{"id":1988,"title":"PROPOSAL FORM KIDNAP & RANSOM 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/11-kidnap-and-ransom-liability-insurance-commercial8c0007ff45fd68ff8a0df0055fa61630.pdf","sha256":"295d681c37679ddcb44640bfe906a33fd177aa95b3655a3f269685ec48be27d7","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is a proposal for Kidnap & Ransom Liability Insurance to be filled by the proposed policyholder (company).","notes":["Answer all questions completely and correctly; write 'Not Applicable' if question does not apply","Proposal must be signed, stamped and dated by authorised signatory","Insurance contract subject to acceptance of proposal and receipt of premium","Attach additional sheets if more space is needed, indicating question number","Use cancelled cheque for bank account details to process claims via EFT","Refer to insurer or broker for any queries or clarifications","Statutory warning on prohibition of rebates under Insurance Act 1938"],"title":"PROPOSAL FORM KIDNAP & RANSOM LIABILITY INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposed Insured Details","fields":[{"help":"","type":"text","label":"Nature of business","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Proposed Insured Company","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Head Office Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Number of Directors, officers and Employees","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"a) Total number of Insured Persons:","options":[],"required":null,"pdf_field":""},{"help":"List insured persons and their country of residence","type":"table","label":"b) Please provide a schedule of Insured Persons and their country of residence:","options":[],"required":null,"pdf_field":""},{"help":"Enter amount in INR","type":"amount","label":"Total Sales: i. Last Year: `","options":[],"required":null,"pdf_field":""},{"help":"Enter amount in INR","type":"amount","label":"ii. Projections for proposed period: `","options":[],"required":null,"pdf_field":""},{"help":"Enter amount in INR","type":"amount","label":"Net Assets: i. Last Year: `","options":[],"required":null,"pdf_field":""},{"help":"Enter amount in INR","type":"amount","label":"ii. Projections for proposed period: `","options":[],"required":null,"pdf_field":""},{"help":"List locations and employee counts","type":"text","label":"Please list the locations of all overseas operations with the approximate number of employees at each operation","options":[],"required":null,"pdf_field":""},{"help":"Provide countries, number and average duration of trips","type":"text","label":"Please submit details of anticipated overseas business travel by insured persons showing countries, number and average duration of trips","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Do any members of staff travel to Central & South America, Africa, former USSR or the Middle East, If so please give details?","options":[],"required":null,"pdf_field":""},{"help":"Enter amount in INR","type":"amount","label":"Aggregate Limits of Liability: INR","options":[],"required":null,"pdf_field":""},{"help":"Select one option","type":"choice","label":"Territorial Scope of Cover and Jurisdiction (tick any one)","options":["India","Worldwide excluding North America","Worldwide"],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP):","options":[],"required":null,"pdf_field":""}],"filled_by":"proposed policyholder"},{"title":"Additional Information about the Insured","fields":[{"help":"Tick Yes or No","type":"yes-no","label":"a. Whether insured is affiliated to any political party","options":["Y","N"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"b. Whether insured keeps body guards","options":["Y","N"],"required":null,"pdf_field":""},{"help":"Attach security arrangement details","type":"attachment","label":"c. Attach details of security arrangement at insured’s office and home.","options":[],"required":null,"pdf_field":""},{"help":"Provide insurer and sum insured details","type":"text","label":"Please provide details of any other insurances of this type known to exist covering the Assured or any person to be included in this application (please include details of the Insurer and the Sum Insured):","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"a. Has any insurer ever: I. Declined your insurance proposal for the proposed cover?","options":["Y","N"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"ii. Refused your renewal for the proposed cover?","options":["Y","N"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"iii. Terminated your insurance for the proposed cover?","options":["Y","N"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"b. Have your company ever been subject to any enquiry or investigation by any Government agency, concerning the threat or safety?","options":["Y","N"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"c. Are you aware of any incidents, conditions, circumstances or threats, which may result in a claim under the proposed cover?","options":["Y","N"],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If yes, please provide full details:","options":[],"required":null,"pdf_field":""},{"help":"Enter start date","type":"date","label":"Period of proposed Insurance Policy: From:","options":[],"required":null,"pdf_field":""},{"help":"Enter end date","type":"date","label":"To:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Any other information which you would like to provide","options":[],"required":false,"pdf_field":""},{"help":"As per bank records","type":"text","label":"Proposed policyholder’s name (as per bank record):","options":[],"required":true,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Proposed policyholder’s account no.:","options":[],"required":true,"pdf_field":""},{"help":"Bank name","type":"text","label":"Name of the bank:","options":[],"required":true,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Branch Name:","options":[],"required":true,"pdf_field":""},{"help":"Bank branch address","type":"text","label":"Address of the bank:","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code of the bank:","options":[],"required":true,"pdf_field":""},{"help":"PAN card number","type":"text","label":"PAN card no. of the proposed policyholder:","options":[],"required":true,"pdf_field":""},{"help":"Attach cancelled cheque of the bank account mentioned","type":"attachment","label":"Cancelled cheque of the proposed policyholder","options":[],"required":true,"pdf_field":""}],"filled_by":"proposed policyholder"},{"title":"Declaration by Proposed Policyholder","fields":[{"help":"Signature of authorised signatory","type":"signature","label":"Proposer's Signature","options":[],"required":true,"pdf_field":""},{"help":"Company stamp","type":"signature","label":"Company Stamp","options":[],"required":true,"pdf_field":""},{"help":"Name of authorised signatory","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Designation of authorised signatory","type":"text","label":"Designation","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposed policyholder"}],"deadlines":[],"applies_to":"Kidnap & Ransom Liability Insurance","attachments":["Last two years annual report","Details of company’s security arrangements","Cancelled cheque of the proposed policyholder"],"declarations":["Consent to verify identity/address proof through KYC sources","Premium paid from legally acquired income and future premiums will be similarly paid","Authorise insurer and ICICI Bank Group to share personal and financial information","Policy voidable if any untrue, incorrect, incomplete or withheld material information","Proposal and declarations form basis of contract and policy conditions apply","Policy issuance and cover commence only after premium realisation","Proposal may be accepted for reduced sum if premium collected is less than quoted","Company may call for documents to establish source of funds","Details furnished are true and correct and changes will be informed within 30 days","Liability for false, untrue, misleading or misrepresenting information"],"dropped_labels":3},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"address","value":"ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400025","label":"Registered Office Address","level":null,"hours":"normal business hours","applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"t of policy with the term more than one year and the risk coverage for such policy years has not commenced.\n9 | P a g e ICICI Lombard General Insurance Company Limited EMI SURAKSHA IRDA Reg. No. 115 CIN: L67200MH2000PLC12940 UIN: IRDAN115RPMS0020V01202627\nMailing Address: Registered Office Address: Toll free no : 1800 2666\n13. Notices\nAny notice, direction or instruction given under th","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"address","value":"601 / 602, 6th Floor, Interface Building No. 16, New Link Road, Malad (West), Mumbai - 400 064.","label":"Office Address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/sales-literature-prospectus-tripsecure-2.pdf","quote":"064. | ICICI Lombard General Insurance\nIRDA Reg. No. 115 | Company Limited\nMailing Address: | UIN: ICITIOP27058V022627\n601 / 602, 6th Floor, Interface Building No. 16, New | CIN: L67200MH2000PLC129408\nLink Road, Malad (West), Registered Office Address:\nICICI Lombard House, 414, P Balu | SALES LITERATURE / PROSPECTUS TRIPSECURE+\nMarg","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"email","value":"customersupport@icicilombard.com","label":"E-mail","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/sales-literature-prospectus-tripsecure-2.pdf","quote":"e, Prabhadevi, | Alternate No.: 86552 22666 (Chargeable)\nMumbai - 400 025. | Website | : www.iciclombard.com\nE-mail | : customersupport@icicilombard.com\nSections | Clause No | Cover Type | Cover Name | Payment Basis | Sum Insured | Deductible/ Special conditions\nTravel De","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800 2666","label":"Toll free number","level":null,"hours":"normal business hours","applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"115 CIN: L67200MH2000PLC12940 UIN: IRDAN115RPMS0020V01202627\nMailing Address: Registered Office Address: Toll free no : 1800 2666\n13. Notices\nAny notice, direction or instruction given under this Policy shall be in writing and delivered by hand, pos","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Ground floor- Interface 11, Sixth floor- Interface 16 Office no 601 & 602, New linking Road, Malad (West), Mumbai – 400064","label":"Office Address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/vibe-prospectus-(1).pdf","quote":"ombard.com Toll free number: 1800 2666 Email: customersupport@icicilombard.com ICICI Lombard General Insurance Co. Ltd. Ground floor- Interface 11, Sixth floor- Interface 16 Office no 601 & 602, New linking Road, Malad (West), Mumbai – 400064\nThere is an Interactive Voice Response (IVR) facility for senior citizens’ grievance redressal for easy and faster reso","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"customersupport@icicilombard.com","label":"Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"grievance the insured person may contact the Company through Website: www.icicilombard.com Toll free: 1800 2666 Email: customersupport@icicilombard.com ICICI Lombard General Insurance Co. Ltd. Ground floorInterface 11, Sixth floor- Interface 16 , Office no 601 & 602, New","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800 2666","label":"Toll free","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"115 CIN: L67200MH2000PLC12940 UIN: IRDAN115RPMS0020V01202627\nMailing Address: Registered Office Address: Toll free no : 1800 2666\n13. Notices\nAny notice, direction or instruction given under this Policy shall be in writing and delivered by hand, pos","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800 4254 732","label":"IRDA Grievance Call Centre (IGCC)","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":": Toll free no : 1800 2666 https://bimabharosa.irdai.gov.in/ or IRDA Grievance Call Centre(IGCC) at their toll free no. 1800 4254 732 / 155255\nMailing Address ICICI Lombard General Insurance Company Limited, ICICI Lombard House 414, Veer Savarkar Marg,","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"https://www.icicilombard.com/docs/defaultsource/policywordings-product-brochure/final-gro-mapping.pdf","label":"Branch details for grievance cell","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"ach the grievance cell at any of the company's branches with the details of grievance. For branch details, please visit https://www.icicilombard.com/docs/defaultsource/policywordings-product-brochure/final-gro-mapping.pdf.\n17. lf lnsured person is not satisfied with the redressal of grievance ,insured person may contact the grievance redre","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"https://www.icicilombard.com/grievanceredressal.com","label":"Grievance redressal officer contact details","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"ach the grievance cell at any of the company's branches with the details of grievance. For branch details, please visit https://www.icicilombard.com/docs/defaultsource/policywordings-product-brochure/final-gro-mapping.pdf.\n17. lf lnsured person is not satisfied with the redressal of grievan","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"https://www.icicilombard.com/docs/defaultsource/policy-wordings-product-brochure/final-gromapping.pdf","label":"Branch details for grievance cell","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/vibe-prospectus-(1).pdf","quote":"cell at any of the company'sOur branches with the\ndetails | of | grievance. | For | branch | details, | please | visit\nhttps://www.icicilombard.com/docs/defaultsource/policy-wordings-product-brochure/final-gromapping.pdf.\nlf you are not satisfied with the redressal of grievance, You may contact the grievance officer at the details provide","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/icici-lombard-general-insurance/1988-proposal-form-kidnap-and-ransom-liability-insurance"}