{"id":2527,"title":"Investment Management Insurance Policy Proposal Form","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/Investment-Management-Insurance-Policy-Proposal-Form.pdf","sha256":"db5665559c474e2dc8dde9482b648984ae34759daf30d1e33cc5b922539814f3","pages":14,"collected":"2026-10-17","instructions":{"about":"This form is used by investment managers or their representatives to apply for an Investment Management Insurance Policy with Bajaj General Insurance Limited. The proposer fills this form to provide detailed information about their business, risk management, cyber security, claims history, and insurance requirements.","notes":["Read the Prospectus, Key Features Document, and Policy Wordings before completing the form.","The insurance coverage starts only after acceptance of the proposal and payment of premium.","Answer all questions fully and accurately; attach separate sheets if needed.","Use block letters and provide original documents where required.","Keep policy contact details updated for faster service.","Politically Exposed Persons (PEPs) must be declared with details.","Consent for KYC verification is mandatory.","Premium must be paid from legally acquired sources."],"title":"Investment Management Insurance Policy Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Full Name of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Full Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Mailing Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Corporate Address","options":[],"required":null,"pdf_field":""},{"help":"Provide telephone numbers including country and area codes if applicable","type":"phone","label":"Tel. Nos.","options":[],"required":null,"pdf_field":""},{"help":"Provide a valid email address","type":"email","label":"E-mail ID:","options":[],"required":null,"pdf_field":""},{"help":"Provide PAN or TAN number as applicable","type":"text","label":"PAN/TAN No.","options":[],"required":null,"pdf_field":""},{"help":"Provide bank details if applicable","type":"text","label":"Bank Details","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please provide details, if any Financial Institution is involved","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"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 type if applicable","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"General Information","fields":[{"help":"","type":"text","label":"(a) Name of Investment Manager","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"(b) Address of Principal Office","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY or as applicable","type":"date","label":"(c) Date of Establishment","options":[],"required":null,"pdf_field":""},{"help":"Provide website URL if available","type":"text","label":"(d) Website address","options":[],"required":false,"pdf_field":""},{"help":"Briefly describe the investment management activities","type":"text","label":"Please provide a general description of your activities","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section A: Investment Manager Information","fields":[{"help":"","type":"yes-no","label":"Is the investment manager authorised and regulated by the Financial Conduct Authority?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the investment manager authorised and regulated by any other regulator?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"List other regulators if applicable","type":"text","label":"If YES, please name the regulators","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the investment manager an Alternative Investment Fund Manager (AIFM) as regulated under the Alternative Investment Fund Managers Directive (AIFMD)?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Can you confirm that the investment manager and all of its subsidiaries: (a) Are registered in the United Kingdom?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(b) Are not listed on any stock exchange or any other form of securities market?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(c) Are not contemplating a share offering or rights issue in the next 12 months?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(d) Have not sold any part of the company in the last 12 months?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(e) Have not made any acquisitions in the last 12 months?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(f) Do not anticipate making any acquisitions or disposals in the next 12 months?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(g) Have not had any board directors leave the company in the last 12 months?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide explanations for any NO answers above","type":"text","label":"If you have answered NO to any of the questions above, please give details here","options":[],"required":false,"pdf_field":""},{"help":"Fill in number of individuals for each position category","type":"table","label":"Please complete the table below in respect to staff numbers: Positions and Number of Individuals (Executive Board, Investment professionals, Administration and back-office functions, Legal, compliance and internal audit, Others, Total)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section B: Fund Details","fields":[{"help":"List each fund or mandate with details in columns","type":"table","label":"Please provide a list of the funds and investment mandates requiring insurance: Fund Names or Investment Mandates, Date of Establishment, Funds under Management, Country of Registration, Investment Strategy","options":[],"required":true,"pdf_field":""},{"help":"Provide percentage split by location for each year","type":"table","label":"Please provide a geographical split (by FUM) of the investors across all funds combined: Locations and % for Past Year, Current Year, Next Year (est.)","options":[],"required":true,"pdf_field":""},{"help":"List countries exceeding 20% investor proportion","type":"text","label":"Please list any other countries with a larger than 20% proportion of total investors","options":[],"required":false,"pdf_field":""},{"help":"Fill revenue details by type and year","type":"table","label":"Please provide your revenues for all funds combined: Type, Currency, Past Year, Current Year (est.), Next year (est.) for Management fees, Performance income, Total","options":[],"required":true,"pdf_field":""},{"help":"Provide percentage for each investor type; total must be 100%","type":"table","label":"Please give a breakdown of the type of investor across all funds: Type of Investor and Percentage (%) of Funds under Management","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(b) No fund has had redemptions of more than 30% of total fund value in the past 12 months?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(c) No fund has ever implemented any redemption gates or suspended redemptions?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(d) No fund had a reduction of greater than 50% of its NAV in the past 12 months?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(e) No fund was liquidated or restructured in the past 12 months?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(f) No fund is likely to be liquidated or restructured in the next 12 months?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(g) No loan covenant has been breached, no lines of credit withdrawn, and no credit facilities has been materially altered for a fund or for any of its portfolio companies?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain any NO answers above","type":"text","label":"If you have answered NO to any of the questions above, please give details here","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you hold positions on the boards of companies in which the fund invests in?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"List companies where board positions are held","type":"text","label":"If you have answered YES, please list the companies below","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"If YES, do you insist that such companies purchase directors & officers insurance?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you outsource any administration, mid-office, back office, custodial or compliance functions to independent third parties?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of outsourced functions","type":"text","label":"If you have answered YES, please provide details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section C: Risk Management Information","fields":[{"help":"","type":"yes-no","label":"Do you have adequate procedures to ensure that: (a) There is a formal due diligence and approval process when selecting new investments and/or altering the investment strategy of a fund?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(b) Incorrect and unauthorised trades are quickly identifiable and rectified?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(c) Investment restrictions and trading limits are complied with and that breaches are promptly identifiable and rectified?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(d) Only authorised investment personnel are able to trade on the systems and that the systems will prevent trades in excess of pre-authorised personal trading limits?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(e) Deals may only be made via approved counterparties?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(f) Counterparties receive authorised confirmation for all trades prior to any settlement?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(g) The accounting, back office and custodial responsibilities are segregated away from the investment professionals?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain any NO answers above","type":"text","label":"If you have answered NO to any of the questions above, please give details here","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Can you confirm the following best practices and minimum security standards are in place: (a) Background checks are performed on all new employees?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(b) Staff education and monitoring procedures to avoid breaches of money laundering, sanctions, insider trading, conflicts of interest and bribery regulations?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(c) Bank accounts are reconciled at least weekly?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(d) The computer systems require passwords for access and restrict users from performing functions that they are not authorised to perform?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(e) All staff receive training to identify and prevent social engineering frauds (eg phishing)?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(f) Staff are required to follow a rigorous process to establish the authenticity of new client/customers and of any request to change personal details of current clients/customers?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(g) Investment redemption payments are only made to bank accounts from which the original investment came?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(h) All payment requests for services or other purchases that exceed £10,000 require rigorous checks, including approval of a senior manager and contact with the seller by a different means of communication to ensure the payment request and all details are genuine?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain any NO answers above","type":"text","label":"If you have answered NO to any of the above, please provide details below with mitigating comments and any additional information regarding internal risk management procedures.","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Can you confirm an internal or external audit team performs independent checks at least annually on: (a) Segregation of duties?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(b) Performance reporting to investors?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(c) Staff training?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(d) Adequacy of IT systems?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(e) Level of investment professionals’ authority?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(f) Managerial oversight?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain any NO answers above","type":"text","label":"If you have answered NO to any of the above, please provide details below with mitigating comments and any additional information regarding your audit function","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Have all material recommendations from the last annual audit been implemented?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain any outstanding audit recommendations","type":"text","label":"If you have answered NO, please provide details below on any outstanding material recommendations that have not been implemented with mitigating comments and any additional information.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section D: Cyber Security","fields":[{"help":"Provide number of PII or unique investor records","type":"number","label":"(a) How many personally identifiable information (PII) records or unique investor records do the investment manager and the funds currently hold (including employees)?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"(b) Does the manager or funds hold or process any of the following types of sensitive data of investors? (i) Names, addresses and/or telephone numbers","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(ii) Identity information (eg NI numbers, passport, identity card numbers)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(ii) Banking details (including credit and debit card records)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(a) Do you have a disaster recovery plan (DRP) &/or business continuity plan (BCP) in place?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide estimated recovery time","type":"text","label":"(b) In your DRP / BCP, how long would it take for you to be fully operational again following an incident?","options":[],"required":false,"pdf_field":""},{"help":"Provide frequency of testing","type":"text","label":"(c) How often do you test your DRP / BCP?","options":[],"required":false,"pdf_field":""},{"help":"List vendors or mark as in-house for each service","type":"table","label":"Please provide details of the vendors for the following services (or check box if it is managed and operated in-house): Internet service provider, Cloud/hosting/data centre provider, Payment processing, Data or information processing (such as marketing or payroll), Offsite archiving, backup and storage","options":["In-house"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Can you confirm the company adheres to the following best practices and minimum security standards: (a) Have a dedicated individual responsible for information security and privacy?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(b) Have a written incident management response plan?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(c) Perform background checks on all employees and contractors with access to sensitive data?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(d) Have restricted access to sensitive data (including physical records)?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(e) Have a process to delete systems access within 48 hours after employee termination?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(f) Have written information security policies and procedures that are reviewed annually and communicated to all employees including information security awareness training?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(g) Ensure all remote access to IT systems is secure?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(h) Only use operating systems that continue to be supported by the original provider?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(i) You use anti-virus, anti-spyware and anti-malware software and update them regularly?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(j) You use firewalls and other security applications between the internet and sensitive data?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(k) You use intrusion detection or intrusion prevention systems (IDS/IPS) and these are monitored?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(l) You ensure all sensitive data on your system is encrypted?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(m) You ensure all sensitive data on all removable media is encrypted?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(n) You ensure sensitive data is permanently removed (e.g. physical destruction not merely deleting) from hard drives and other storage media and paper records are shredded or confidentially disposed of?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(o) You perform regular backups and periodically monitor the quality of the backups?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain any NO answers above","type":"text","label":"If you have answered NO to any of the above, please detail below along with mitigating comments","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section E: Claims History","fields":[{"help":"","type":"yes-no","label":"After having made full enquiries, including of all directors, partners and principals, can you confirm that: (a) No claims (successful or otherwise) have been made against or have been threatened to be made against: i. the investment manager or any fund or any of their predecessors in respect to any negligence, breach of duty of care, libel or slander, dishonesty of any employee or to any other act, error or omission that has or might have given rise to a claim?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"any director, partner or officer in respect to any wrongful act committed by them whilst acting in such capacity?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(b) The investment manager, the funds or any director/employee has not been subject to any regulatory investigation?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(c) The investment manager and the funds have not suffered from any attempt, successful or otherwise: i. to steal any money, financial instruments or any other asset that it either owns or for which it is legally responsible.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"ii. of extortion against it by a threat to commit a theft, cyber-attack or other malicious or criminal event.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(d) The investment manager and the funds have not received complaints, orally or in writing, regarding its investment performance, advice given or its administration?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(e) The investment manager and the funds have not been adversely affected by or suffered any loss from: i. a privacy breach, virus, distributed denial of service (DDOS) or hacking incident?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"ii. an unforeseen down time to its website or IT network of more than 3 hours?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"(f) You are not aware of any circumstance or problem that might in the future give rise to a claim, regulatory investigation against or a loss for the investment manager, funds or any of their directors, officers or partners that is covered under the proposed insurance policy?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain any NO answers above","type":"text","label":"If you have answered NO to any of the above, please provide full details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section F: Insurance Details","fields":[{"help":"Specify the indemnity limit desired","type":"text","label":"What limit of indemnity is required?","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you buy this cover currently? Civil Liability (Professional Indemnity)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"D&O - Investment Manager","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"D&O - Fund","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Crime","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Cyber Liability and Loss","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Specify payment mode","type":"text","label":"Mode of Payment","options":[],"required":true,"pdf_field":""},{"help":"Provide payment details","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Specify premium amount","type":"amount","label":"Amount","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consents","fields":[{"help":"Agree to the declaration","type":"checkbox","label":"Signatory’s Declaration: To the best of my/our knowledge and belief and after due enquiries, the statements and information contained in, and attached to, this Proposal Form are true and no material fact has been withheld.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Agree to the important notice","type":"checkbox","label":"Important notice: False or incomplete information or the omitting of information may lead to a complete, retroactive deprivation of the insurance coverage.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Agree to policy nullification clause","type":"checkbox","label":"I/We agree that the Policy shall become null and void, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material particular in the proposal form/personal statement, declaration and connected documents.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Agree to premium realisation condition","type":"checkbox","label":"I/We agree that the issuance of Policy shall be subject to realisation of premium cheque.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Consent to data sharing","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.","options":["Agree","Disagree"],"required":true,"pdf_field":""},{"help":"Politically Exposed Person declaration","type":"choice","label":"AML Declaration for Retail Policies/Individual Customers: Are you or any of the proposal applicants a PEP or a close relative of PEP? If yes, please share the details.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Consent for KYC verification","type":"checkbox","label":"Consent/Declaration to be added in proposal and claim for CKYC no.: I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through Central KYC Registry or National Securities Depository Limited Portal for the purpose of undertaking KYC verification.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Declaration of premium source","type":"checkbox","label":"Consent/Declaration to be added in proposal for Premium paid from own funds: 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":["Agree"],"required":true,"pdf_field":""},{"help":"Consent for KYC verification for juridical persons","type":"checkbox","label":"AML Declaration for Juridical Person/Non-Individual Customer and Group Policies: Consent/Declaration to be added in proposal: I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through Central KYC Registry or Goods and Service Tax Portal or Ministry Of Corporate Affairs Portal or National Securities Depository Limited portal for the purpose of undertaking KYC.","options":["Agree"],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Location of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Print name of signer","type":"text","label":"Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Investment Management Insurance Policy","attachments":["Attach separate sheet if insufficient space to provide relevant information","Attach documents as required by the insurer or agent"],"declarations":["The statements and information provided are true and no material fact has been withheld.","False or incomplete information may lead to loss of insurance coverage and recovery of indemnities paid.","Policy shall be null and void if any material misrepresentation or non-disclosure occurs.","Policy issuance is subject to realisation of premium cheque.","Consent is given to share personal information with group companies and others as needed.","Declarations related to AML, PEP status, KYC consent, and premium source are agreed."],"dropped_labels":1},"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/2527-investment-management-insurance-policy-proposal-form"}