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general.bajajallianz.com Open in urlscan Pro
103.153.88.34  Public Scan

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Submitted URL: http://lnk.renewals.ncm14.com/gtrack?sl=dUolRDEyGWF0MUxeCw0XFl0NVBVVCUAYXgBfBQ1IAQlfTA==&ml=BQNQCFEdVAUPUUwBVFBFGAg=&ul=BQZXDF...
Effective URL: https://general.bajajallianz.com/BagicNxt/call/donotCall.do
Submission: On March 06 via api from CH — Scanned from DE

Form analysis 1 forms found in the DOM

Name: fetchform — POST saveDetails.do

<form method="post" action="saveDetails.do" name="fetchform" id="fetchform">
  <table width="766" border="0" align="center" cellpadding="0" cellspacing="0" class="bold_link">
    <tbody>
      <tr class="in_tbl">
        <td height="25" colspan="4" align="left" valign="top">
          <div align="justify" class="bold_link"><br> We at Bajaj Allianz Life Insurance send you information on our latest products and services. We convey such information by e-mail or the phone and only to those who we think will find these
            products and services interesting and beneficial. We respect your privacy, and appreciate that some of you may not want to be contacted over the phone for our telemarketing activities or receive e-mailers. In case you do not want us to
            contact you on your cell phone or landline number or email address, kindly fill the Do Not Call Form. We will take all efforts not to disturb you on the numbers and email addresses provided by you. Please allow 30 working days for the
            removal of the specified numbers or email address from our databases. Incase you continue to receive phone calls or sms from us please email us at<a href="mailto: donotcall@bajajallianz.co.in "> donotcall@bajajallianz.co.in </a></div>
        </td>
      </tr>
      <tr class="in_tbl">
        <td height="22" colspan="4" align="left" valign="middle"><strong>Please Enter Your Details Below</strong></td>
      </tr>
      <tr class="in_tbl">
        <td width="170" height="25" align="left" valign="middle">First Name: </td>
        <td width="219" align="left" valign="middle">
          <input name="fname" type="text" class="ip_field_1" id="fname" size="30" maxlength="20">
          <label></label>
        </td>
        <input type="hidden" name="p_cust_dtls.stringval1" id="p_cust_dtls.stringval1" value="">
        <td width="154" align="left" valign="middle">Last Name:</td>
        <td width="223" align="left" valign="middle">
          <input name="lname" type="text" class="ip_field_1" id="lname" size="30" maxlength="20">
        </td>
      </tr>
      <tr class="in_tbl">
        <td height="25" align="left" valign="middle">State :</td>
        <td align="left" valign="middle">
          <select name="p_cust_dtls.stringval9" id="p_state" class="ip_field_2" onchange="loadcity()">
            <option value="">-- Not Selected --</option>
            <option value="ANDAMAN AND NICOBAR ISLANDS"> ANDAMAN AND NICOBAR ISLANDS</option>
            <option value="ANDHRA PRADESH"> ANDHRA PRADESH</option>
            <option value="APO"> APO</option>
            <option value="ARUNACHAL PRADESH"> ARUNACHAL PRADESH</option>
            <option value="ASSAM"> ASSAM</option>
            <option value="BIHAR"> BIHAR</option>
            <option value="CHANDIGARH"> CHANDIGARH</option>
            <option value="CHATTISGARH"> CHATTISGARH</option>
            <option value="DADRA AND NAGAR HAVELI AND DAMAN AND DIU"> DADRA AND NAGAR HAVELI AND DAMAN AND DIU</option>
            <option value="DELHI"> DELHI</option>
            <option value="GOA"> GOA</option>
            <option value="GUJARAT"> GUJARAT</option>
            <option value="HARYANA"> HARYANA</option>
            <option value="HIMACHAL PRADESH"> HIMACHAL PRADESH</option>
            <option value="JAMMU AND KASHMIR"> JAMMU AND KASHMIR</option>
            <option value="JHARKHAND"> JHARKHAND</option>
            <option value="KARNATAKA"> KARNATAKA</option>
            <option value="KERALA"> KERALA</option>
            <option value="LADAKH"> LADAKH</option>
            <option value="LAKSHADWEEP"> LAKSHADWEEP</option>
            <option value="MADHYA PRADESH"> MADHYA PRADESH</option>
            <option value="MAHARASHTRA"> MAHARASHTRA</option>
            <option value="MANIPUR"> MANIPUR</option>
            <option value="MEGHALAYA"> MEGHALAYA</option>
            <option value="MIZORAM"> MIZORAM</option>
            <option value="NAGALAND"> NAGALAND</option>
            <option value="ODISHA"> ODISHA</option>
            <option value="ORISSA"> ORISSA</option>
            <option value="PONDICHERRY"> PONDICHERRY</option>
            <option value="PUNJAB"> PUNJAB</option>
            <option value="RAJASTHAN"> RAJASTHAN</option>
            <option value="SIKKIM"> SIKKIM</option>
            <option value="TAMIL NADU"> TAMIL NADU</option>
            <option value="TELANGANA"> TELANGANA</option>
            <option value="TRIPURA"> TRIPURA</option>
            <option value="UTTAR PRADESH"> UTTAR PRADESH</option>
            <option value="UTTARAKHAND"> UTTARAKHAND</option>
            <option value="UTTARANCHAL"> UTTARANCHAL</option>
            <option value="UTTRAKHAND"> UTTRAKHAND</option>
            <option value="WEST BENGAL"> WEST BENGAL</option>
          </select>
        </td>
        <td align="left" valign="middle">City :</td>
        <td align="left" valign="middle">
          <select name="p_cust_dtls.stringval8" id="p_city_list" class="ip_field_2">
          </select>
        </td>
      </tr>
      <tr class="in_tbl">
        <td height="25" align="left" valign="middle">Pincode :</td>
        <td align="left" valign="middle">
          <input type="text" name="p_cust_dtls.stringval3" id="p_cust_dtls.stringval3" size="30" maxlength="6" class="ip_field_1" onkeypress="return numbersonly()">
        </td>
        <td align="left" valign="middle">&nbsp;</td>
        <td align="left" valign="middle">&nbsp;</td>
      </tr>
      <tr class="in_tbl">
        <td height="25" colspan="4" align="left" valign="middle"><strong>Please enter the phone number or email address on which you do not want to be contacted :</strong></td>
      </tr>
      <tr class="in_tbl">
        <td height="25" align="left" valign="middle">Mobile number:</td>
        <td align="left" valign="middle">
          <input type="text" name="p_cust_dtls.stringval6" id="p_cust_dtls.stringval6" size="30" maxlength="11" class="ip_field_1" onkeypress="return numbersonly()" onblur="validateMobile(this)">
        </td>
        <td align="left" valign="middle">Landline number(O):</td>
        <td align="left" valign="middle">
          <input type="text" name="p_cust_dtls.stringval4" id="p_cust_dtls.stringval4" size="5" maxlength="4" class="ip_field_1" onkeypress="return numbersonly()" onblur="validatePhone(this)">
          <input type="text" name="p_cust_dtls.stringval5" id="p_cust_dtls.stringval5" size="15" maxlength="8" class="ip_field_1" onkeypress="return numbersonly()">
        </td>
      </tr>
      <tr class="in_tbl">
        <td align="left" valign="middle">Email address:</td>
        <td align="left" valign="middle"><input type="text" name="p_cust_dtls.stringval7" id="p_cust_dtls.stringval7" size="30" maxlength="99" class="ip_field_1" onblur="isValidEmail(this.value)">
        </td>
        <td align="left" valign="middle">Effective From Date :</td>
        <td align="left" valign="middle"><label>
            <input type="text" size="30" id="p_from_date" value="" name="p_cust_dtls.stringval17" class="ip_field_1" readonly="">
            <a href="javascript: void(0);" onmouseover="if (timeoutId) clearTimeout(timeoutId);window.status='Show Calendar';return true;" onmouseout="if (timeoutDelay) calendarTimeout();window.status='';" onclick="g_Calendar.show(event,'fetchform.p_from_date',false); return false;">
												<img src="../images/calendar.gif" name="imgCalendar" width="34" height="21" align="middle" border="0" alt="Pick a Date !"> 
												</a></label></td>
      </tr>
      <tr class="in_tbl">
        <td height="25" colspan="4" align="left" valign="middle">Are you an existing Bajaj Allianz customer? <input type="radio" name="bjaz_cust" id="radio1" value="1" onclick="existing()"> Yes <input type="radio" name="bjaz_cust" id="radio2"
            value="2" checked="" onclick="nonexist()"> No <label></label>
          <input type="hidden" name="p_cust_dtls.stringval16" id="p_cust_dtls.stringval16">
        </td>
      </tr>
      <tr class="in_tbl" id="cust" style="display: none;">
        <td height="25" align="left" valign="middle">Existing Policy Number :</td>
        <td align="left" valign="middle"><input name="p_cust_dtls.stringval18" type="text" class="ip_field_1" id="p_cust_dtls.stringval18" size="30" maxlength="20"></td>
      </tr>
      <tr class="in_tbl">
        <td height="34" colspan="4" align="center" valign="middle"><label>
            <input type="button" name="button" id="button" value="Submit" class="button" onclick="verify()">
            <input type="reset" value="Reset" class="button">
          </label></td>
      </tr>
    </tbody>
  </table>
</form>

Text Content

DO NOT DISTURB   Home  

 


DO NOT DISTURB

We at Bajaj Allianz Life Insurance send you information on our latest products
and services. We convey such information by e-mail or the phone and only to
those who we think will find these products and services interesting and
beneficial. We respect your privacy, and appreciate that some of you may not
want to be contacted over the phone for our telemarketing activities or receive
e-mailers. In case you do not want us to contact you on your cell phone or
landline number or email address, kindly fill the Do Not Call Form. We will take
all efforts not to disturb you on the numbers and email addresses provided by
you. Please allow 30 working days for the removal of the specified numbers or
email address from our databases. Incase you continue to receive phone calls or
sms from us please email us at donotcall@bajajallianz.co.in
Please Enter Your Details Below First Name: Last Name: State : -- Not Selected
-- ANDAMAN AND NICOBAR ISLANDS ANDHRA PRADESH APO ARUNACHAL PRADESH ASSAM BIHAR
CHANDIGARH CHATTISGARH DADRA AND NAGAR HAVELI AND DAMAN AND DIU DELHI GOA
GUJARAT HARYANA HIMACHAL PRADESH JAMMU AND KASHMIR JHARKHAND KARNATAKA KERALA
LADAKH LAKSHADWEEP MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND
ODISHA ORISSA PONDICHERRY PUNJAB RAJASTHAN SIKKIM TAMIL NADU TELANGANA TRIPURA
UTTAR PRADESH UTTARAKHAND UTTARANCHAL UTTRAKHAND WEST BENGAL City : Pincode :  
  Please enter the phone number or email address on which you do not want to be
contacted : Mobile number: Landline number(O): Email address: Effective From
Date : Are you an existing Bajaj Allianz customer? Yes No Existing Policy Number
:

  © Bajaj Allianz Insurance Co. Ltd. 2023 All Rights Reserved. Insurance is the
subject matter of solicitation. IRDA Reg. No. 113