{"id":2517,"title":"BAJAJ GENERAL PROFESSIONAL PROTECT INSURANCE POLICY ENGINEERS: 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-Engineers-Professional-Indemnity-Insurance-Proposal-Form-Commercial.pdf","sha256":"0e58158f3de7800c571ad14268f8d094e6248ccaf7588ec23fd1466fcfcd3e00","pages":14,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for professional indemnity insurance for engineers, to be filled by the policyholder (the engineering firm or individual).","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.","Use additional sheets if space is insufficient, indicating question number.","This is a claims made policy; coverage applies only to claims made and notified during the policy period.","Familiarize yourself with the standard form of policy before submitting this proposal.","The form includes a detailed questionnaire about the firm, staff, professional services, claims history, and previous insurance.","The form requires detailed financial and contract information for underwriting.","Declarations and consents must be signed and dated by an authorized partner, director or principal."],"title":"BAJAJ GENERAL PROFESSIONAL PROTECT INSURANCE POLICY ENGINEERS: 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":"Select the constitution type of the firm","type":"choice","label":"Constitution Details","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO - Provide DARPAN Portal Registration, if applicable","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":null,"pdf_field":""},{"help":"Provide DARPAN Portal Registration if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":false,"pdf_field":""},{"help":"List other business entities related to the firm","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 other offices","type":"text","label":"Please list addresses of all other offices currently trading","options":[],"required":false,"pdf_field":""},{"help":"Answer 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":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Answer 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":null,"pdf_field":""},{"help":"Provide details if above is yes","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 columns: Name, Date of Birth, Relevant Qualifications, Year became Partner/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":"List staff details with the columns: Name, Date of Birth, Relevant Qualifications, Number of Years Experience","type":"table","label":"Please give details of Staff within the Engineers Department: Name, Date of Birth, Relevant Qualifications, Number of Years Experience","options":[],"required":null,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Is cover required for the professional activities of any principal, partner or director prior to joining the business?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Provide numbers 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, Other Technical Staff, All Others","options":[],"required":null,"pdf_field":""},{"help":"Describe assistance arrangements","type":"text","label":"What arrangements do you have to assist you during your temporary absence on business, leave, sickness, or unforeseen emergency?","options":[],"required":false,"pdf_field":""},{"help":"Describe procedure to safeguard quality","type":"text","label":"If you are absent while engaged in supervision of construction what is your procedure to safeguard the quality of your work?","options":[],"required":false,"pdf_field":""},{"help":"Answer 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":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Professional Services","fields":[{"help":"Answer yes or no","type":"yes-no","label":"Has the name of the practice ever been changed?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Has any other practice or business amalgamated or merged with you?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Have you purchased any other practice or business?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Is any Partner, Principal or Director connected or associated (financially or otherwise) with any other practice or business?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Does the entity(s) or any principal, partner or director provide professional services on projects in which any Principal, Officer, Director or an immediate family member of such person retains an ownership interest of greater than 25%?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Which professional bodies or associations are the entity(s) or any principal, partner or director members of?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Provide income details in INR for each year and region","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":null,"pdf_field":""},{"help":"Provide percentage for each type of work; total must be 100%","type":"table","label":"Please detail the approximate percentage of your commission, brokerage, or insurance or other consulting fees derived from the following fields of work: Type of Work and Percentage for Architectural - New Build / Refurbishment, Architectural refurbishment - Non Structural, Structural Survey / Inspection Reports, Managing Contractor, Interior Designing, Estate Agency, Landscaping, Civil Engineering, Structural Engineering, Mechanical Engineering, Electrical Engineering, Heating & Ventilating/Air Conditioning Engineering, Nuclear Engineering, Chemical Engineering, Soil Engineering, Project Co-ordination, Project Management, Adjudication / Arbitration, Town Planning, Expert Witness, Feasibility, Fees Paid to Sub-consultants, Surveying - Land, Surveying - Quantity, Surveying – Building, Others (please specify)","options":[],"required":null,"pdf_field":""},{"help":"Provide percentage for each field of work; total must be 100%","type":"table","label":"Please detail the approximate percentage of your total work in the following areas: Field of Work and Percentage for Individual Dwellings, Low Rise Buildings (up to 7 floors), High Rise Buildings (above 7 floors), Modular Dwellings, Office / retail / mixed use, Highways, Bridges, Tunnels and Dams, Railways, Airports - Non safety/ Airside/ Trackside related, Harbours and Jetties - Non structural, Sewage/ Water Schemes, Power Plants, Manufacturing Plants, Refineries and Petro Chemical - non safety, Mechanical Plant, Bulk Handling Equip, Industrial System Build, Low key Healthcare (doctors surgeries / Nursing Home etc), Other Healthcare (Hospitals etc), Primary Schools / Adult education Centres, Secondary Schools / College / Universities, Hotels and Recreation exc. Swimming pools, Leisure inc. Swimming Pools, Landscape ex. Sports/Golf course design, Ecclesiastical / Theatres, Others (please specify)","options":[],"required":null,"pdf_field":""},{"help":"List details for five largest contracts","type":"table","label":"Please provide brief description, location, contract value and fees for the five (5) largest contracts undertaken over the past five (5) years: Brief Description, Location, Contract Value (INR), Your Fees (INR)","options":[],"required":null,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Does any contract or client represent more than 50% of your annual work or fees?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Do you use any independent sub-contractors?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Do you require them to carry a minimum level of professional liability cover?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Provide percentage","type":"text","label":"What percentage of your professional service is subcontracted to others?","options":[],"required":false,"pdf_field":""},{"help":"Describe types of subcontracted services","type":"text","label":"What kinds of services are subcontracted?","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Do you execute a written contract, agreement or engagement letter for services with every client?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Are these client contracts reviewed by a law firm experienced in your profession?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Describe review and approval process","type":"text","label":"If no, how do you review and approve client contracts?","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Do these client contracts contain: Specific description of services that you provide?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Guarantees or warranties of your services?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Limitation of your liability to your clients?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Hold harmless or indemnity agreements to your benefit?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Hold harmless or indemnity agreements to your client’s benefit?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Disclosure of actual or potential conflicts of interest?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Are all changes to your contracts, verbal reports or advice confirmed in writing?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Describe substantiation method","type":"text","label":"If No, how do you substantiate such changes, verbal reports or advice?","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Do you engage in any actual construction or manufacturing?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Answer yes or no","type":"yes-no","label":"Do you envisage any substantial changes in your activities or are there any major new operations contemplated during the next 12 months?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"List details for three largest upcoming projects","type":"table","label":"Please give details of the three largest projects where construction is likely to commence in the coming 12 months: Name of Client, Total Contract Value (INR), Your Fee (INR), Your Service (INR), Expected Completion Date","options":[],"required":false,"pdf_field":""},{"help":"Provide largest annual fee details","type":"text","label":"Please provide the amount of the largest annual fee for any one client: Client name, Year, Gross Fees (INR)","options":[],"required":false,"pdf_field":""},{"help":"Specify indemnity limits in INR","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 in the aggregate, Legal Representation Costs in the aggregate, Lost Documents in the aggregate","options":[],"required":null,"pdf_field":""},{"help":"Specify policy start and end dates","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":"Answer 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":null,"pdf_field":""},{"help":"Provide details of fraud or dishonesty loss","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Answer 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":null,"pdf_field":""},{"help":"Provide details of allegation or occurrence","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""},{"help":"Answer 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":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":false,"pdf_field":""},{"help":"Answer 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":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":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Previous Insurance","fields":[{"help":"Answer yes or no","type":"yes-no","label":"Has the firm(s) previously been insured for Professional Liability insurance?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide previous insurance details","type":"table","label":"If “YES”, please supply details: Renewal Date, Limit of Liability, Premium, Excess, Insurer","options":[],"required":false,"pdf_field":""},{"help":"Answer 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":null,"pdf_field":""},{"help":"Provide details if above is yes","type":"text","label":"If “YES”, please supply details","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declarations and Consent","fields":[{"help":"PEP means Politically Exposed Persons as defined","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":null,"pdf_field":""},{"help":"Consent for KYC verification","type":"checkbox","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":null,"pdf_field":""},{"help":"Declaration of legal source of premium","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":["Yes","No"],"required":null,"pdf_field":""},{"help":"Consent to share personal information","type":"checkbox","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":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Signature of authorized person","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":""},{"help":"Name of policyholder","type":"text","label":"Policyholder","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":[],"applies_to":"Engineers Professional Indemnity Insurance","attachments":["If there is insufficient space to answer questions, please use an additional sheet and attach it to this form (please indicate question number)."],"declarations":["The statements made in this proposal form are true, accurate and complete and form the basis of the insurance contract.","The policy shall be void if any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material particular is made.","The policy issuance is subject to realization of premium cheque.","No person shall allow or offer any rebate of the premium except as allowed by the insurer's published prospectus or tables.","Consent is given for KYC verification through specified portals.","Premiums are declared to be paid from legally acquired sources.","Consent is given for sharing personal information with group companies subject to privacy policies."],"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/2517-bajaj-general-professional-protect-insurance-policy-engineers-proposal-form"}