{"id":2778,"title":"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/personal-cyber-risks-policy/proposal-forms/personal-cyber-risks-policy-retail-proposal-form.pdf","sha256":"4788448eaf694f6e9cd07085c140824606612dccb79bdc6d69ff348fd767b30d","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals aged above 21 years to apply for a Personal Cyber Risk Insurance Policy with Generali Central Insurance Co. Ltd. The proposer fills this form to provide personal, device, and insurance-related information for underwriting the policy.","notes":["Insurance is a contract of utmost good faith; disclose all material facts","Person above 21 years can apply","Cover commences only after acceptance and premium receipt","Use separate sheet if more space is needed, signed and dated","Deductible amount does not apply under Personal Malware Cover","Limits mentioned are sub-limited to Limits of Liability under all insuring clauses","Original bills and documents may be required for claims","Go Green initiative: policy document will be sent electronically unless physical copy is requested by ticking the box","Section 41 of Insurance Act prohibits rebates except as allowed by insurer's published prospectus","Anti-money laundering and anti-financial crime compliance is mandatory"],"title":"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":null,"pdf_field":""},{"help":"","type":"text","label":"Present Address of the Proposer:","options":[],"required":null,"pdf_field":""},{"help":"","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":"Format: DD/MM/YYYY","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Male or Female:","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Enter 12-digit Aadhaar number","type":"text","label":"Aadhaar Card Number:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation:","options":[],"required":null,"pdf_field":""},{"help":"Central KYC Registry number if available","type":"text","label":"CKYC Number (if available):","options":[],"required":false,"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.","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":"Provide device IMEI/Serial and Make for each device listed","type":"table","label":"Information of your devices including information of your spouse and Children(s) - Device Details (IMEI/Serial, Make) for Mobile-1, Mobile-2, Laptop, Desktop, Tablets","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Cover","fields":[{"help":"Tick Yes or No","type":"yes-no","label":"Do you wish to insure covers towards credit card loss cover? YES/NO","options":["YES","NO"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Your Activity","fields":[{"help":"Tick 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 device and on your Cards? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Do you use anti-virus, anti-spyware and anti-malware software? Yes/No","options":["Yes","No"],"required":null,"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":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Security Incident and Loss History","fields":[{"help":"Tick 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":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Are you aware of any Incidents, Conditions, Circumstances which may Result in a claim?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Prior Insurance","fields":[{"help":"Tick 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":null,"pdf_field":""},{"help":"Attach details if answer is Yes","type":"attachment","label":"If yes, please attach details.","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Does the Applicant currently have cyber security or similar insurance? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide insurer name, limits, deductible, and policy period if current insurance exists","type":"text","label":"If yes, please provide the following details: Insurer, Limits, Deductible, Policy Period","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Policy Period and Premium Details","fields":[{"help":"Enter start date of policy coverage","type":"date","label":"Policy period required from: (12 months only)","options":[],"required":null,"pdf_field":""},{"help":"Specify payment mode","type":"choice","label":"Mode of Payment","options":[],"required":null,"pdf_field":""},{"help":"Provide payment reference or details","type":"text","label":"Payment Details","options":[],"required":null,"pdf_field":""},{"help":"Enter premium amount paid","type":"amount","label":"Amount in (₹)","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YY","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":null,"pdf_field":""},{"help":"Provide PAN if premium is 100,000 or more","type":"text","label":"PAN (If premium is 1 Lac and Above.)","options":[],"required":false,"pdf_field":""},{"help":"Provide GSTIN or attach annexure if multiple","type":"text","label":"GSTIN (If more than one GSTIN, kindly attach an annexure with details)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details of Proposer for Refund or Claim Purpose","fields":[{"help":"","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder):","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number:","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFS Code:","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the proposer:","options":[],"required":null,"pdf_field":""},{"help":"Enter 10-digit mobile number","type":"phone","label":"Mobile Number:","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E-Mail ID:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of Nominee - Present address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Permanent address: (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Details of Nominee - Name of Account holder:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Name & Branch:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Account Number:","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFS Code:","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Authorized Person Details (in case nominee is a minor)","fields":[{"help":"Provide details if nominee is minor","type":"text","label":"Authorized person details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Proposer","fields":[{"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":""},{"help":"Sign here","type":"signature","label":"Signature of the Proposer(s)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Personal Cyber Risk Policy","attachments":["If additional space is needed, attach a separate signed and dated sheet referencing the relevant question number","If answer to security incident question is yes, attach a complete description of the incident(s)","If refused or cancelled prior insurance, attach details","If more than one GSTIN, attach an annexure with details","Request for authorization form to receive Claim/Refund payments if premium paid is more than Rs 10,000"],"declarations":["All statements and information provided are complete and accurate and form the basis of the insurance contract","Misrepresentation or suppression of material facts may render the policy void and premium forfeited","Policyholder and related persons will assist insurer with records and information to address anti-financial crime practices","Premium paid is from legitimate sources and insurer may verify source of funds and reject or terminate policy if otherwise","Consent to receive policy and service communications electronically and for insurer to process personal data as needed","Consent to insurer accessing CKYC records for verification and receiving information via SMS/email","Agreement to abide by insurer's Privacy Policy","Insurer reserves right to reject proposal or terminate contract if proposer or associated persons are named in sanctions list","KYC records are current and proposer will inform insurer of any changes"],"dropped_labels":3},"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/2778-personal-cyber-risks-policy-proposal-form"}