{"id":2054,"title":"ACKO CYBER PROTECTION PLAN PROPOSAL FORM (Group)","purpose":"proposal","insurer":{"slug":"acko-life-insurance","name":"Acko Life Insurance Limited"},"source_pdf":"https://acko-cms.ackoassets.com/Acko_Cyber_Protection_Plan_Group_Proposal_Form_a1b86a23ca.pdf","sha256":"538e3803bace6bfd5b0b18323942000349df44d58d531197683ade1f539b4fa4","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is for the proposer to apply for group cyber protection insurance coverage under the Acko Cyber Protection Plan.","notes":["Complete the form in CAPITAL LETTERS.","Submit the original form only; copies will not be accepted.","Attach a separate sheet for detailed claim records if applicable.","The section VI on Prohibition of Rebates is for information and legal compliance."],"title":"ACKO CYBER PROTECTION PLAN PROPOSAL FORM (Group)","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"I. PROPOSER DETAILS","fields":[{"help":"Enter the start date of the proposed policy period in DD/MM/YYYY format","type":"date","label":"Proposed Policy Period From","options":[],"required":true,"pdf_field":""},{"help":"Enter the full name of the proposer","type":"text","label":"Proposer Name","options":[],"required":true,"pdf_field":""},{"help":"Enter the name of the principal contact person for correspondence","type":"text","label":"Principal Contact Person Name","options":[],"required":true,"pdf_field":""},{"help":"Enter the full correspondence address","type":"text","label":"Correspondence Address","options":[],"required":true,"pdf_field":""},{"help":"Enter the city of the correspondence address","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Enter the state of the correspondence address","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"Enter the postal pin code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter the telephone number (optional)","type":"phone","label":"Telephone Number","options":[],"required":false,"pdf_field":""},{"help":"Enter the mobile phone number","type":"phone","label":"Mobile","options":[],"required":true,"pdf_field":""},{"help":"Enter the email address","type":"email","label":"E-mail","options":[],"required":true,"pdf_field":""},{"help":"Enter identification detail 1","type":"text","label":"ID1","options":[],"required":false,"pdf_field":""},{"help":"Enter identification detail 2","type":"text","label":"ID2","options":[],"required":false,"pdf_field":""},{"help":"Enter office details if applicable","type":"text","label":"Office (Optional)","options":[],"required":false,"pdf_field":""},{"help":"Enter GSTIN if applicable","type":"text","label":"Customer Goods & Service Tax Identification Number (if any)","options":[],"required":false,"pdf_field":""},{"help":"Select the nature of the group","type":"choice","label":"Nature of Group","options":["Employer/employee","Non-employer/employee"],"required":true,"pdf_field":""},{"help":"Provide a description of the group","type":"text","label":"Description of the Group","options":[],"required":true,"pdf_field":""},{"help":"Select the nature of the policy","type":"choice","label":"Nature of Policy","options":["Named basis","Unnamed basis"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"II. DETAILS OF PREVIOUS INSURER(S) (IF RENEWAL)","fields":[{"help":"Enter the name of the previous insurer if renewing","type":"text","label":"Name of Insurer","options":[],"required":false,"pdf_field":""},{"help":"Enter the previous policy number","type":"text","label":"Policy Number","options":[],"required":false,"pdf_field":""},{"help":"Enter the expiring terms of cover","type":"text","label":"Expiring terms of cover","options":[],"required":false,"pdf_field":""},{"help":"Enter the period of insurance for the previous policy","type":"text","label":"Period of insurance","options":[],"required":false,"pdf_field":""},{"help":"Enter the premium amount paid for the previous policy","type":"amount","label":"Premium paid","options":[],"required":false,"pdf_field":""},{"help":"Attach a separate sheet with detailed claim records if any","type":"attachment","label":"Claim details (Please attach separate sheet providing complete details of claims with individual claim records)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"IV. DECLARATION & AUTHORISATION","fields":[{"help":"Enter the name of the principal contact person signing the declaration","type":"text","label":"Principle Contact Person Name","options":[],"required":true,"pdf_field":""},{"help":"Enter the date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form here","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter the place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"V. SALES PERSON/INSURANCE AGENT/INTERMEDIARY DECLARATION","fields":[{"help":"Enter full name of the agent/intermediary","type":"text","label":"Full Name","options":[],"required":true,"pdf_field":""},{"help":"Enter license number or ID","type":"text","label":"License No. / ID (Agent / Corporate Agent / Broker / Sales Person)","options":[],"required":true,"pdf_field":""},{"help":"Enter the date of signing in DD/MM/YYYY format","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter the place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Signature of the proposer or intermediary","type":"signature","label":"Signature of Proposer/ Intermediary","options":[],"required":true,"pdf_field":""}],"filled_by":"insurance agent / intermediary"}],"deadlines":[],"applies_to":"Group proposals for Acko Cyber Protection Plan","attachments":["Separate sheet providing complete details of claims with individual claim records"],"declarations":["The proposer declares that all information provided is true and complete to the best of their knowledge.","The policy will come into force only after full payment of the premium and acceptance by the insurer.","The proposer authorizes the company to share proposal information for underwriting and claims settlement purposes.","If any information is found untrue or material facts are not disclosed, the insurer may alter or cancel the policy.","The sales person/agent declares that they have explained the proposal form contents and consequences of untrue statements or non-disclosure.","The liability of the company does not commence until full premium is received and proposal acceptance is intimated."],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"phone","value":"1800-210-1992","label":"Customer Care Number","level":null,"hours":"Monday to Sunday: 9:00 AM – 8:00 PM","applies_to":"life","source_url":"https://www.acko.com/life/contact-us/","quote":"t us\nSupport\nRenewals\nNew to ACKO?\nRenew life insurance\nExisting ACKO Customer\nLogin and renew policy\nClaims\nCall us at\n1800-210-1992\nEmail us at\n[email protected]\nLogin\nACKO Life Home\n/\nLife Insurance\n/\nAcko Life Insurance Customer Care | Customer Care","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"+91 8069067215","label":"Customer Care Phone Number for PERSONS WITH DISABILITIES (PwD)","level":null,"hours":"Monday to Sunday: 9:00 AM – 8:00 PM","applies_to":"life","source_url":"https://www.acko.com/life/contact-us/","quote":"y to Sunday: 9:00 AM – 8:00 PM\nACKO Life Insurance Customer Care Phone Number for PERSONS WITH DISABILITIES (PwD)\nCall: +91 8069067215\nMonday to Sunday: 9:00 AM – 8:00 PM\nProducts\nLife insurance\nTerm insurance\n1 crore term insurance\nCompany\nAbout us\nCare","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-210-1992","label":"Grievance desk phone number","level":1,"hours":null,"applies_to":"life","source_url":"https://www.acko.com/life/customer-service/grievance-redressal/","quote":"t us\nSupport\nRenewals\nNew to ACKO?\nRenew life insurance\nExisting ACKO Customer\nLogin and renew policy\nClaims\nCall us at\n1800-210-1992\nEmail us at\n[email protected]\nLogin\nACKO Life Home\n/\nACKO Life Insurance Customer Service\n/\nACKO Life Insurance Grievan","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Ms. Komal Arawat (Grievance Redressal Officer) Acko Life Insurance Limited, 36/5 Hustlehub One East, Somasandrapalya, 27th Main Road, Sector 2, HSR Layout, Bangalore – 560102","label":"Grievance Redressal Officer postal address","level":2,"hours":null,"applies_to":"life","source_url":"https://www.acko.com/life/customer-service/grievance-redressal/","quote":null,"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/acko-life-insurance/2054-acko-cyber-protection-plan-proposal-form-group"}