{"id":2797,"title":"FIDELITY GURANTEE 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/fidelity-guarantee-insurance/proposal-forms/fidelity-guarantee-insurance-retail-proposal-form.pdf","sha256":"8175344f539c1594668fd93ba1f2dece1cc9a517407905f0619837fcf4f09105","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (individual or entity) to apply for Fidelity Guarantee Insurance coverage, providing details about their business, employees, and risk management practices.","notes":["Read the prospectus/key features/policy wordings before completing the form.","Disclose all material facts fully and do not suppress any material facts.","Attach separate signed and dated sheets if space is insufficient for answers.","Cover commences only after acceptance and receipt of premium.","Use original documents where required.","Fill all questions in full.","For premium above Rs 10,000, fill request for authorization form for NEFT payments.","The company reserves the right to reject proposals or terminate contracts if the proposer is named in any blacklist.","Section 41 of Insurance Act prohibits rebates as inducements for insurance."],"title":"FIDELITY GURANTEE 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":"Proposer Details","fields":[{"help":"Enter the start and end dates of the insurance coverage period","type":"date","label":"Period of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Full legal name of the proposer","type":"text","label":"Name of the Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"Complete current address including state, pin code, telephone and mobile numbers","type":"text","label":"Present Address of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Complete permanent address or 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":"Describe the nature of the business","type":"text","label":"Business of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Date or year when the business was established","type":"date","label":"Since when Established","options":[],"required":true,"pdf_field":""},{"help":"Central KYC Registry number if available","type":"text","label":"CKYC No. (if available)","options":[],"required":false,"pdf_field":""},{"help":"Select 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":"Select 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":"Describe type of impairment if applicable","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"Enter percentage if applicable","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":""},{"help":"Select Yes or No","type":"yes-no","label":"Have there been any reported losses (whether insured or not) due to fraud or dishonesty of employees, partners or directors during the last five years?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has any Insurer in respect of the risks to which this proposal relates ever declined a proposal, refused renewal or cancelled an insurance?","options":[],"required":true,"pdf_field":""},{"help":"Provide details; attach separate sheet if needed","type":"text","label":"If yes please provide details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Cover Options and Employee Details","fields":[{"help":"Select one cover option","type":"choice","label":"Which of the following types of cover do you require? (Please tick only one option)","options":["Cover entire workforce (please complete Question 12)","Cover for selected categories of employees only (please complete Question 13)","Cover for named employees only (please complete Question 14)","Cover for selected categories of employees and named employees (please complete Questions 13 and 14)"],"required":true,"pdf_field":""},{"help":"Fill details for staff with direct responsibility and other staff","type":"table","label":"Cover for entire workforce - Category of staff, No. of employees, Estimated annual wages (Rs), Employee Sum Insured (Rs)","options":[],"required":false,"pdf_field":""},{"help":"Provide details for selected categories","type":"table","label":"Cover for selected categories of employees - Category of staff, No. of employees, Employee Sum Insured (Rs)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Employee Honesty and Control Systems","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Is there a system to obtain references from previous Employers?","options":[],"required":true,"pdf_field":""},{"help":"Describe alternative practice if no references obtained","type":"text","label":"If NO, specify practice followed","options":[],"required":false,"pdf_field":""},{"help":"Provide maximum amounts and duration","type":"table","label":"State the estimate of maximum amount held by any employee at any one time and for how long? (Money, Stock, Amount (Rs), Period (no. of years))","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has there been any occasion to question honesty or conduct of any person proposed for guarantee?","options":[],"required":true,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If yes, please provide details","options":[],"required":false,"pdf_field":""},{"help":"Describe frequency","type":"text","label":"How often are the employees required to account for money?","options":[],"required":true,"pdf_field":""},{"help":"Describe system","type":"text","label":"What independent system is there to check that all sums received by employees are accounted for?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is the division of responsibilities between departments, sections and different employees well defined in respect of ordering of stocks and materials, the recording of receipt of such and authorizing payment for them, so that no one person handles a transaction from beginning to end?","options":[],"required":true,"pdf_field":""},{"help":"Describe division of responsibilities","type":"text","label":"If yes, please provide details","options":[],"required":false,"pdf_field":""},{"help":"Describe frequency","type":"text","label":"How often is the cash book balanced, the entries checked with vouchers and Bank’s Pass Book and with counterfoils of receipt books?","options":[],"required":true,"pdf_field":""},{"help":"Describe frequency","type":"text","label":"How often is the cash book balanced and the stock books reconciled with control records?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is there a requirement of at least two signatories to authorise payments?","options":[],"required":true,"pdf_field":""},{"help":"Describe signatories and confirmation","type":"text","label":"If yes, please give description of such authorised signatories and confirm that the requirement for co-signatories is followed","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is there a requirement of dual signatories for cheques issuance, and is such requirement met?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do the employees who receive cash and cheques in the course of their duties issue pre-numbered official receipts as confirmation of the receipt?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are all the cash and cheques received banked in daily or at the latest the next banking day?","options":[],"required":true,"pdf_field":""},{"help":"Explain if banking is delayed","type":"text","label":"If no, please specify","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is there an imprest system for handling of petty cash funds?","options":[],"required":true,"pdf_field":""},{"help":"List authorized persons","type":"text","label":"If yes, please specify the persons who are authorised to manage the petty cash funds","options":[],"required":false,"pdf_field":""},{"help":"Describe bank account operation and precautions","type":"text","label":"What is the system of operation of Bank account followed and what are the precautions taken?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Whether such payments/ withdrawals are authorized by a senior employee and compared with supporting documents?","options":[],"required":true,"pdf_field":""},{"help":"Describe frequency","type":"text","label":"How often are the bank reconciliations and check of receipt counterfoils and vouchers being carried out?","options":[],"required":true,"pdf_field":""},{"help":"Describe credit conditions","type":"text","label":"Under what circumstances will your customers qualify for credit privileges?","options":[],"required":true,"pdf_field":""},{"help":"Describe frequency","type":"text","label":"How often is the balancing and control of debtor accounts with statements sent to all debtors?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are there stocks (of any kind) kept for the conduct of your business?","options":[],"required":true,"pdf_field":""},{"help":"Describe frequency","type":"text","label":"How often are stock-takings conducted?","options":[],"required":true,"pdf_field":""},{"help":"List responsible persons","type":"text","label":"Please list the persons responsible for carrying out stock-taking","options":[],"required":true,"pdf_field":""},{"help":"Provide maximum amount and if exceeded","type":"text","label":"Please state the maximum amount of stocks each employee can requisition at any one time? Is this ever exceeded?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is there close supervision of storage and custody of all stocks maintained?","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are all deliveries to and from stores properly authorised?","options":[],"required":true,"pdf_field":""},{"help":"Provide date, auditor and findings","type":"text","label":"When was the last stock audit undertaken, by whom, and what did it reveal?","options":[],"required":true,"pdf_field":""},{"help":"Provide date, auditor and findings","type":"text","label":"When was the proposer last audited, by whom, and what did the audit reveal?","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 paid","type":"amount","label":"Amount in (₹)","options":[],"required":true,"pdf_field":""},{"help":"Date when payment was made","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"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) 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":"Name on bank account","type":"text","label":"Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":true,"pdf_field":""},{"help":"Name and branch of bank","type":"text","label":"Bank Name & Branch","options":[],"required":true,"pdf_field":""},{"help":"Bank account number","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":"Full name of nominee","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 address","type":"text","label":"Address of Nominee","options":[],"required":true,"pdf_field":""},{"help":"Nominee's present address","type":"text","label":"Present address","options":[],"required":true,"pdf_field":""},{"help":"Nominee's 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":"Name on nominee's bank account","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":true,"pdf_field":""},{"help":"Nominee's bank name and 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 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":"Declarations","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 the form; stamp if applicable","type":"signature","label":"Signature of the Proposer(s) (Affix stamp, where proposer is a juridical person)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"For 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":"Fidelity Guarantee Insurance","attachments":["Separate signed and dated sheet for answers if insufficient space","Separate sheet for details of reported losses due to fraud or dishonesty","Separate sheet for details if insurer declined proposal or imposed conditions","Separate sheet for named employees if needed","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 insurer adheres to anti-financial crime practices and may require assistance with relevant records.","Premiums are paid from legitimate sources and the insurer may verify source of funds and reject or terminate policy if otherwise.","Consent is given to receive communications electronically and for processing of personal data as per privacy policy.","Consent is given for insurer to access CKYC records for verification and communication.","The insurer may reject 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":4},"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/2797-fidelity-gurantee-insurance-proposal-form"}