{"id":2784,"title":"CONSEQUENTIAL LOSS (FIRE) OF PROFIT PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/consequential-loss-fire-of-profit/proposal-forms/consequential-loss-fire-of-profit-retail-proposal-form.pdf","sha256":"012ef5346e90af9c243c6d2b956c022237e22b81a198632b58b4bb8371975ab7","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for Consequential Loss (Fire) of Profit insurance policy with Generali Central Insurance Co. Ltd.","notes":["Use separate signed and dated sheet if space is insufficient for answers.","Attach one copy of latest audited accounts.","Attach annexure for multiple GSTINs if applicable.","Fill PAN if premium is 1 lakh or above.","Request authorization form needed to receive claim/refund payments via NEFT if premium paid is more than Rs 10,000.","Original bills and documents may be required for claims (implied).","Use block letters where applicable (implied).","The form is subject to utmost good faith and disclosure of all material facts.","The insurer reserves the right to reject proposal or terminate contract unilaterally under certain conditions.","Section 41 of Insurance Act prohibits rebates on commission or premium."],"title":"CONSEQUENTIAL LOSS (FIRE) OF PROFIT PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Present Address of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin code","options":[],"required":true,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Telephone no.","options":[],"required":false,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile no.","options":[],"required":false,"pdf_field":""},{"help":"If different from present address","type":"text","label":"Permanent Address of the Proposer","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin code","options":[],"required":false,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Telephone no.","options":[],"required":false,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile no","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Business Details","fields":[{"help":"Describe your business activity","type":"text","label":"Nature of Trade or Business","options":[],"required":true,"pdf_field":""},{"help":"Enter amount in million rupees","type":"number","label":"Please specify Paid-up capital of the firm (in Rs. Million)","options":[],"required":true,"pdf_field":""},{"help":"Central KYC Registry number if applicable","type":"text","label":"CKYC number (if available)","options":[],"required":false,"pdf_field":""},{"help":"Tick all that apply","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":"If differently abled, specify impairment type","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If differently abled, specify percentage","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Unique Disability ID if applicable","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details","fields":[{"help":"Number of insured locations","type":"number","label":"Please specify the number of locations to be insured","options":[],"required":true,"pdf_field":""},{"help":"Provide full address(es) of insured location(s)","type":"text","label":"Please provide the address of the location to be insured (Please attach separate sheet for multiple locations)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":true,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin code","options":[],"required":true,"pdf_field":""},{"help":"Include STD code if applicable","type":"phone","label":"Telephone no.","options":[],"required":false,"pdf_field":""},{"help":"10 digit mobile number","type":"phone","label":"Mobile no.","options":[],"required":false,"pdf_field":""},{"help":"List all joint insured parties","type":"text","label":"Please provide details of Joint Insured (i.e. list of all the parties who have insurable interest including financial institutions/banks)","options":[],"required":false,"pdf_field":""},{"help":"Number of years","type":"number","label":"How long have you carried on business in these premises or elsewhere?","options":[],"required":true,"pdf_field":""},{"help":"Select one","type":"choice","label":"Describe type of Process","options":["Continuous Process","Other than Continuous Process"],"required":true,"pdf_field":""},{"help":"Number of months indemnity period","type":"number","label":"Please specify the indemnity period required in months","options":[],"required":true,"pdf_field":""},{"help":"Enter amount in rupees","type":"amount","label":"Sum insured: a. Gross Profit (Net Profit and Standing Charges)","options":[],"required":true,"pdf_field":""},{"help":"Provide serial no., description of standing charges, and amount for each","type":"table","label":"Please specify the standing charges to be covered in detail","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Are your books regularly audited?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide auditor details and attach latest audited accounts","type":"text","label":"Please indicate the name and address of the auditors and enclose one copy of the latest audited accounts","options":[],"required":false,"pdf_field":""},{"help":"Provide insurer name, location, property covered, sum insured, date, premium, commencement and expiry of cover","type":"table","label":"Please furnish particulars of sum insured, period of insurance and premium of all Fire Insurance (material damage) policies in respect of the premises now proposed for loss of profits insurance","options":[],"required":false,"pdf_field":""},{"help":"Select one","type":"choice","label":"Please indicate the basis of indemnity required","options":["Turnover basis","Output basis","Difference basis","Revenue basis"],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Has any insurance company declined your proposal or cancelled any insurance?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Explain reason if any proposal was declined or insurance cancelled","type":"text","label":"If YES, please provide details","options":[],"required":false,"pdf_field":""},{"help":"Provide claim details for last 3 years","type":"text","label":"Please provide details of Claims Experience for the last three years","options":[],"required":false,"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 amount paid in rupees","type":"amount","label":"Amount in (₹)","options":[],"required":true,"pdf_field":""},{"help":"Date format day/month/year","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Permanent Account Number if premium ≥ 1 lakh","type":"text","label":"PAN (If premium is 1 Lac and Above.)","options":[],"required":false,"pdf_field":""},{"help":"Goods and Services Tax Identification Number","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":"Name as per bank records","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":true,"pdf_field":""},{"help":"Full bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Account number for refund or claim","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Indian Financial System Code","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Nominee full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Date format day/month/year","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship with the proposer","options":[],"required":true,"pdf_field":""},{"help":"Nominee mobile number","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Nominee email address","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"Nominee full address","type":"text","label":"Address of Nominee","options":[],"required":true,"pdf_field":""},{"help":"Nominee present address","type":"text","label":"Present address","options":[],"required":false,"pdf_field":""},{"help":"Nominee permanent address","type":"text","label":"Permanent address: (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"Details below","type":"section","label":"Bank Account Details of Nominee","options":[],"required":false,"pdf_field":""},{"help":"Nominee bank account holder name","type":"text","label":"Name of Account holder","options":[],"required":false,"pdf_field":""},{"help":"Nominee bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":false,"pdf_field":""},{"help":"Nominee bank account number","type":"text","label":"Bank Account Number","options":[],"required":false,"pdf_field":""},{"help":"Nominee bank IFSC code","type":"text","label":"IFS Code","options":[],"required":false,"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":"Declarations","fields":[{"help":"Sign here","type":"signature","label":"Proposer’s Signature","options":[],"required":true,"pdf_field":""},{"help":"Location 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":"proposer"},{"title":"Intermediary Use Only","fields":[{"help":"Full name","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 assigned to intermediary","type":"text","label":"Intermediary’s Code","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Intermediary’s Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary"}],"deadlines":[],"applies_to":"Consequential Loss (Fire) of Profit Policy","attachments":["Separate signed and dated sheet if insufficient space to answer any question","One copy of the latest audited accounts","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.","Policyholder and related persons will assist the insurer with records to address anti-financial crime practices.","Premium is paid from legitimate sources and insurer may verify source of funds and reject policy if otherwise.","Consent to receive policy and service communications electronically and for processing of personal data.","Consent to insurer accessing CKYC records for verification and receiving related information.","Agreement to abide by insurer's Privacy Policy.","Insurer may reject proposal or terminate contract if proposer or associates are named in sanctions lists.","KYC records are current and proposer will inform insurer of any changes."],"dropped_labels":0},"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/2784-consequential-loss-fire-of-profit-proposal-form"}