation Costs in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in INR","type":"amount","label":"c) Lost Documents in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Enter start date of policy","type":"date","label":"Policy Period : Risk Inception Date","options":[],"required":true,"pdf_field":""},{"help":"Enter end date of policy","type":"date","label":"Risk End Date","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Claims Information","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Has the firm(s) sustained any loss through the fraud or dishonesty of any person?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details of loss","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","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?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details of allegation or occurrence","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","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?","options":["YES","NO"],"required":true,"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":false,"pdf_field":""},{"help":"Select Yes or No","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?","options":["YES","NO"],"required":true,"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":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Previous Insurance","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Has the firm(s) previously been insured for Professional Liability insurance?","options":["YES","NO"],"required":true,"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":false,"pdf_field":""},{"help":"Select Yes or No","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?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details of insurer actions","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declarations and Consent","fields":[{"help":"Politically Exposed Persons status","type":"choice","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":""},{"help":"Consent for KYC verification","type":"yes-no","label":"I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through CERSAI records or National Securities Depository Limited Portal for the purpose of undertaking KYC verification.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Declaration of legal source of premium","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":"Consent for sharing personal information","type":"yes-no","label":"I/We hereby give voluntary consent to Bajaj General/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, to be used in accordance with their respective privacy policies and subject to appropriate measures being in place to safeguard my/our personal information","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Signature of authorized signatory","type":"signature","label":"Signature of Partner / Director / Principal","options":[],"required":true,"pdf_field":""},{"help":"Name of signatory","type":"text","label":"Name","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Professional Indemnity Insurance for Media Professionals","attachments":["Additional sheets if there is 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-description or non-disclosure is made.","Policy issuance is subject to realization of premium cheque.","Consent to KYC verification and sharing of personal information as per privacy policies.","Premiums are paid from legally acquired sources."],"dropped_labels":3},"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/2515-bajaj-general-professional-protect-insurance-for-media-professionals-proposal-fo"}