{"id":2792,"title":"ELECTRONIC EQUIPMENT INSURANCE PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/electronic-equipment-insurance/proposal-forms/electronic-equipment-insurance-proposal-form.pdf","sha256":"8745976a16db9db8d9061926de9027ef49db431f4580ea29c640ee7f37591b57","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for electronic equipment insurance with Generali Central Insurance Co. Ltd. The proposer fills it out to provide details about themselves, the equipment, and other relevant information for underwriting.","notes":["Read prospectus/key features/policy wordings before completing the form.","Answer all questions; attach separate signed sheet if more space is needed.","Cover starts only after acceptance and premium receipt.","If permanent address is left blank, it is considered same as present address.","Use original bills and documents as required for claims (implied from general insurance practice).","For premium above Rs 10,000, fill authorization form for NEFT payments.","The insurer reserves the right to reject proposal or terminate contract if proposer or associated persons are on any blacklist or sanctions list.","Use block letters where applicable (implied).","Physical copy of policy available on request; otherwise policy will be sent electronically."],"title":"ELECTRONIC EQUIPMENT INSURANCE PROPOSAL FORM","submit":{"to":"Generali Central Insurance Company Limited","how":"","address":"Registered Office: Unit No. 801 & 802, 8th Floor, Tower C, Embassy 247 Park, LBS Marg, Vikhroli (West), Mumbai – 400083\nEmail ID: gcicare@generalicentral.com\nToll-free Phone: 1800 220 233 / 1860 500 3333 / 022 6783 7800"},"purpose":"proposal","sections":[{"title":"Section I - Proposer and Equipment Details","fields":[{"help":"Enter start and end date of insurance period","type":"date","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"Include state and pin code","type":"text","label":"A. Present Address of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"Include state and pin code","type":"text","label":"B. Permanent address of the proposer (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Telephone no.","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile no.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Type of Business","options":[],"required":null,"pdf_field":""},{"help":"Include state and pin code","type":"text","label":"Location of equipment to be insured (address of building/ storey)","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":"choice","label":"If you are Differently Abled, please tick on the checkbox to provide confirmation.","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"If Yes to differently abled, specify type","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes to differently abled, specify percentage","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes to differently abled, provide UDID number","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""},{"help":"Tick all that apply","type":"checkbox","label":"Structure of Building","options":["Steel Skeleton","Brickwork","Concrete","Wood"],"required":null,"pdf_field":""},{"help":"If yes, specify items and companies","type":"yes-no","label":"Has any of the equipment to be insured previously been covered by other insurance companies?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"List items and companies","type":"text","label":"If YES, which items of the specification and by which companies?","options":[],"required":false,"pdf_field":""},{"help":"Start date of insurance","type":"date","label":"State when Insurance is to commence.","options":[],"required":null,"pdf_field":""},{"help":"If no, specify second-hand items","type":"yes-no","label":"Is all the equipment to be insured new?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"List second-hand items","type":"text","label":"If not, which items of the specification are second-hand?","options":[],"required":false,"pdf_field":""},{"help":"List items obtainable ex works","type":"text","label":"What equipment can still be obtained ex works? (State items of the specification)","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Condition of equipment – Is the equipment maintained in accordance with the manufacturer's instructions?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Quality of staff – Have operators been trained with manufacturer?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"If yes, specify cause","type":"yes-no","label":"Is there a risk of flood and inundation?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Tick applicable causes","type":"checkbox","label":"If YES, specify","options":["By bodies of water","By torrential rainfall","By sewer backflow","Or by others"],"required":false,"pdf_field":""},{"help":"If yes, specify materials","type":"yes-no","label":"Are dangerous materials used in the vicinity?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Tick applicable materials","type":"checkbox","label":"If YES, specify","options":["Acids","Prepared or sensitized papers","Dyes","Test solutions","Developers","Explosives","Isotopes","Others"],"required":false,"pdf_field":""},{"help":"If yes, enclose copy","type":"yes-no","label":"Is a valid Maintenance Contract in force?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Tick applicable","type":"checkbox","label":"Air conditioning Plant is","options":["Pressurized","Recommended by manufacturers","Not necessary"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section II - Electronic Data Processing (EDP)","fields":[{"help":"","type":"date","label":"Date of start of operation","options":[],"required":false,"pdf_field":""},{"help":"Enter hours per day","type":"number","label":"Operational hours per day in shifts","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name and address of manufacturer and/or lessor","options":[],"required":false,"pdf_field":""},{"help":"Attach copy of lease contract if available","type":"text","label":"What are the provisions of your lease contract regarding your liability in the case of damage to the EDP system?","options":[],"required":false,"pdf_field":""},{"help":"If no, specify deviations","type":"yes-no","label":"Is Installation in accordance with the manufacturer’s recommendations?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If not, specify deviations from instructions","options":[],"required":false,"pdf_field":""},{"help":"Tick applicable installation method","type":"checkbox","label":"State the manner in which the EDP system has been installed","options":["On vibration absorbers","On rollers","By rigid anchoring","Without anchoring"],"required":false,"pdf_field":""},{"help":"Tick applicable","type":"checkbox","label":"Air-conditioning Plant","options":["Prescribed","Recommend by the manufacturer","Used for EDP system only"],"required":false,"pdf_field":""},{"help":"If yes, specify for excessive temperature or moisture","type":"yes-no","label":"Does the air conditioning plant automatically shut off by limit switches, if the normal control facility fails?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify optical or acoustic signal and conditions","type":"yes-no","label":"Is the airconditioning plant also equipped with an independent signaling device in case of disturbance or failure?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are adequate loss prevention measures initiated immediately, even if the above protective devices are actuated outside operational hours?","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section III - Increased Cost of Working","fields":[{"help":"","type":"yes-no","label":"Is it possible in the event of failure to utilize other EDP system so as to obviate using an outside system?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify","type":"yes-no","label":"Are there any special agreement regarding continued payment of the rent and other costs if the EDP system fails?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify","type":"yes-no","label":"Is the use of the outside EDP systems subject to any special conditions (waiting periods, conversion measures, etc.)?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify frequency, max duration and max cost incurred","type":"yes-no","label":"Has the system already been used?","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"Specify causes of failure","type":"text","label":"Causes","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Indemnity period per occurrence (Weeks)","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Aggregate indemnity limit during the period of insurance (Rs.)","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Personnel Expenses (Rs.)","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Transportation of material (Rs.)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"","type":"text","label":"Mode of Payment","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Payment Details","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Amount in (₹)","options":[],"required":null,"pdf_field":""},{"help":"","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(s)","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":"","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":"","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":"","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"E-Mail ID","options":[],"required":false,"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":"","type":"text","label":"IFS Code","options":[],"required":null,"pdf_field":""},{"help":"Provide 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":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Electronic Equipment Insurance policies","attachments":["Separate signed and dated sheet if additional space is needed","Copy of lease contract if available","Copy of valid Maintenance Contract if in force","Annexure with GSTIN details if more than one GSTIN"],"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.","The policyholder and related persons will assist the insurer with anti-financial crime compliance.","Premium is paid from legitimate sources and insurer may verify source of funds and reject policy if otherwise.","Consent to receive communications electronically and for processing of personal data as per privacy policy.","Consent for insurer to access CKYC records for verification and communication.","KYC records are current and proposer will inform insurer of any changes."],"dropped_labels":14},"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/2792-electronic-equipment-insurance-proposal-form"}