{"id":1983,"title":"PROPOSAL FORM COMMERCIAL CYBER LIABILITY INSURANCE","purpose":"proposal","insurer":{"slug":"icici-lombard-general-insurance","name":"ICICI LOMBARD General Insurance Company Limited"},"source_pdf":"https://www.icicilombard.com/docs/default-source/default-document-library/2-commercial-cyber-liability8c0007ff45fd68ff8a0df0055fa61318.pdf","sha256":"def136e36813ecac86de72d51625c62537c95799088351cb3e395fdb54ac5b2b","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is a proposal for Commercial Cyber Liability Insurance to be filled by the policyholder or proposer seeking insurance coverage.","notes":["Answer all questions completely and accurately on behalf of all persons to be insured.","Mention 'NA' where a question does not apply.","Insurance is a contract of Utmost Good Faith; disclose all material facts.","Insurance is not effective until proposal is accepted and premium received.","Seek advice of insurance advisor or agent if unclear about terms.","Use separate sheet if additional space is needed.","Statutory warning on prohibition of rebates under Section 41 of Insurance Act 1938 applies."],"title":"PROPOSAL FORM COMMERCIAL CYBER LIABILITY INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Customer Information","fields":[{"help":"","type":"text","label":"Name of the policyholder","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City / Town / Village","options":[],"required":null,"pdf_field":""},{"help":"Enter the postal PIN code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"E-Mail Address","options":[],"required":null,"pdf_field":""},{"help":"Enter website URL if applicable","type":"text","label":"Website","options":[],"required":false,"pdf_field":""},{"help":"Enter contact phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Fax Number","options":[],"required":false,"pdf_field":""},{"help":"Provide details if answered Yes above","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP):","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder / proposer"},{"title":"Risk Details","fields":[{"help":"Specify the desired policy limit","type":"text","label":"Policy Limit Required","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder / proposer"},{"title":"Declarations and Consent","fields":[{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Policyholder","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder / proposer"}],"deadlines":["Inform ILGIC immediately of any changes before the policy is issued.","Undertake to inform changes immediately, not later than 30 days."],"applies_to":"Commercial Cyber Liability Insurance","attachments":["If additional space is required to provide relevant information, attach a separate sheet."],"declarations":["Consent to verify identity/address proof through Central KYC Registry or UIDAI or other modes for KYC.","Premium has been and will be paid from legally acquired sources of income.","Answers and documentation submitted are true, complete and accurate with no withheld material information.","Company has right to call for documents to establish source of funds.","Details furnished are true and correct to the best of knowledge and belief and changes will be informed immediately.","False or misleading information may result in liability."],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"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/icici-lombard-general-insurance/1983-proposal-form-commercial-cyber-liability-insurance"}