{"id":2516,"title":"Bajaj General Professional Protect Insurance Policy Miscellaneous Professional Indemnity 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-pw/Professional-Protect-Insurance-Policy-Miscellaneous-Proposal-Form-Commercial.pdf","sha256":"8c5f1b4d811ced53706a951570d6cba97adf310deff23d85f8c5571d7e6bc33c","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for professional indemnity insurance to be filled by the applicant seeking coverage for their professional services.","notes":["If the applicant is less than three years old, attach resumes or biographies of all principals.","Attach samples of service agreements and brochures if applicable.","Attach sample contracts if the applicant assumes liability for others.","Use original and truthful information; any changes must be reported before policy issuance.","Signatures of authorized representative and executive officer are mandatory.","The form includes a declaration about prohibition of rebates under Insurance Act 1938 Section 41.","PEP status must be declared and details provided if applicable."],"title":"Bajaj General Professional Protect Insurance Policy Miscellaneous Professional Indemnity Insurance Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Applicant Information","fields":[{"help":"","type":"text","label":"Name of Applicant:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of Applicant’s principal or registered office:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Web site address of Applicant (if applicable):","options":[],"required":false,"pdf_field":""},{"help":"Select the constitution type and explain if 'Other'.","type":"choice","label":"Is the Applicant a:\n• Sole Proprietor\n• Partnership\n• Private Company\n• Publicly traded Corporation\n• Other (Explain):","options":["Sole Proprietor","Partnership","Private Company","Publicly traded Corporation","Other"],"required":null,"pdf_field":""},{"help":"If less than three (3) years, attach resumes or biographies of all principals.","type":"number","label":"Year Established:","options":[],"required":null,"pdf_field":""},{"help":"Only services listed on the policy as Professional Services will be covered.","type":"text","label":"Professional Services:\nPlease describe in detail the professional services that the Applicant provides for which coverage is required, including services offered by subsidiaries:","options":[],"required":null,"pdf_field":""},{"help":"Provide revenue and number of clients for U.S./Canada, OECD countries, Non OECD, and India for previous, current, and projected next year.","type":"table","label":"Annual Gross Revenue derived from the professional services described in response to question 5:","options":[],"required":null,"pdf_field":""}],"filled_by":"applicant"},{"title":"Applicant 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 if applicable.","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"Other Business Ownership and Regulatory Details","fields":[{"help":"","type":"yes-no","label":"Does the Applicant wholly or partially own, operate, manage or control any other business and for which coverage is requested?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of other businesses owned or controlled.","type":"text","label":"If yes, provide details below: NAME, LOCATION, OWNERSHIP, BUSINESS","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Does any regulatory authority license the Applicant?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"List all applicable regulatory authorities.","type":"text","label":"If yes, please list the regulatory authority (ies):","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the Applicant been involved in any mergers, acquisitions or consolidations in the past five (5) years?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of mergers, acquisitions or consolidations.","type":"text","label":"If yes, please provide full details.","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the Applicant presently involved in or considering any merger, acquisition or change in control?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of current or planned mergers or acquisitions.","type":"text","label":"If yes, please provide full details.","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has the Applicant changed its name in the past five (5) years?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide previous names and details of name changes.","type":"text","label":"If yes, please provide full details.","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"In the next eighteen (18) months, does the Applicant anticipate any changes in the nature of the professional services described in response to question 5?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Describe anticipated changes in professional services.","type":"text","label":"If yes, please provide full details.","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"Professional Services Details","fields":[{"help":"","type":"yes-no","label":"a. Are contract fees negotiated and agreed to in advance?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach a sample service agreement if yes.","type":"yes-no","label":"b. Are written service agreements required for all clients? (If Yes, attach a sample).","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"c. Have the written service agreements been reviewed by a law firm experienced in the Applicant's field?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"d. Are all changes to service agreements confirmed in writing?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"e. Does the Applicant provide warranties or guarantees?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach a brochure sample if yes.","type":"yes-no","label":"f. Does the Applicant describe services in a brochure? (If Yes, attach a sample).","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"g. Is there a formal procedure for handling client complaints?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"ADR means Alternative Dispute Resolution.","type":"yes-no","label":"h. Is ADR or mediation to resolve complaints part of the service Agreement?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"i. Are audits or reviews of service performed by employees conducted?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify frequency of audits or reviews.","type":"choice","label":"j. How often? Annually ___ Semi-Annually ___ Quarterly ___ Other","options":["Annually","Semi-Annually","Quarterly","Other"],"required":null,"pdf_field":""},{"help":"Attach sample contract if yes.","type":"yes-no","label":"k. Does the Applicant ever assume liability for others by contract? (If yes, please attach a sample contract)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes, specify the licenses or certifications.","type":"yes-no","label":"l. Do employees hold professional licenses or certification? If Yes, please identify –","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"m. Does the Applicant pay for continuing education to maintain such professional licenses or certification?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"n. Are there formal criteria for accepting new clients?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"o. Is there a formal policy for conflict of interest?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"p. Is there a formal policy for client confidentiality?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach description if yes.","type":"yes-no","label":"q. Does the Applicant engage in any other professional activities not listed in question 5 above? (If Yes, attach description or explanation.)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"applicant"},{"title":"Attachments","fields":[{"help":"","type":"attachment","label":"Latest audited annual report & accounts","options":[],"required":false,"pdf_field":""},{"help":"","type":"attachment","label":"Latest interim report & accounts","options":[],"required":false,"pdf_field":""},{"help":"","type":"attachment","label":"Brochures describing services or products offered","options":[],"required":false,"pdf_field":""},{"help":"","type":"attachment","label":"Sample service agreements","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"Prior Knowledge / Warranty","fields":[{"help":"Provide details if yes.","type":"yes-no","label":"a) Has the Applicant, any partner, officer, director, or employee for whom coverage is being requested, ever been censored, fined, or had a professional license suspended or revoked? (If yes, provide details.)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if yes.","type":"yes-no","label":"b) Does the Applicant, any partner, officer, director, or employee for whom coverage is being requested, know of any circumstances, acts, errors or omissions that could result in a professional liability claim against the Applicant, or any past or present partner, officer, director, or employee? (If yes, provide details.)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if yes.","type":"yes-no","label":"c) Has any professional liability claim ever been made against the Applicant or any past or present partner, officer, director, or employee? (If yes, provide details.)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if yes.","type":"yes-no","label":"d) Has the Applicant or any of its predecessor organisations in business or any partner, officer, director, or employee for whom coverage is being requested ever had any insurer cancel, refuse to renew or accept only on special terms any professional liability insurance? (If yes, provide details.)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"applicant"},{"title":"Prior Insurance","fields":[{"help":"","type":"yes-no","label":"Do you currently purchase professional liability coverage?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If yes, please list: Current Insurer:","options":[],"required":false,"pdf_field":""},{"help":"Policy term dates.","type":"text","label":"Term:","options":[],"required":false,"pdf_field":""},{"help":"Coverage limit amount.","type":"amount","label":"Limit:","options":[],"required":false,"pdf_field":""},{"help":"Deductible amount.","type":"amount","label":"Deductible","options":[],"required":false,"pdf_field":""},{"help":"Premium amount paid.","type":"amount","label":"Premium:","options":[],"required":false,"pdf_field":""},{"help":"Date from which coverage is effective retroactively.","type":"date","label":"Retroactive date:","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"Signature and Agreements","fields":[{"help":"Sign and provide title.","type":"signature","label":"Signature of Authorized Representative & Title","options":[],"required":true,"pdf_field":""},{"help":"Date of signature.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign and provide title.","type":"signature","label":"Signature of an executive Officer of the Applicant & title","options":[],"required":true,"pdf_field":""},{"help":"Date of signature.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"applicant"},{"title":"Politically Exposed Persons (PEP) Declaration and Consent","fields":[{"help":"PEP means individuals with prominent public functions in foreign countries.","type":"choice","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 if yes.","type":"text","label":"If yes, please share the details","options":[],"required":false,"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 payment.","type":"checkbox","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":[],"required":true,"pdf_field":""},{"help":"Consent for sharing personal information.","type":"choice","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. Yes / No","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"applicant"}],"deadlines":[],"applies_to":"Miscellaneous Professional Indemnity Insurance","attachments":["resumes or biographies of all principals (if established less than 3 years)","sample written service agreements (if applicable)","brochures describing services or products offered (if applicable)","sample contracts (if applicant assumes liability for others)","latest audited annual report & accounts","latest interim report & accounts"],"declarations":["The statements in this application and attachments are true and complete to the best of the applicant's knowledge after reasonable inquiry.","Signing this application does not obligate the company to issue insurance but forms the basis for policy issuance.","Any material changes before policy effective date must be notified to the company.","Limits of liability include payment of claims and defense expenses as defined in the policy.","Defense costs may exhaust the limits of liability and deductibles apply to investigation, defense, and indemnity costs.","No coverage applies to claims based on facts or circumstances disclosed in prior knowledge questions 15(a), (b), or (c).","Premiums must be paid from legally acquired sources.","Consent is given for KYC verification and sharing of personal information as per privacy policies.","Rebates on commission or premium are prohibited under Insurance Act 1938 Section 41."],"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/2516-bajaj-general-professional-protect-insurance-policy-miscellaneous-professional-i"}