{"id":2800,"title":"FIRE SURAKSHA 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/fire-suraksha-policy/proposal-forms/fire-suraksha-policy-proposal-form.pdf","sha256":"06d8aea377ef7eea6b2c8a4727524d1eec3587a27e6dcff1fb2b978393cd12de","pages":14,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for the Fire Suraksha insurance policy covering home and business properties. The proposer fills it to provide details about themselves, the property, coverage required, and other relevant information.","notes":["Insurance is a contract of utmost good faith requiring full disclosure of material facts.","Answer all questions; use separate signed and dated sheet if needed.","Cover commences only after acceptance and receipt of premium.","For long term policies, period shall not exceed 30 years.","Buildings with wooden planks, thatched leaves, grass, bamboo, plastic cloth, asphalt, canvas, tarpaulin etc. are Kutcha construction; others are Pucca.","Use block letters where applicable.","Original bills and documents may be required for claims.","The company reserves the right to reject proposals or terminate contracts unilaterally in case of blacklisting or non-compliance.","Section 41 of Insurance Act prohibits rebates except as per published prospectus or tables."],"title":"FIRE SURAKSHA POLICY PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"A. Details about Proposer and Policy Period","fields":[{"help":"","type":"text","label":"Name of Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Present Address of 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":"","type":"phone","label":"Phone No. a. Mobile","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Central KYC Registry number if available","type":"text","label":"CKYC No. (if available)","options":[],"required":false,"pdf_field":""},{"help":"List all parties with insurable interest","type":"text","label":"Policy to be issued in favour of (list out all the parties who have insurable interest) including the financial institutions","options":[],"required":null,"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":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":"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":null,"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":"Start date of insurance","type":"date","label":"Period of Insurance From","options":[],"required":null,"pdf_field":""},{"help":"For long term policy, max 30 years","type":"number","label":"Home and Content cover: No of Years in case of long term policy","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"B. Covers Opted","fields":[{"help":"Tick Yes or No","type":"yes-no","label":"Is there any policy in place for the same property? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of existing policy if any","type":"text","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"C. Location of Home Building","fields":[{"help":"Provide full address including pin code","type":"text","label":"Location of Home Building - full postal address with Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Pin code of the location","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Select one","type":"choice","label":"Is it in a multi-storey building or is it a standalone house?","options":["Multi-storey building","Standalone house"],"required":true,"pdf_field":""},{"help":"Floor number of your house in the building","type":"number","label":"Please provide the floor number of Your house","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Is there a basement to Your house?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Business and Location of Business","fields":[{"help":"Describe the business","type":"text","label":"Business of Proposer","options":[],"required":null,"pdf_field":""},{"help":"Provide address, pin code, occupancy, age of unit, floor (GF/MF/Higher Floor) for each location","type":"table","label":"Location of Risk/business to be covered - full–postal address with Pin code","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"D. Details of Home Building","fields":[{"help":"Area in square metres","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":true,"pdf_field":""},{"help":"Rate per square metre","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date","options":[],"required":true,"pdf_field":""},{"help":"Select age category","type":"choice","label":"Age of Home Building","options":["Upto 5 Years","More than 5years - Upto 10 Years","More than 10years Upto 25 Years","Above 25 Years"],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Are Fire Protection devices installed?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick all that apply or specify others","type":"checkbox","label":"If Yes, please select the type","options":["Hand Appliances","Hand Appliances & Hydrant System","Hand Appliances + Hydrant System & independent Sprinkler/ Fixed Water Spray System","Others, pls specify"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Is round the clock security guard available in your premises?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Distance in kilometers","type":"number","label":"Distance of your proposed Property from the public fire station? (in KM)","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Is there a railway crossing in between the public fire station and your Property?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Distance in meters","type":"number","label":"Please provide the distance of your Property from the nearest water body (in meters)","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Please confirm whether your proposed Property has insulated wiring in place?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Are there any loose wiring, connections or improper electrical Installations in your Property?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Are you following standard housekeeping practices in your Property?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details about business covered at the insured location","fields":[{"help":"Tick all that apply and specify others","type":"checkbox","label":"Details of insured property - Please tick in the space below: a. Offices, Shops, Hotels, etc Yes / No b. Industrial / Manufacturing risks Yes / No c. Storage outside Industrial/ Manufacturing risks Yes / No d. Tanks / Gas holders outside Industrial/ Manufacturing risks Yes / No e. Utilities located outside Industrial/Manufacturing risks Yes / No f. Boundary wall Yes / No g. Basement storage Yes / No h. Others (please specify)","options":["Offices, Shops, Hotels, etc","Industrial / Manufacturing risks","Storage outside Industrial/ Manufacturing risks","Tanks / Gas holders outside Industrial/ Manufacturing risks","Utilities located outside Industrial/Manufacturing risks","Boundary wall","Basement storage","Others"],"required":null,"pdf_field":""},{"help":"List goods stored","type":"text","label":"If used as warehouse / godown (not located in a manufacturing unit), please give the list of goods stored","options":[],"required":false,"pdf_field":""},{"help":"Describe products manufactured","type":"text","label":"If used as an Industrial Manufacturing unit give products manufactured at the location proposed (detailed block plan showing various facilities to be enclosed wherever applicable.)","options":[],"required":false,"pdf_field":""},{"help":"Select status","type":"choice","label":"If used as an Industrial Manufacturing unit, please state whether the factory is working or silent?","options":["Working","Silent"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Fire Protection devices installed? Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick all that apply or specify others","type":"checkbox","label":"If Yes, Please tick the correct answer in the box below","options":["Portable Extinguishers","Small bore hose reels","Trailer Pumps/Fire engines","Hydrant System","Sprinkler System","Fixed Water Spray System","Foam System","Fire Alarm System","Gas Flooding System","Others"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Indicate whether AMC( Annual Maintenance contract) for the Fire Protection Appliances is in force","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select one","type":"choice","label":"Please select the type of Construction quality/structure","options":["Earthquake Resistant Construction","Superior Construction","Class I Construction","Class II Construction"],"required":false,"pdf_field":""},{"help":"Number of floors in building","type":"number","label":"Number of Floors","options":[],"required":false,"pdf_field":""},{"help":"Select age category","type":"choice","label":"Age of the Building","options":["Less than 5 Years","5-10 Years","Upto 15 Years","Above 15 Years"],"required":false,"pdf_field":""},{"help":"Distance in unspecified units","type":"number","label":"Distance between the risk to be covered and nearest Fire Brigade","options":[],"required":false,"pdf_field":""},{"help":"Distance in meters","type":"number","label":"Please provide the distance of the premises from the nearest water body (in meters)","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Whether You have insured the same property with any other Insurance Company with the same type of coverage (Give details)","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Whether Insurance was declined by any other Company (Give details)","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Is Watchmen on Duty (Round the Clock) available at your Storage Facility?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Are you following standard housekeeping practices at premises to be covered?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Please confirm whether your premises has conductive wiring in place?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select age range","type":"choice","label":"Please confirm the average age of equipment in the premises","options":["Less than 2 years","3 - 5 years","5-10 years","10 - 15 years","15 - 20 years","20 - 25 years","Above 25 years"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"E. Details of Home Contents","fields":[{"help":"Sum insured for basement contents","type":"amount","label":"In case of Basement, If there are contents in it, please provide the Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Provide sum insured amounts for each category","type":"table","label":"Sum Insured and Other details of Insured Property (Description of Block Building including plinth, Basement and additional structures, Plant & Machinery, Furniture & Fixtures, Fittings and other equipment, Raw Material, Stock in Process, Finished Stock, Other Contents (Please specify), Total)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"H. Claim Details","fields":[{"help":"Provide claim history details","type":"table","label":"Please specify details of any loss to the proposed Property in last 3 years, In case, your Property is more than 3 yrs old, please provide the loss details for last 10 years (Year, Date of Loss, Cause of Loss, Claimed Amount, Settled Amount/please specify if claim is outstanding)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Specify payment mode","type":"text","label":"Mode of Payment","options":[],"required":null,"pdf_field":""},{"help":"Provide payment details","type":"text","label":"Payment Details","options":[],"required":null,"pdf_field":""},{"help":"Premium amount paid","type":"amount","label":"Amount in (Rs.)","options":[],"required":true,"pdf_field":""},{"help":"Date of payment","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Provide PAN if premium ≥ 1 lakh","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":""},{"help":"Bank account holder name","type":"text","label":"Bank details of proposer for refund or claim purpose: Name of bank account holder (mention specifically, if different from name of policyholder)","options":[],"required":null,"pdf_field":""},{"help":"Bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":null,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFS Code","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Nominee's full name","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Nominee's date of birth","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Relationship to proposer","type":"text","label":"Relationship with the proposer","options":[],"required":null,"pdf_field":""},{"help":"Nominee's mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Nominee's email address","type":"email","label":"E-Mail ID","options":[],"required":false,"pdf_field":""},{"help":"Nominee's present address","type":"text","label":"Address of Nominee: Present address","options":[],"required":null,"pdf_field":""},{"help":"Nominee's 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":"Nominee's bank account holder name","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":false,"pdf_field":""},{"help":"Nominee's bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":false,"pdf_field":""},{"help":"Nominee's bank account number","type":"text","label":"Bank Account Number","options":[],"required":false,"pdf_field":""},{"help":"Nominee's 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":"Declaration of 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) (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":"Fire Suraksha Policy proposal for home building, home contents, and business property insurance","attachments":["Separate signed and dated sheet if additional space is needed for answers","Detailed block plan showing various facilities for industrial manufacturing unit (where applicable)","Annexure with GSTIN details if more than one GSTIN","Request for authorization form to receive claim/refund payments via NEFT if premium amount is more than Rs.10,000/-"],"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 must assist the insurer with records and information to address anti-financial crime practices.","Premium must be paid from legitimate sources; insurer may verify source and reject or terminate policy if otherwise.","Consent to receive policy and service communications electronically and for processing personal data for insurance purposes.","Consent for insurer to access CKYC records for verification and communication.","Agreement to abide by the insurer's Privacy Policy.","Insurer reserves the right to reject or terminate policy if policyholder or associated persons are named in sanctions lists.","KYC records are current and valid and proposer will inform insurer of any changes."],"dropped_labels":15},"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/2800-fire-suraksha-policy-proposal-form"}