{"id":2542,"title":"Card Protection Group Insurance Policy","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/card-protection-group-insurance-policy/Card-Protection-Group-Insurance-Policy-pf.pdf","sha256":"7e764912f864cc9162cf46d5d430d10dc6b6d13256f27f6481051587a3e13f9f","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for a Card Protection Group Insurance Policy to be filled by the proposer who is applying for group insurance coverage.","notes":["Use full incorporated or firm names as applicable.","Attach separate sheet if space is insufficient.","This proposal form is also deemed to be proposal form for renewal of cover.","The Insurance Act 1938 Section 41 prohibits rebates on commission or premium.","Certified intermediary signature required if proposer did not fill the form."],"title":"Card Protection Group Insurance Policy","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Full incorporated name if company; full name and partners if partnership; proprietor name if proprietorship firm","type":"text","label":"Name of the Proposer ( in full )","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"PAN/TAN Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address for Communication","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Telephone Number","options":[],"required":null,"pdf_field":""},{"help":"Describe the group or association whose members are insured","type":"text","label":"Please mention detail of the Group/ Association/ Institution/ Corporate Body whose members are being covered under the Policy?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the group being formed with the sole purpose of obtaining Insurance?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Explain relationship if group not solely for insurance","type":"text","label":"If answer to Question 6 is No please mention the relationship between the members and the group manager for services other than Insurance","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Please state whether all members of the Group/ Association/ Institution/ Corporate Body are proposed for Insurance?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E mail ID","options":[],"required":null,"pdf_field":""},{"help":"Select the constitution type of the proposer","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":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage and Past Insurance Details","fields":[{"help":"","type":"number","label":"Please mention the total number of persons to be covered initially:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Please mention the expected no of persons to be covered during the policy period?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any company/Insurer in respect of Insurance Declined your Proposal?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Cancelled or refused to renew your policy?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If yes, provide details below","type":"yes-no","label":"Past Claims Experience, if any","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Date when loss occurred","type":"date","label":"Date of Occurrence","options":[],"required":null,"pdf_field":""},{"help":"Describe the loss","type":"text","label":"Details of loss","options":[],"required":null,"pdf_field":""},{"help":"Amount claimed for loss","type":"amount","label":"Amount of loss Rs.","options":[],"required":null,"pdf_field":""},{"help":"Name of insurer and policy number for past claims","type":"text","label":"Name of the Insurer & Policy Number","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"Sign and date the form","type":"signature","label":"Signature of 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":null,"pdf_field":""},{"help":"To be filled if proposal form not filled by proposer","type":"text","label":"Name of the Intermediary/Officer of the Company","options":[],"required":null,"pdf_field":""},{"help":"Intermediary or officer code","type":"text","label":"Code Number/Employee Number","options":[],"required":null,"pdf_field":""},{"help":"Place and date of intermediary signature","type":"text","label":"Place and Date","options":[],"required":null,"pdf_field":""},{"help":"Signature if proposal not filled by proposer","type":"signature","label":"Signature of Intermediary/Officer of the Company","options":[],"required":null,"pdf_field":""},{"help":"Tick to confirm understanding","type":"checkbox","label":"The salient features of the policy, terms and conditions of this proposal have been explained to me/us in vernacular language, and I/We agree to the same. (Please tick in case same is agreed).","options":["Tick if agreed"],"required":null,"pdf_field":""},{"help":"PEP means Politically Exposed Persons as defined","type":"yes-no","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":"yes-no","label":"I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through CERSAI records or National Securities Depository Limited Portal for the purpose of undertaking KYC verification.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Declaration of legal source of premium","type":"yes-no","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 data","type":"yes-no","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":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Card Protection Group Insurance Policy","attachments":["If there is insufficient space in this proposal for you to provide relevant information, please attach a separate sheet"],"declarations":["The statements and particulars given in this proposal form and declaration are true and complete to the best of my knowledge and belief.","I am authorized to propose on behalf of all persons proposed to be insured.","Information provided forms the basis of the insurance policy and is subject to underwriting policy of the Company.","If any information is found incorrect, untrue, or misleading, the Company shall have no liability and may cancel the policy and forfeit premium.","I agree to immediately inform the Company of any changes in this proposal form or risk after submission.","I agree to accept the Standard Terms and Conditions and form of the policy issued by the Company.","The contract of Insurance will be effective only upon Company acceptance and receipt of full premium.","I have understood the salient features, terms and conditions explained in vernacular language.","I give consent for KYC verification through specified portals.","I declare premium is paid from legally acquired sources.","I give consent to share my personal information with group companies and others as per privacy policies."],"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/2542-card-protection-group-insurance-policy"}