{"id":2521,"title":"BAJAJ GENERAL PROFESSIONAL PROTECT INSURANCE FOR TECHNOLOGY & TELECOMMUNICATIONS PROFESSIONAL: PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/Proposal-Form-Technology-and-Telecommunication-rp.pdf","sha256":"f849d7aaee75d3bb3179f0a377b98c82451bfaece0e5a53fe52541175bd28314","pages":12,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for professional indemnity insurance for technology and telecommunications professionals. It is filled by the policyholder or proposer seeking insurance coverage.","notes":["All questions must be answered to enable a quotation to be given.","If there is insufficient space to answer questions, use additional sheets and attach them indicating question number.","Use original and relevant supporting documents for policy issuance and claims.","Keep policy updated with contact and bank details for faster service requests.","The form includes sections for proposer, agent, and authorised representative signatures where applicable."],"title":"BAJAJ GENERAL PROFESSIONAL PROTECT INSURANCE FOR TECHNOLOGY & TELECOMMUNICATIONS PROFESSIONAL: 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":"","type":"text","label":"Address of Principal Office","options":[],"required":true,"pdf_field":""},{"help":"Format: DD/MM/YYYY or as per form","type":"date","label":"Date of Establishment","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Website Address","options":[],"required":false,"pdf_field":""},{"help":"List all entities with years of establishment and cessation if applicable","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":"List all office addresses","type":"text","label":"Please list addresses of all other offices currently trading","options":[],"required":false,"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)?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"checkbox","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":[],"required":true,"pdf_field":""},{"help":"Provide e-lA number if applicable","type":"text","label":"Electronic-Insurance Account: IFSC Code, Please provide e-lA No. to deposit your insurance policy","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Do you want to open e-lA account: Yes/No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"I hereby confirm that, there is no change in my existing KYC details that are available from my previous/existing policy.","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Staff and Partners","fields":[{"help":"Provide 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":true,"pdf_field":""},{"help":"Provide number of staff in each category","type":"number","label":"Please give details of number of permanent staff in current business: Full Time - Principal/Partners/Directors, Professionally Qualified, All Others; Part Time","options":[],"required":true,"pdf_field":""},{"help":"If YES, answer following questions","type":"yes-no","label":"Does the firm(s) use specialist designers, consultants or sub-contractors?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the firm(s) insist that the specialist designers / Consultants / sub-contractors maintain their own Pl cover?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"What services does the firm(s) use the specialist designers/ consultants/ sub-contractors for?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"How does the firm(s) select and manage the specialist designers/ consultants/ subcontractors?","options":[],"required":false,"pdf_field":""},{"help":"If YES, please answer the following","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":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Activities","fields":[{"help":"Provide income 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, In USA/Canada or elsewhere for clients whose domiciled address is in USA/Canada","options":[],"required":true,"pdf_field":""},{"help":"List activities and percentage of total work","type":"table","label":"Please categorise the activities of your firm(s) and state the approximate percentage of the total work carried out in each instance","options":[],"required":true,"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?","options":["YES","NO"],"required":true,"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?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If YES to any, provide details","type":"checkbox","label":"If there were a failure of any of the firm(s) products or services could this result in any: Loss of life or injury to others, Destruction or damage to physical property, Immediate and large financial loss, Significant cumulative financial loss","options":["Loss of life or injury to others","Destruction or damage to physical property","Immediate and large financial loss","Significant cumulative financial loss"],"required":true,"pdf_field":""},{"help":"Provide percentage for each sector","type":"table","label":"Please split the firm(s) business between the following market sectors: Government, Finance, Manufacturing/Industrial, Commercial, Construction/Engineering, Aerospace, Retail, Rail, Healthcare / Medical, Other","options":[],"required":true,"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?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details for each contract","type":"table","label":"Please give details of the 5 largest contracts undertaken in the past 3 years or for a new practice, in the forthcoming year: Name of Client, Business Nature of Client, Total Contract Value INR, Income to You INR","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Risk Management","fields":[{"help":"If NO, answer following questions","type":"yes-no","label":"Does the firm(s) always use standard written contract conditions?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"What are the procedures for the sign-off / approval of a non-standard contract?","options":[],"required":false,"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?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Limitation of liabilities?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Direct, Consequential and Economic Loss Exclusion?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Indirect, Consequential and Economic Loss Exclusion?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Force Majeure?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Guarantees?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Warranty Disclaimers?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Hold Harmless Agreement?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Arbitration Agreement?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Does the client always sign the contract?","options":["YES","NO"],"required":true,"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?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","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":"","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":"Specify amount if applicable","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","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?","options":["Weekly","Monthly","Quarterly","Other (please specify)"],"required":true,"pdf_field":""},{"help":"Provide amounts in INR or local currency","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":true,"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?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If YES, supply details including Date of Claimant, Details of Claim including any payments made or reserves held","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":"If YES, supply details including Date of Circumstance, Claimant, Details of Circumstance","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":""}],"filled_by":"policyholder"},{"title":"Previous Insurance","fields":[{"help":"If YES, supply details: Renewal Date, Limit of Liability, Premium, Excess","type":"yes-no","label":"Has the firm(s) previously been insured for Professional Liability insurance?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If YES, supply details including Insurer","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":""}],"filled_by":"policyholder"},{"title":"Declarations and Consent","fields":[{"help":"Sign and date the form","type":"signature","label":"Declaration: I/We, the undersigned hereby declare and warrant that the above statements are true, accurate and complete...","options":[],"required":true,"pdf_field":""},{"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?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Signature of proposer, date, place, name and signature of witness","type":"signature","label":"Declaration: The content of this form and its particulars have been explained by me in vernacular to the proposer who has understood and confirmed the same","options":[],"required":true,"pdf_field":""},{"help":"If Yes, provide details and disability certificate","type":"yes-no","label":"Disability Declaration: Any Physical deformity or handicap","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Agent / Intermediary Declaration","fields":[{"help":"Agent/IMD name, code, signature; SP/BQP/DP/PoS name, CoR No., signature","type":"signature","label":"Agent / IMD (SP/DP/ BQP) signature and their code","options":[],"required":true,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Professional Indemnity Insurance for Technology & Telecommunications Professionals","attachments":["Additional sheets if insufficient space to answer questions","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability (if applicable)","Relevant and supporting documents sought by the company for policy issuance and claims processing"],"declarations":["The statements made in the 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-disclosure or withholding of material information is found.","Issuance of policy is subject to realization of premium cheque.","No rebate of commission or premium is allowed except as per published prospectus or tables of the insurer.","Consent is given to verify identity/address through official registries for KYC purposes.","Premiums are paid from legally acquired sources of income.","Consent is given to share personal information with group companies or others for insurance related services.","The contents of the form have been explained to the proposer in vernacular and understood.","Agent declares that the proposal form contents have been explained to the proposer and that untrue statements or non-disclosure may lead to policy variation or cancellation."],"dropped_labels":15},"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/2521-bajaj-general-professional-protect-insurance-for-technology-and-telecommunicatio"}