{"id":2794,"title":"ERRORS AND OMISSIONS INSURANCE POLICY PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/errors-and-omissions-insurance-policy/proposal-forms/errors-and-omissions-insurance-policy-proposal-form-retail.pdf","sha256":"6fb011633765fa334c1d247e7378c9e91deb7e4a6fd2090985426508491c8466","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (individual or firm) to apply for an Errors and Omissions Insurance Policy by providing detailed information about their business, professional activities, and insurance history.","notes":["Answer all questions fully and accurately; provide additional information on separate sheet if needed.","Failure to disclose material facts may result in claim rejection or policy avoidance.","Use of utmost good faith is required.","If premium paid is more than Rs 10,000, fill request for authorization form for NEFT payments.","Physical copy of policy document available on request; otherwise digital copy will be sent.","Section 41 of Insurance Act, 1938 prohibits rebates on commission or premium."],"title":"ERRORS AND OMISSIONS INSURANCE POLICY PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer and Business Details","fields":[{"help":"Enter the start and end dates of the policy period","type":"date","label":"Policy Period From To","options":[],"required":null,"pdf_field":""},{"help":"Enter the full legal name of the firm or proposer","type":"text","label":"Name of Firm/ Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter the current office address","type":"text","label":"Present address of office/ Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter the permanent office address","type":"text","label":"Permanent address of office/ Proposer","options":[],"required":true,"pdf_field":""},{"help":"List addresses of any other offices","type":"text","label":"Address of all other offices","options":[],"required":false,"pdf_field":""},{"help":"Enter Central KYC Registry number if available","type":"text","label":"CKYC No. (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":null,"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":"Select Yes or No","type":"choice","label":"If you are Differently Abled, please tick on the checkbox to provide confirmation","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If Yes above, specify type of impairment","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes above, specify percentage","type":"number","label":"Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes above, provide UDID number","type":"text","label":"UDID Number","options":[],"required":false,"pdf_field":""},{"help":"Describe your profession or business activities in detail","type":"text","label":"State nature of the profession/ business including full details of activities undertaken and any intended change in these","options":[],"required":true,"pdf_field":""},{"help":"Enter the date or year of establishment","type":"date","label":"When was Firm established","options":[],"required":true,"pdf_field":""},{"help":"Provide Name, Qualifications, Date Qualified, Number of years in this capacity with Proposer","type":"table","label":"Give details of partners/directors/sole practitioner","options":[],"required":true,"pdf_field":""},{"help":"Enter number of technical and non-technical staff","type":"number","label":"State number of permanent staff Technical Staff Non-Technical Staff","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No for each question and provide details if Yes","type":"choice","label":"Does the proposer or any partner / director act on behalf of or undertake for work for any company or business? a) which forms part of the same group of companies or businesses as the Proposer (e.g. subsidiary, associate, parent) or b) in which the Proposer or any partner/ director has a financial interest and is able to take or influence major policy decisions in such company or business If ‘Yes’ in either case, please give details","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide start and end dates of financial year","type":"text","label":"State the dates of the financial year","options":[],"required":true,"pdf_field":""},{"help":"Provide gross fees or turnover for last and current financial year by territory","type":"table","label":"State the gross fees for the last and current financial year (including those paid to sub-contractors) payable by clients. If the business is newly established, state the estimated gross fees for the forthcoming year. For any non-fee earning business / practice, state total turnover. i) In territory where domiciled ii) In the USA/Canada or elsewhere for clients whose address is in the USA/Canada iii) Elsewhere Total","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No and provide details if Yes","type":"choice","label":"Is the Proposer represented in any way in the USA or Canada? If ‘Yes’, state how (e.g. by subsidiary company, local office, local representative or by any other person or concern holding a power of attorney on behalf of the Proposer)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide amounts for last and current financial year","type":"table","label":"State a) gross fees paid to sub-contractors b) largest fee earned from any client Last Financial Year Current Financial Year (Estimate)","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No and provide insurance details if Yes","type":"choice","label":"Does the Proposer currently hold any Professional Indemnity Insurance? If ‘Yes’ state Renewal Date Limit of Indemnity Retroactive Date","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No and provide details if Yes","type":"choice","label":"Is cover required for Partners’ Previous Business? If ‘Yes’, state Name of Partner Title of Previous Business Dates with Previous Business","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No for each cover","type":"choice","label":"Please indicate if the following covers are required i) Loss of Documents. If ‘Yes’, does the Proposer keep documents in fire proof cabinets? ii) Libel and Slander iii) Dishonesty of Employees","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No and provide details if Yes","type":"choice","label":"Has any insurer in respect of the risks to which this proposal relates ever a) declined a proposal, refused renewal or terminated an insurance? b) required an increased premium or imposed special conditions? If ‘Yes’ in either case, please give details","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No and provide details if Yes","type":"choice","label":"Has any claim been made against the Proposer or any partner, director, consultant or employee for neglect, error or omission in relation to professional duties? Has the Proposer or any partner, director, consultant or employee incurred any other loss or expense which might be within the terms of the cover? If ‘Yes’ in either case, please give details separately of the circumstances of each incident including any amounts paid and the estimated potential cost of the incident.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No and provide details if Yes","type":"choice","label":"Is the Proposer of any principal, consultant or employee, after enquiry, aware of any circumstances which might a) give rise to a claim against the Proposer or his predecessors in business or any of the present or former partners or principals? b) result in the Proposer or his predecessors in business or any of the present or former partners or principals incurring any losses or expenses which might be within the terms of the cover? c) otherwise affect the Insurer’s consideration of this insurance? If ‘Yes’, please give details separately","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter indemnity amount(s) required","type":"amount","label":"What is the amount of Indemnity required? Please state any alternative amounts for which a quotation is required AOA AOY","options":[],"required":true,"pdf_field":""},{"help":"Enter contribution amount(s) towards each claim","type":"amount","label":"Please state the amount the Proposer wish to contribute towards each and every claim Please state any alternative amounts for which a quotation is required","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium and Payment Details","fields":[{"help":"Select mode of payment","type":"choice","label":"Mode of Payment","options":[],"required":true,"pdf_field":""},{"help":"Provide payment details","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Enter amount paid","type":"amount","label":"Amount in (₹)","options":[],"required":true,"pdf_field":""},{"help":"Enter payment date","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Provide PAN if premium is 100,000 INR or more","type":"text","label":"PAN (If premium is 1 Lac and Above.)","options":[],"required":false,"pdf_field":""},{"help":"Provide GSTIN(s) or attach annexure","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":"Enter bank account holder name","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":true,"pdf_field":""},{"help":"Enter bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFS Code","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Enter nominee's full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's date of birth","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship to proposer","type":"text","label":"Relationship with the proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's mobile number","type":"phone","label":"Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's email address","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's present address","type":"text","label":"Address of Nominee Present address","options":[],"required":true,"pdf_field":""},{"help":"Enter permanent address or leave blank if 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":"Provide nominee's bank details","type":"text","label":"Bank Account Details of Nominee Name of Account holder Bank Name & Branch Bank Account Number IFS Code","options":[],"required":false,"pdf_field":""},{"help":"Provide details of authorized person 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 Insured","fields":[{"help":"Sign and stamp if applicable","type":"signature","label":"Signature of the Proposer(s) (Affix stamp, where proposer is a juridical person)","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"For Intermediary Use Only","fields":[{"help":"Enter intermediary's 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":"Enter intermediary code","type":"text","label":"Intermediary’s Code","options":[],"required":true,"pdf_field":""},{"help":"Intermediary to sign","type":"signature","label":"Intermediary’s Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary"}],"deadlines":[],"applies_to":"Errors and Omissions Insurance Policy proposals","attachments":["Separate sheet if insufficient space to provide relevant information","Annexure with GSTIN details if more than one GSTIN"],"declarations":["All statements and information provided are complete and accurate with no relevant information 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 and information to address anti-financial crime practices.","Premium is paid 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 processing of personal data as per privacy policy.","Consent to insurer accessing CKYC records for verification and receiving information via SMS/email.","Obligation to keep CKYC records current and inform insurer of changes.","Insurer reserves right to reject proposal or terminate contract if proposer or associated persons are named in sanctions lists."],"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/2794-errors-and-omissions-insurance-policy-proposal-form"}