{"id":2813,"title":"PRODUCTS LIABILITY 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/products-liability-insurance/proposal-forms/products-liability-insurance-retail-proposal-form.pdf","sha256":"4402d8f72f2a4ff5f6f9e3485b1dbbe245919b6e65dd68bb2912f733ab42e586","pages":9,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (individual or company) to apply for products liability insurance coverage from Generali Central Insurance Co. Ltd. The proposer provides detailed information about their business, products, and risk factors.","notes":["Read prospectus/key features/policy wordings before completing the form.","Insurance is a contract of utmost good faith; disclose all material facts fully.","Attach separate signed and dated sheet if space is insufficient for answers.","Cover starts only after acceptance and receipt of premium.","Fill all questions in full and use block letters if applicable.","Original bills and documents may be required for claims (implied from context).","For premium above Rs 10,000, fill authorization form for NEFT payments.","Use the Go Green initiative to receive policy documents electronically unless physical copy is requested."],"title":"PRODUCTS LIABILITY INSURANCE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer and Business Details","fields":[{"help":"","type":"text","label":"Name of the Proposer (in full)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Names of the Subsidiaries & Associate Cos. (in full)","options":[],"required":null,"pdf_field":""},{"help":"Include city and pin code","type":"text","label":"Registered Address of the Proposer.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin","options":[],"required":null,"pdf_field":""},{"help":"Include state","type":"text","label":"Business address of the Proposer.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Location from where distribution is effected.","options":[],"required":null,"pdf_field":""},{"help":"Duration in years or months","type":"text","label":"How long have you been in the business?","options":[],"required":null,"pdf_field":""},{"help":"Central KYC Registry number if available","type":"text","label":"CKYC Number (If applicable)","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 NGO/NPO","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 impairment type","type":"text","label":"Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes, 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":""},{"help":"Tick Yes or No and specify parts if No","type":"choice","label":"Do you manufacture the complete product? If not, what components/parts are purchased by you?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Can the date of manufacture of each product be identified by the factory number stamped on it?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Do your have any assets and/or representation and/or activities and/or association (financial, technical or otherwise) in USA/Canada and other foreign countries? If so, please furnish details of association.","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Are you affiliated in any manner with any of your suppliers and distributors?","options":["YES","NO"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Business and Product Details","fields":[{"help":"Provide turnover details for last three years","type":"table","label":"Please give full description of the following for the last three years: Year, goods manufactured – actual turnover, goods sold/supplied – actual turnover, goods repaired, serviced, tested and processed - actual turnover","options":[],"required":null,"pdf_field":""},{"help":"Provide projected turnover","type":"text","label":"For the above, please give the projected turnover for the proposed period of insurance as under: 1. Goods manufactured 2. Goods sold or supplied 3. Goods repaired, serviced, tested and processed","options":[],"required":null,"pdf_field":""},{"help":"Name the product","type":"text","label":"Please furnish details of products to be considered for insurance which are manufactured and/or designed - Name of the product","options":[],"required":null,"pdf_field":""},{"help":"Main component of the product","type":"text","label":"Principal component","options":[],"required":null,"pdf_field":""},{"help":"Number of units produced annually","type":"number","label":"Annual Units produced","options":[],"required":null,"pdf_field":""},{"help":"Annual sales turnover","type":"amount","label":"Annual turnover","options":[],"required":null,"pdf_field":""},{"help":"Duration product has been marketed","type":"text","label":"How long has it been in the market?","options":[],"required":null,"pdf_field":""},{"help":"Expected product lifespan","type":"text","label":"Expected life of use","options":[],"required":null,"pdf_field":""},{"help":"Target customer group","type":"text","label":"Intended customer/ultimate user","options":[],"required":null,"pdf_field":""},{"help":"Any warranties provided","type":"text","label":"Warranties as to use","options":[],"required":null,"pdf_field":""},{"help":"Details of technical collaboration if any","type":"text","label":"Technical know-how/collaboration","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Do you have Research and Development Dept.?","options":["YES","NO"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Product Safety and Compliance","fields":[{"help":"List hazardous products and precautions","type":"text","label":"Please specify any products which are inflammable/explosive, dangerous, radioactive, harmful to health, poisonous by themselves or any combination with others. If so, please give full details and state what precautions are taken.","options":[],"required":null,"pdf_field":""},{"help":"Provide disclaimer details if applicable","type":"text","label":"Please state whether goods sold or supplied subject to disclaimer notice, and if so, please give full text, particulars of such disclaimer notice.","options":[],"required":null,"pdf_field":""},{"help":"List new products planned","type":"text","label":"Please furnish particulars of new products to be marketed during the next 12 months.","options":[],"required":null,"pdf_field":""},{"help":"List discontinued or recalled products","type":"text","label":"Please furnish details and list of products discontinued or recalled or withdrawn during the last five years.","options":[],"required":null,"pdf_field":""},{"help":"Describe reporting system","type":"text","label":"Please elaborate complaints, incident/accident reporting system in your organization.","options":[],"required":null,"pdf_field":""},{"help":"Describe quality control measures","type":"text","label":"Please give details of checks or examinations or controls including batch control and testing carried out or effected to discover possible defects or errors in products.","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Do your products comply with standards like ISI or any other standards?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details of any investigations","type":"text","label":"Have your products ever been subject to any enquiry or investigation by any Government agency, concerning the efficiency/adequacy or labelling, hazardous contents or safety? If so, please give full details.","options":[],"required":null,"pdf_field":""},{"help":"Provide failure rate information","type":"text","label":"What is the failure rate of each product after hand over?","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Guarantees, Claims and Insurance History","fields":[{"help":"Describe guarantees and warranty periods","type":"text","label":"Do you issue guarantees and/or warranties to purchasers? If so, for what period do you guarantee and/or warrant your product?","options":[],"required":null,"pdf_field":""},{"help":"Explain how usage directions and warnings are provided","type":"text","label":"Particulars regarding directions for use: Is it by printing on container or product? Is it by separate leaflet or brochure? Is the hazard warning clearly shown?","options":[],"required":null,"pdf_field":""},{"help":"Provide claims data for last three years","type":"table","label":"Please furnish claims history for the last three years in the following format: Year, No. of Claims, Total amount paid (Bodily injury, Property damage, Cost of defence action), Total amount of pending claim (Bodily injury, Property damage, Cost of defence action)","options":[],"required":null,"pdf_field":""},{"help":"Disclose any known potential claims","type":"text","label":"Are you aware of any incidents, conditions, defects, circumstances or suspected defects, which may result in claim?","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Have your proposal or renewal been declined or premium increased, special terms imposed by any Insurer? If so please give particulars","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance Coverage and Export Details","fields":[{"help":"Specify indemnity limits","type":"amount","label":"Please indicate the limit of indemnity required for domestic sales. a. Any one accident: b. Aggregate during the policy period","options":[],"required":null,"pdf_field":""},{"help":"Specify voluntary excess amounts by region","type":"amount","label":"Please indicate the Voluntary Excess for each claim (in addition to Compulsory Excess) you are willing to bear. U.S.A, Canada, All other Countries including India","options":[],"required":null,"pdf_field":""},{"help":"Provide sales turnover by region and product","type":"table","label":"Please quantify sales turnover product wise for the last 3 years as under: a. Domestic b. USA/Canada c. OECD countries (to list) d. Other countries including non-OECD countries.","options":[],"required":null,"pdf_field":""},{"help":"Provide export duration and coverage requirement","type":"text","label":"How long have you been exporting to the following countries and do you require cover for exports to these countries? a. USA and Canada: b. OECD countries: c. Other countries including non-OECD countries (Cover for exports will be granted only if domestic turnover is covered).","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No and attach contract if Yes","type":"choice","label":"Do you require “Limited Vendor’s Endorsement”? (Please enclose a copy of the contract with the vendor/s and give the names to each product of export to such countries)","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Do you comply with USA/Canadian State/Federal laws/Standards applicable to each product of export to such countries?","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Please give details of any power of attorney on Assets in USA/Canada.","options":[],"required":null,"pdf_field":""},{"help":"Specify start and end dates","type":"date","label":"Policy period: From 12.00 midnight of ________ to 12.00 midnight of ________","options":[],"required":null,"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 reference/details","type":"text","label":"Payment Details","options":[],"required":null,"pdf_field":""},{"help":"Amount paid","type":"amount","label":"Amount in (₹)","options":[],"required":null,"pdf_field":""},{"help":"Date payment was made","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":null,"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":""}],"filled_by":"proposer"},{"title":"Bank and Nominee Details","fields":[{"help":"Provide 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":"Provide bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":null,"pdf_field":""},{"help":"Provide bank account number","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"Provide IFSC code","type":"text","label":"IFS Code","options":[],"required":null,"pdf_field":""},{"help":"Nominee full name","type":"text","label":"NOMINEE DETAILS: Name","options":[],"required":null,"pdf_field":""},{"help":"Nominee 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 mobile number","type":"phone","label":"Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Nominee email address","type":"email","label":"E-Mail ID","options":[],"required":null,"pdf_field":""},{"help":"Nominee present address","type":"text","label":"Address of Nominee: Present address","options":[],"required":null,"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":"Nominee bank account holder name","type":"text","label":"Bank Account Details of Nominee: Name of Account holder","options":[],"required":null,"pdf_field":""},{"help":"Nominee bank name and branch","type":"text","label":"Bank Name & Branch","options":[],"required":null,"pdf_field":""},{"help":"Nominee bank account number","type":"text","label":"Bank Account Number","options":[],"required":null,"pdf_field":""},{"help":"Nominee IFSC code","type":"text","label":"IFS Code","options":[],"required":null,"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 and Consent","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":"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":""}],"filled_by":"proposer"},{"title":"Intermediary Declaration","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":"Products Liability Insurance","attachments":["Separate signed and dated sheet if insufficient space to answer any question","Leaflets, brochures and/or any other literature for products","Copy of the contract with the vendor/s if Limited Vendor’s Endorsement is required","Annexure with 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.","The insurer adheres to anti-financial crime practices and may require assistance for compliance.","Premiums are paid from legitimate sources; insurer may verify source and reject or terminate policy if otherwise.","Consent to receive communications electronically and for processing personal data as per privacy policy.","Consent to insurer accessing CKYC records for verification and updates.","KYC records are current and proposer will inform insurer of any changes.","Insurer may reject proposal or terminate contract if proposer or associated persons are on any recognized blacklist or sanctions list."],"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/2813-products-liability-insurance-proposal-form"}