{"id":2401,"title":"Commercial General Liability Policy (Claims Made) Proposal Form","purpose":"proposal","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/Commercial_General_Liability_Policy_Claims_Made_Proposal_Form_629b4f3aaa.pdf","sha256":"41017dc4e9661fbfdd4d9a79e336fa8d6e80556fdcbdd49743ca44acba81234d","pages":11,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for insurance under the Commercial General Liability Policy (Claims Made) and is to be filled by the proposer (the insured or applicant).","notes":["Proposers desiring only Public Liability coverage are not required to fill Section IV.","Proposers desiring only Product Liability coverage are not required to fill Section III.","Proposers not desiring extensions under Section V and VI are not required to fill those Sections.","Mark Not Applicable (N/A) where sections do not apply.","Attach separate sheet if space is insufficient.","Fees of working directors not to be included in employee details.","Use soft copy communication unless physical copy requested.","PAN is mandatory.","Email id is mandatory for Electronic Insurance Account details."],"title":"Commercial General Liability Policy (Claims Made) Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Section I: General Information","fields":[{"help":"","type":"text","label":"Policy issuing office","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy servicing office","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary/Agent Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary License no /Agent code.","options":[],"required":null,"pdf_field":""},{"help":"Provide contact number of intermediary or agent","type":"phone","label":"Intermediary/Agent Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Include all subsidiaries or affiliated companies to be insured","type":"text","label":"Name & Registered Address of the Insured (including names of all subsidiaries or affiliated companies to be insured)","options":[],"required":true,"pdf_field":""},{"help":"Provide official website address","type":"text","label":"Website Address","options":[],"required":false,"pdf_field":""},{"help":"Describe the nature of your business operations","type":"text","label":"Please describe your business operations and activities","options":[],"required":true,"pdf_field":""},{"help":"Select Yes if communication address is same as head office","type":"yes-no","label":"Is the Communication address same as the Head Office address ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide communication address if different from head office","type":"text","label":"Communication Address","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section II: Insurance Requirement","fields":[{"help":"Select the form type of insurance coverage required","type":"choice","label":"Form Type","options":["Claims Made","Occurrence Based"],"required":true,"pdf_field":""},{"help":"Specify limits for each category","type":"amount","label":"Limits of Insurance (Amount in Indian Rupees)","options":[],"required":true,"pdf_field":""},{"help":"Limit for any one event","type":"amount","label":"Limit of Liability Any One Event In the Aggregate","options":[],"required":true,"pdf_field":""},{"help":"Aggregate limit for premises and operations","type":"amount","label":"General Aggregate Limit Premises and Operations","options":[],"required":true,"pdf_field":""},{"help":"Limit for transportation liability extension","type":"amount","label":"Transportation Liability Extension","options":[],"required":false,"pdf_field":""},{"help":"Limit for products/completed operations","type":"amount","label":"Products/Completed Operations Limit","options":[],"required":false,"pdf_field":""},{"help":"Employers liability limit","type":"amount","label":"Employers Liability","options":[],"required":false,"pdf_field":""},{"help":"Limit for non-owned/hired automobile liability","type":"amount","label":"Automobiles Liability (Non Owned/Hired) Extension","options":[],"required":false,"pdf_field":""},{"help":"Specify start and end dates of policy period","type":"date","label":"Policy Period","options":[],"required":true,"pdf_field":""},{"help":"Provide retroactive date if applicable","type":"date","label":"Retroactive date (only for Claims Made Form)","options":[],"required":false,"pdf_field":""},{"help":"Select the territory of coverage","type":"choice","label":"Territory","options":["India","Worldwide excluding USA and Canada","Worldwide including USA and Canada"],"required":true,"pdf_field":""},{"help":"Select the jurisdiction applicable","type":"choice","label":"Jurisdiction","options":["India","Worldwide excluding USA and Canada","Worldwide including USA and Canada"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section III: General Liability","fields":[{"help":"Provide location, number of locations, and nature of risk for manufacturing units and warehouses/godowns/shops/depots/tank farms/offices in India and overseas","type":"table","label":"List all premises to be insured in India and overseas","options":[],"required":true,"pdf_field":""},{"help":"Provide turnover for premises operations and transportation for projected, current, and last year","type":"table","label":"Please quantify annual sales turnover of last three years (Amount in Indian Rupees)","options":[],"required":true,"pdf_field":""},{"help":"Describe industrial, agricultural, residential areas and others in North, East, South, West directions","type":"table","label":"Please describe in brief surrounding areas and third party property within an approximate radius of 2 kms from each manufacturing unit","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Do you handle or use gases, pressure-storage, explosive, hazardous substances, asbestos, toxic, radioactive materials and hydrocarbons? If so, please give details of their quantity, storage, handling and precautions taken","options":[],"required":false,"pdf_field":""},{"help":"Describe fire prevention and emergency provisions","type":"text","label":"Is there a programme for the prevention of fire, explosion incidents? If so, pls indicate: (a). Type of detection and alarm system; (b). Availability of service organisation in case of such incidents (fire brigade, specialists in environmental protection and toxicology); (c). Provisions made for supply of energy, water etc. in an emergency","options":[],"required":false,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Will you, or your employees, handle or come into contact with any industrial dust of known harmful nature (e.g. asbestos, silica, cotton), radioactive materials, or any other substance harmful to health?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section IV: Product Liability","fields":[{"help":"Select extensions required","type":"checkbox","label":"Extensions required: (a). Act of God Perils Extension (viz., Earthquake, Storm, Typhoon, Flood and Inundation etc.); (b). 72 Hrs Sudden and Accidental Pollution Extension; (c). Effluent Discharge Extension","options":["Act of God Perils Extension","72 Hrs Sudden and Accidental Pollution Extension","Effluent Discharge Extension"],"required":false,"pdf_field":""},{"help":"Provide pipeline length if Effluent Discharge Extension selected","type":"text","label":"If yes, what is the length of pipeline from the compound wall of your premises to the disposal point?","options":[],"required":false,"pdf_field":""},{"help":"Provide total travel days per year","type":"number","label":"Number of travel days per year","options":[],"required":false,"pdf_field":""},{"help":"Describe purpose of overseas trips","type":"text","label":"Purpose of trips","options":[],"required":false,"pdf_field":""},{"help":"List overseas destinations","type":"text","label":"Overseas Travel Destinations","options":[],"required":false,"pdf_field":""},{"help":"Answer and provide details if applicable","type":"text","label":"Do you use comparative advertising in your advertisements? If \"Yes\", was an independent organization consulted on how such comparisons were made?","options":[],"required":false,"pdf_field":""},{"help":"Answer and provide details if applicable","type":"text","label":"Is music used in your advertisements? If \"Yes\", were all the rights secured prior to use?","options":[],"required":false,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Is the likeness of famous people used in your advertisements?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Have you ever been sued, or have you sued another, for copyright or trademark infringement?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Besides the information related to your goods, products or services, do you produce any other publications for external use?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach relevant product brochures or literature","type":"attachment","label":"Please attach a product brochure or literature or labels or warnings etc. with this form","options":[],"required":false,"pdf_field":""},{"help":"Provide product name, principal components, annual units produced, end usage/intended customer use, expected life of the product","type":"table","label":"Please furnish details of products to be considered for insurance","options":[],"required":true,"pdf_field":""},{"help":"Provide turnover for USA/Canada/Australia, UK/Europe, Rest of the World, India for projected, current, and last year","type":"table","label":"Please quantify annual sales turnover of last three years (Amount in Indian Rupees)","options":[],"required":true,"pdf_field":""},{"help":"Describe services and turnover if applicable","type":"text","label":"Do you provide any services or treatment other than sale of products? If yes, pls describe the nature of services and estimated annual turnover","options":[],"required":false,"pdf_field":""},{"help":"Provide details of new products","type":"text","label":"Please furnish particulars of new products to be marketed during the next 12 months","options":[],"required":false,"pdf_field":""},{"help":"Provide duration of export to these regions","type":"text","label":"How long have you been exporting to these countries? (a). USA and Canada; (b). UK/Europe","options":[],"required":false,"pdf_field":""},{"help":"Provide details of components purchased if any","type":"text","label":"Do you manufacture the complete product? If not, what components/parts are purchased by you?","options":[],"required":false,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Do you have Research & Development department or Technical Know-how/Collaboration?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Do you retain rights of recovery against manufacturers?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details and precautions","type":"text","label":"Please specify any products, which are inflammable/explosive, dangerous, radioactive, and harmful to health, poisonous by themselves or any combination with others. If so, please give full details and state what precautions are taken","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Please furnish details and list of products discontinued or recalled or withdrawn during the last five years","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Have your products ever been subject to any enquiry or investigation by any Government agency, concerning the efficiency/adequacy or labelling, hazardous contents or safety? If so, please give full details","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Are any products manufactured and sold under someone else’s label or trademark? If yes, please give full details","options":[],"required":false,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Does the Insured’s contract of sale agree to hold distributors harmless?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide vendor details if applicable","type":"text","label":"Does the Insured require the name of vendor to be included as a Named Insured? If yes, pls provide the name, address and list of products to be supplied to the vendor","options":[],"required":false,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Does the vendor undertake final preparation of product?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Do your products comply with standards like ISI or any other Standards?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section V: Employee details","fields":[{"help":"Provide number and wage roll for each employee category and region","type":"table","label":"Please provide projected details for the next 12 months: Description of Employees* (Clerical Staff, Supervisory/Manual, Hazardous Activity**, All other employees) by region (USA/Canada/Australia, UK/Europe, Rest of the World, India) with No. and Wage roll","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section VI: Non-Owned and Hired Automobile Liability","fields":[{"help":"List countries where automobiles are hired","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"Provide estimated number of automobiles hired","type":"number","label":"Estimated No. of Automobiles Hired","options":[],"required":false,"pdf_field":""},{"help":"Specify type of vehicle hired","type":"text","label":"Type Of Vehicle","options":[],"required":false,"pdf_field":""},{"help":"Specify frequency of hire","type":"text","label":"Frequency of Hire","options":[],"required":false,"pdf_field":""},{"help":"Specify duration of each hire","type":"text","label":"Duration of a Single Hire","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section VII: Loss Information","fields":[{"help":"Provide date of occurrence, description of claim, date of claim, amount paid, amount reserved, claim status","type":"table","label":"Please enter all claims or losses (regardless of fault and whether or not insured) or any occurrences or incidents, conditions, defects, circumstances or suspected defects, which may give rise to a claim; over the last five years under Public Liability and/or Products Liability (Amount in Indian Rupees)","options":[],"required":true,"pdf_field":""},{"help":"Answer if aware of any such incident","type":"yes-no","label":"Are you aware of any incident/circumstance that could lead to loss or claim under the proposed policy (Yes/No)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if answered Yes above","type":"text","label":"If yes please provide full details of that incident/circumstance","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section VIII: Prior Insurance","fields":[{"help":"*Premium excluding taxes and ERF contribution","type":"table","label":"Please provide details of expiring policy: Type, Insurer, Limit of Liability, Premium*, Deductible","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section IX: Other Information (Compulsory)","fields":[{"help":"Select all applicable sources of funds","type":"checkbox","label":"Sources of funds","options":["Salary","Business","Investments","Other (Please Specify)"],"required":true,"pdf_field":""},{"help":"Provide CKYC Identifier if available","type":"text","label":"Company’s CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"Provide PAN number","type":"text","label":"PAN (mandatory)","options":[],"required":true,"pdf_field":""},{"help":"Provide GSTIN if applicable","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Provide details of authorised signatory","type":"text","label":"Please share the below details for the Authorised Signatory: Name, Designation, PAN, CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":true,"pdf_field":""},{"help":"Provide bank account details for payment and refund/claims","type":"text","label":"Bank Account Details","options":[],"required":true,"pdf_field":""},{"help":"Provide EIA account details or request creation","type":"text","label":"Electronic Insurance Account details of Proposer (e-mail id is mandatory): Do you have an EIA Account? If Yes, please quote EIA Number and name of Insurance Repository; If No, do you want Us to create an EIA account for you?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide email id registered with Insurance Repository","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Are You or any of the proposed applicants or close relatives is/are associated to Politically Exposed Person (PEP)?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Are you a Non-Profit Organization? (only in case of an entity)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select applicable type","type":"choice","label":"Type of Organization making the payment","options":["Limited Company","Government Organization","Non-Government Organization (NGO)","Society","Trust","Partnership","International Organization","Co-operatives","Section 25 Company","Others"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Signature and stamp of proposer","type":"signature","label":"Signature and Stamp of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Signature of proposer","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Signature and stamp of insurance advisor or authorized person","type":"signature","label":"Signature & Stamp as applicable of the Insurance Advisor/ Specified person of Corporate Agent/Authorised Employee of Broker/ Sales person","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and agent"}],"deadlines":[],"applies_to":"Commercial General Liability Policy (Claims Made) insurance proposals","attachments":["Separate sheet if space indicated in the proposal form is insufficient","Lay-Out Plans and Risk Inspection Report of the manufacturing units proposed for Insurance","Product brochure or literature or labels or warnings etc."],"declarations":["Statements made in this Proposal Form are true to the best of the proposer’s knowledge and belief and form the basis of the contract.","Policy and service related communication will be sent in soft copy to the email id mentioned unless physical copy is requested.","Consent is given to verify identity/address proof through specified government portals for KYC purposes.","All premiums have been/will be paid from bonafide sources and not from proceeds of crime under Prevention of Money Laundering Act, 2002.","The Company has the right to cancel the insurance contract if found guilty under money laundering statutes.","Agent declares that policy features and terms have been fully explained to the proposer.","Vernacular declaration confirms contents and terms have been explained in language understood by proposer.","Submission of proposal or payment does not oblige the Company to issue a policy; acceptance is at Company’s sole discretion.","Premium must be received in full and in time for liability to commence.","If proposal is not accepted, payment will be refunded without interest.","No person shall offer or accept any rebate of commission or premium except as allowed by insurer’s published prospectus or tables.","Default in complying with rebate prohibition may lead to penalty up to ten lakh rupees."],"dropped_labels":6},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"email","value":"care@zurichkotak.com","label":"Email Address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/customer-support/grievance-redressal-process","quote":"in\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be used for calls. This is chat only number.\nAccessibility\nZoom in page\nZoom out page\nIncrea","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800 2120","label":"Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/customer-support/grievance-redressal-process","quote":"age claims\nCustomer support\nGrievance redressal\nLogin\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be used for calls. This is cha","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"+91-22-69417220","label":"Toll Number (INDIA And Overseas)","level":null,"hours":"IST 8 am to 8 pm","applies_to":"all","source_url":"https://www.zurichkotak.com/customer-support/grievance-redressal-process","quote":"Download policy\nManage policy\nManage claims\nCustomer support\nGrievance redressal\nLogin\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"whatsapp","value":"7998879988","label":"WhatsApp Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/customer-support/grievance-redressal-process","quote":"t\nGrievance redressal\nLogin\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be used for calls. This is chat only number.\nAccessibilit","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"grievanceofficer@zurichkotak.com","label":"Grievance Officer","level":1,"hours":null,"applies_to":"all","source_url":"https://cms.zurichkotak.com/uploads/Policy_Wordings_CPI_dc7b416cf1.pdf","quote":"om .\nIn case the I nsured is not satisfied with the response, I nsured may contact the Grievance Officer of the ZKGI at grievanceofficer@zurichkotak.com . In case if the I nsured is not satisfied with the solution the\nGrievance Officer has provided, | I nsured | can write","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Unit no. 401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East) Mumbai- 400063. Maharashtra, India.","label":"Registered & Corporate Office","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/","quote":"ker\nHealth portability\nResearch & Reports\nCorrespondence Address\nZurich Kotak General Insurance Company (India) Limited\nUnit no. 401, 4th Floor, Silver Metropolis,\nJai Coach Compound, Off Western Express Highway,\nGoregaon (East) Mumbai- 400063. Maharashtra, India.\nConnect with us\n: 022 - 69417220 (Toll number)\n: 1800 2120 (Toll free)\n+91-22-69417220 (IST 8 am to 8 pm)\nwww.zurichkot","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"care@zurichkotak.com","label":"Customer Care Email","level":null,"hours":null,"applies_to":"all","source_url":"https://cms.zurichkotak.com/uploads/Policy_Wordings_CPI_dc7b416cf1.pdf","quote":"may contact the respective branch office of the ZKGI or may call toll free number 1800 2120 or may write an e - mail at care@zurichkotak.com .\nIn case the I nsured is not satisfied with the response, I nsured may contact the Grievance Officer of the ZKGI at gr","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"www.zurichkotak.com","label":"Grievance Redressal Process","level":null,"hours":null,"applies_to":"all","source_url":"https://cms.zurichkotak.com/uploads/Policy_Wordings_CPI_dc7b416cf1.pdf","quote":"nder.\nThe details of the Insurance Ombudsman/ complete Grievance Redressal Process is also available at ZKGI’s website: www.zurichkotak.com\nThe updated details of Insurance Ombudsman offices are also available on the website of | Council for\nInsurance Ombudsm","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/zurich-kotak-general-insurance/2401-commercial-general-liability-policy-claims-made-proposal-form"}