{"id":2777,"title":"GROUP PERSONAL CYBER RISKS POLICY PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/lifestyle-insurance/group-personal-cyber-risks-policy/proposal-forms/group-personal-cyber-risk-retail-proposal-form.pdf","sha256":"6ec1178c43a7683f0ac5319e8bd2952154bfb5b33c712fc92c877065d26fbc59","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by persons above 21 years to apply for Group Personal Cyber Risk insurance coverage under Generali Central Insurance Company Limited. The proposer fills this form to provide personal, security, and insurance history details for the group policy.","notes":["Insurance is a contract of utmost good faith requiring full disclosure of material facts.","Person above 21 years can apply for coverage.","Minimum 50 members required for group policy.","Deductible amounts do not apply under Personal Malware Cover.","Limits mentioned are sub-limited to Limits of Liability under all insuring clauses.","Use separate sheet if more space is needed, signed and dated.","For premium above Rs 10,000, fill authorization form for NEFT payments.","The insurer reserves the right to reject proposals or terminate contracts if the proposer or associated persons are on any blacklist.","True to Go Green initiative, policy documents will be sent electronically unless physical copy is requested."],"title":"GROUP PERSONAL CYBER RISKS POLICY PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"General Information","fields":[{"help":"","type":"text","label":"Name of Applicant","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Present Address of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Leave blank if same as Present Address","type":"text","label":"Permanent Address of the Proposer: (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Occupation","options":[],"required":true,"pdf_field":""},{"help":"Central KYC Registry number if available","type":"text","label":"CKYC number (if available)","options":[],"required":false,"pdf_field":""},{"help":"Minimum 50 members required","type":"number","label":"No of Members to be added (not less then 50 Members)","options":[],"required":true,"pdf_field":""},{"help":"Tick all applicable categories","type":"checkbox","label":"I am (please tick all that are applicable)","options":["High Net Worth Individual/s","Non-Residential Indian/s","Politically Exposed Person","Non-Governmental Organisation","Non-Profit Organisation"],"required":false,"pdf_field":""},{"help":"Provide registration number if applicable","type":"text","label":"If you are an NGO/NPO, please provide Niti Ayog – Darpan Portal Registration Number","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"If you are Differently Abled, please tick on the checkbox to provide confirmation. Yes / No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide if Differently Abled is Yes","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Provide if Differently Abled is Yes","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Provide if Differently Abled is Yes","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""},{"help":"Optional cover selection","type":"yes-no","label":"Do you wish to insure covers towards credit card loss cover? YES/NO","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Your Activity","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"Do you actively exercise proper security recommended by Financial Institutions (Banks) and Telecom Services Provider such as not sharing sensitive information and change in password/Pin in your devise and on your Cards? Yes/No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No and describe update frequency if Yes","type":"text","label":"Do you use anti-virus, anti-spyware and anti-malware software? Yes/No if yes, do you regularly update on the notification on update application?","options":[],"required":true,"pdf_field":""},{"help":"Describe frequency of data backup","type":"text","label":"How often do you update your data on cloud/external device for your computer including other devices?","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Security Incident and Loss History","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"Has the Applicant had any computer or network security incidents during the past two (3) years? Yes/ No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach detailed incident description if Yes","type":"attachment","label":"If the answer to question 3 is “yes”, please attach a complete description of the incident(s) including whether the Applicant reported the incident to law enforcement authorities and/or its insurer.","options":[],"required":false,"pdf_field":""},{"help":"Describe any known potential claims","type":"text","label":"Are you aware of any Incidents, Conditions, Circumstances which may Result in a claim?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Prior Insurance","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"Has the Applicant ever been refused cyber security or similar insurance or had a similar policy cancelled? Yes/ No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach details if Yes","type":"attachment","label":"If “yes”, please attach details.","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Does the Applicant currently have cyber security or similar insurance? Yes/No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide current insurance details if Yes","type":"text","label":"If “yes”, please provide the following details: Insurer, Limits, Deductible, Policy Period","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Requested Limit and Policy Period","fields":[{"help":"Select one limit","type":"choice","label":"Requested Limit (Tick on desired Limits, mentioned below)","options":["₹ 1,00,000","₹ 2,00,000","₹ 5,00,000","₹ 10,00,000","₹ 20,00,000","₹ 30,00,000","₹ 50,00,000","₹ 75,00,000","₹ 10,00,000","₹ 15,00,000","₹ 20,00,000"],"required":true,"pdf_field":""},{"help":"Start date of policy","type":"date","label":"Policy period required from (12 months only)","options":[],"required":true,"pdf_field":""},{"help":"End date of policy","type":"date","label":"To","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Specify payment mode","type":"text","label":"Mode of Payment","options":[],"required":true,"pdf_field":""},{"help":"Provide payment reference or details","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Enter premium amount","type":"amount","label":"Amount in (₹)","options":[],"required":true,"pdf_field":""},{"help":"Date payment was made","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Provide PAN if premium ≥ ₹100,000","type":"text","label":"PAN (If premium is 1 Lac and Above.)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details of Proposer for Refund or Claim Purpose","fields":[{"help":"Name on bank account for refunds/claims","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":true,"pdf_field":""},{"help":"Bank branch details","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Account number for refunds/claims","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Nominee's full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Nominee's date of birth","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Relationship to proposer","type":"text","label":"Relationship with the proposer","options":[],"required":true,"pdf_field":""},{"help":"Nominee's mobile number","type":"phone","label":"Mobile Number","options":[],"required":true,"pdf_field":""},{"help":"Nominee's email address","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"Nominee's present address","type":"text","label":"Address of Nominee: Present address","options":[],"required":true,"pdf_field":""},{"help":"Nominee's permanent address or same as present","type":"text","label":"Permanent address: (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"Nominee's bank account holder name","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":true,"pdf_field":""},{"help":"Nominee's bank branch","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Nominee's bank account number","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Nominee's bank IFSC code","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""},{"help":"Provide authorized person details if nominee is minor","type":"text","label":"Authorized person details (in case nominee is a minor)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Proposer","fields":[{"help":"Sign and date the form","type":"signature","label":"Signature of the Proposer(s) (Affix stamp, where proposer is a juridical person)","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Intermediary Use Only","fields":[{"help":"Name of intermediary","type":"text","label":"Name of Insurance Agent/POSP/Specified Person of the Corporate Agent/Authorized Person of the Broker/IMF","options":[],"required":true,"pdf_field":""},{"help":"Code of intermediary","type":"text","label":"Intermediary’s Code","options":[],"required":true,"pdf_field":""},{"help":"Signature of intermediary","type":"signature","label":"Intermediary’s Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary"}],"deadlines":[],"applies_to":"Group Personal Cyber Risk Policy","attachments":["If additional space is needed, attach a separate signed and dated sheet referencing the question number","Complete description of security incidents if any","Details if previously refused or cancelled insurance","Annexure with GSTIN details if more than one GSTIN"],"declarations":["All statements and information provided are complete and accurate with no material facts withheld.","Misrepresentation or suppression of material facts may render the policy void and premium forfeited.","The insurer adheres to anti-financial crime practices and may verify records and reject or terminate policy if violations occur.","Premiums are paid from legitimate sources and the insurer may verify source of funds.","Consent is given to receive communications electronically and for processing of personal data for the policy.","Consent is given for insurer to access CKYC records for verification.","The proposer agrees to abide by the insurer's Privacy Policy.","The insurer may reject the proposal or terminate the contract if the proposer or associated persons are named in any recognized sanctions list.","KYC records are current and proposer will inform insurer of any changes."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"grievance","channel":"email","value":"GCIcare@generalicentral.com","label":"HELPLINE Email","level":1,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"atrix given below.\nLEVEL 1\nYou Can Call On Our HELPLINE\n1800-220-233 / 1860-500-3333 / 022-67837800\nOR\nSEND US AN EMAIL\nGCIcare@generalicentral.com\nOur senior citizen policyholders can avail priority support by choosing the valid option from the helpline menu or writ","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-220-233 / 1860-500-3333 / 022-67837800","label":"HELPLINE","level":1,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"may have. You can escalate your concerns as per the\nescalation matrix given below.\nLEVEL 1\nYou Can Call On Our HELPLINE\n1800-220-233 / 1860-500-3333 / 022-67837800\nOR\nSEND US AN EMAIL\nGCIcare@generalicentral.com\nOur senior citizen policyholders can avail priority support by choosing","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Generali Central Insurance Company Ltd.\nUnit No. 301, 3rd Floor Part, Building No. 8,\nMindspace IT/ITES SEZ, MIDC Industrial Area,\nAiravali, Navi Mumbai,\nThane District – 400 708.","label":"Corporate Grievance Redressal Officer (GRO) Address","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mishra\nADDRESS\nGenerali Central Insurance Company Ltd.\nUnit No. 301, 3\nrd\nFloor Part, Building No. 8,\nMindspace IT/ITES SEZ, MIDC Industrial Area,\nAiravali, Navi Mumbai,\nThane District – 400 708.\nLEVEL 3\nIf you are still not satisfied with the solution provided, you can email\nour CEO’s office.\nEMAIL OUR CEO’s OFF","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"GCIGRO@generalicentral.com","label":"Corporate Grievance Redressal Officer (GRO) Email","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"solution provided to you does not meet your expectations,\nyou can write directly to our Corporate GRO.\nSEND US AN EMAIL\nGCIGRO@generalicentral.com\nOR\nCALL US ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mish","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"+91-79001 97777","label":"Corporate Grievance Redressal Officer (GRO) Phone","level":2,"hours":null,"applies_to":"all","source_url":"https://www.generalicentralinsurance.com/customer-service/grievance-redressal","quote":"ur expectations,\nyou can write directly to our Corporate GRO.\nSEND US AN EMAIL\nGCIGRO@generalicentral.com\nOR\nCALL US ON\n+91-79001 97777\nOR\nSend your complaint to our Corporate Grievance Redressal Officer\nMr. Hari Shankar Mishra\nADDRESS\nGenerali Central In","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/generali-central-insurance/2777-group-personal-cyber-risks-policy-proposal-form"}