{"id":2522,"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.pdf","sha256":"9b6f506dc73a6558155539fd066e870d034cc86116df074f26854961407e8dc2","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 an additional sheet and attach it to the form indicating question number.","It is mandatory to keep policy updated with contact and bank details for faster service.","Use original documents for claims processing and submit additional documents on demand.","The form includes sections for proposer, agent, and witness signatures.","The policy is a 'claims made' policy covering claims made and notified during the policy period only."],"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 applicable","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":"Select the constitution type of your firm","type":"choice","label":"Constitution Details","options":["Partnership Firm","Limited Liability/Partnership Firm","NGO/NPO","Company","Trust","Society","Section 8 Company","Proprietorship Firm","Others (Please specify)"],"required":true,"pdf_field":""},{"help":"Provide registration details if applicable","type":"text","label":"Provide DARPAN Portal Registration, if applicable","options":[],"required":false,"pdf_field":""},{"help":"List all other office addresses","type":"text","label":"Please list addresses of all other offices currently trading","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","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":[],"required":true,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If \"YES\", please supply details","options":[],"required":false,"pdf_field":""},{"help":"Provide bank name","type":"text","label":"Name Of Bank","options":[],"required":true,"pdf_field":""},{"help":"Provide bank account number","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"Provide IFSC code of the bank branch","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Confirm acceptance","type":"yes-no","label":"I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":[],"required":true,"pdf_field":""},{"help":"Provide IFSC code for e-Insurance Account if applicable","type":"text","label":"Electronic-Insurance Account: IFSC Code","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you want to open e-lA account","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide PID or Policy number if existing customer","type":"text","label":"If Yes, Please provide PID No / Policy No","options":[],"required":false,"pdf_field":""},{"help":"Confirm if KYC details unchanged","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 counts of full-time staff by category","type":"number","label":"Please give details of number of permanent staff in current business: Full Time - Principal/Partners/Directors, Professionally Qualified, All Others","options":[],"required":true,"pdf_field":""},{"help":"Provide counts of part-time staff","type":"number","label":"Please give details of number of permanent staff in current business: Part Time","options":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Does the firm(s) use specialist designers, consultants or sub-contractors?","options":[],"required":true,"pdf_field":""},{"help":"Provide percentage or description","type":"text","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":"Answer Yes or No","type":"yes-no","label":"ii) Does the firm(s) insist that the specialist designers / Consultants / sub-contractors maintain their own Pl cover?","options":[],"required":false,"pdf_field":""},{"help":"Describe 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 process","type":"text","label":"iv) How does the firm(s) select and manage the specialist designers/ consultants/ subcontractors?","options":[],"required":false,"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":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Activities","fields":[{"help":"Provide income amounts 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":"Answer 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":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Are any substantial changes in the percentage amounts shown above anticipated during the next 12 months?","options":[],"required":true,"pdf_field":""},{"help":"Explain anticipated changes","type":"text","label":"If \"YES\", please provide an explanation","options":[],"required":false,"pdf_field":""},{"help":"Tick all that apply","type":"checkbox","label":"If there were a failure of any of the firm(s) products or services could this result in any: i) Loss of life or injury to others, ii) Destruction or damage to physical property, iii) Immediate and large financial loss, iv) 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 details of potential consequences","type":"text","label":"If the firm(s) have answered \"YES\" to any of the above, please provide details","options":[],"required":false,"pdf_field":""},{"help":"Provide percentage split 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":"Answer Yes or No","type":"yes-no","label":"Are any substantial changes in the percentage amounts shown above anticipated during the next 12 months?","options":[],"required":true,"pdf_field":""},{"help":"Explain anticipated changes","type":"text","label":"If \"YES\", please provide an explanation","options":[],"required":false,"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":"Answer Yes or No","type":"yes-no","label":"Does the firm(s) always use standard written contract conditions?","options":[],"required":true,"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":"Answer 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":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Does the client always sign the contract?","options":[],"required":true,"pdf_field":""},{"help":"Answer 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":[],"required":true,"pdf_field":""},{"help":"Answer 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":[],"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":"Answer Yes or No","type":"yes-no","label":"Is any employee allowed to sign cheques on his/her signature alone for values exceeding","options":[],"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 (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":""}],"filled_by":"policyholder"},{"title":"Limits of Indemnity and Policy Period","fields":[{"help":"Specify amount in INR or local currency","type":"amount","label":"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":"Specify amount if required","type":"amount","label":"Sub Limits, which form part of and are not in addition to the Limit of Liability: Emergency Costs Advancement in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Specify amount if required","type":"amount","label":"Legal Representation Costs in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Specify amount if required","type":"amount","label":"Lost Documents in the aggregate","options":[],"required":false,"pdf_field":""},{"help":"Format MM/YYYY","type":"date","label":"Policy Period: Risk Inception Date","options":[],"required":true,"pdf_field":""},{"help":"Format MM/YYYY","type":"date","label":"Risk End Date","options":[],"required":true,"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":[],"required":true,"pdf_field":""},{"help":"Provide details of loss","type":"text","label":"If \"YES\", please supply details","options":[],"required":false,"pdf_field":""},{"help":"Provide details","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":[],"required":true,"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":[],"required":true,"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":[],"required":true,"pdf_field":""},{"help":"Provide previous insurance details","type":"table","label":"If \"YES\", please supply details: Renewal Date, Limit of Liability, Premium, Excess","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":[],"required":true,"pdf_field":""},{"help":"Provide details","type":"text","label":"If \"YES\", please supply details","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declarations and Consents","fields":[{"help":"Sign and date the declaration","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":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Partner/ Director/ Principal","options":[],"required":true,"pdf_field":""},{"help":"Print your name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Declaration - Physical Proposal Form: Are you or any of the proposal applicants a PEP or a close relative of PEP?","options":[],"required":true,"pdf_field":""},{"help":"Signature of proposer","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":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Print name of witness","type":"text","label":"Name of Witness","options":[],"required":true,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"Date of witness signature","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of witness signature","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Disability Declaration: Any Physical deformity or handicap","options":[],"required":true,"pdf_field":""},{"help":"Provide details and attach certificate","type":"text","label":"If Yes, Please provide details (Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability)","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorised representative","type":"signature","label":"I, authorised representative of Mr./Miss/Mrs. ___ hereby giving consent on the behalf of the proposer due to his/her disability, that he/she has understood the content of this form and its particulars and confirmed the same","options":[],"required":false,"pdf_field":""},{"help":"Print name","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Place of signature","type":"text","label":"Place","options":[],"required":false,"pdf_field":""},{"help":"Confirm submission of documents","type":"checkbox","label":"Claim Docs: I/we hereby confirm that I/we have provided all relevant and supporting documents sought by the company, required for the issuance of the policy.","options":[],"required":true,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Agent / Intermediary Declaration","fields":[{"help":"Agent signature","type":"signature","label":"I, acting in my capacity as an Insurance Advisor/Specified Person of the Corporate Agent/Authorized Employee of the Broker/Relationship Officer, hereby declare that I have explained all the contents of this Proposal Form to the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Provide license number","type":"text","label":"IRDAI COR No./ License No.(Advisor/Corporate Agent/Broker/Relationship Officer)","options":[],"required":true,"pdf_field":""},{"help":"Agent signature","type":"signature","label":"Agent / IMD (SP/DP/ BQP) signature and their code","options":[],"required":true,"pdf_field":""},{"help":"Print name","type":"text","label":"SP/ BQP /DP/ PoS Name","options":[],"required":false,"pdf_field":""},{"help":"Provide code number","type":"text","label":"SP/ BQP /DP/ PoS CoR No.","options":[],"required":false,"pdf_field":""},{"help":"Signature","type":"signature","label":"SP/ BQP /DP/ PoS Signature","options":[],"required":false,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Professional Indemnity Insurance for Technology & Telecommunications Professionals","attachments":["Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability","Any additional sheets if insufficient space to answer questions"],"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.","Consent to verify identity/address through official registries for KYC purposes.","Declaration that premium is paid from legally acquired sources.","Consent to share personal information with group companies for insurance and related services.","Agent declares that the proposal form contents have been explained to the proposer in vernacular language.","Compliance with Insurance Act 1938 Section 41 prohibiting rebates."],"dropped_labels":22},"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/2522-bajaj-general-professional-protect-insurance-for-technology-and-telecommunicatio"}