{"id":2816,"title":"PUBLIC LIABILITY POLICY- INDUSTRIAL RISKS PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/other-insurance/public-liability-policy-industrial-risks/proposal-forms/public-liability-policy-industrial-risks-proposal-form.pdf","sha256":"4a56191d27544fc142281beb62e06f532459a2cbaf6f9c2c4923ea2e576124ca","pages":10,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for public liability insurance covering industrial risks. It is filled by the proposer (policyholder) seeking insurance coverage.","notes":["Read the prospectus/key features document/policy wordings before completing the form.","Disclose all material facts fully and do not suppress any information.","If insufficient space, attach separate signed and dated sheet referencing question number.","Liability of the company starts only after proposal acceptance and premium payment.","Territorial limit of policy is anywhere in India.","Answer questions with respect to each plant/manufacturing unit.","Use original bills and documents where required.","Fill the request for authorization form to receive payments via NEFT if premium paid is more than Rs 10,000.","The form includes a Go Green initiative offering digital policy documents; tick box if physical copy is desired.","Section 41 of Insurance Act, 1938 prohibits rebates; penalties apply for violations."],"title":"PUBLIC LIABILITY POLICY- INDUSTRIAL RISKS 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 and Addresses","fields":[{"help":"","type":"text","label":"1. Name of the Proposer (in full)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"2. Registered Address of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Registered Address of the Subsidiaries & Associate Companies","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"3. Business Address of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"4. Location and address of all premises proposed for Insurance","options":[],"required":null,"pdf_field":""},{"help":"Provide Central KYC Registry number if available","type":"text","label":"5. CKYC Number (if available)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Proposer Status and Disability Details","fields":[{"help":"Tick all applicable categories","type":"checkbox","label":"6. 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":"choice","label":"If you are Differently Abled, please tick on the checkbox to provide confirmation. Yes / No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"If Yes above, specify impairment type","type":"text","label":"i. Type of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes above, specify percentage","type":"number","label":"ii. Percentage of Impairment","options":[],"required":false,"pdf_field":""},{"help":"If Yes above, provide UDID number","type":"text","label":"iii. UDID Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance and Business Details","fields":[{"help":"Provide locations and turnover details","type":"text","label":"7. (a) Do you wish to Insure Depots, Warehouses, Godowns, Tank farms etc. If so, there locations and turnover.","options":[],"required":null,"pdf_field":""},{"help":"Describe activities needing insurance","type":"text","label":"7. (a) Please give full description of activities for which cover is required.","options":[],"required":null,"pdf_field":""},{"help":"Provide technical collaboration details","type":"text","label":"8. Please give details of technical know how/collaboration.","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"9. Do you have any assets and/or representation and/or any domiciled operations and/or activities and/or association (financial, technical or otherwise in USA/ Canada & other foreign countries? If so, please furnish details of association.","options":[],"required":null,"pdf_field":""},{"help":"Specify duration in business","type":"text","label":"10. How long have you been in the business?","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Surroundings and Third-Party Property","fields":[{"help":"Describe industrial area nearby","type":"text","label":"11. Please describe in brief surrounding areas and third-party property for each unit a) Industrial area within an approx. radius of 2 kms.","options":[],"required":null,"pdf_field":""},{"help":"Describe agricultural area nearby","type":"text","label":"b) Agricultural area within an approx. radius of 2 kms.","options":[],"required":null,"pdf_field":""},{"help":"Describe residential area nearby","type":"text","label":"c) Residential area within an approx. radius of 2 kms.","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Hazardous Materials and Compliance","fields":[{"help":"Provide details of hazardous materials and safety measures","type":"text","label":"12. (a) Do you handle or use gases, pressure-storage, explosive, hazardous substances, asbestos, toxic, radioactive materials and hydrocarbons? If so, please give details of their quantity, storage, handling, and precautions taken","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premises Security and Safety Measures","fields":[{"help":"Specify fencing and locking status","type":"text","label":"13. (a) Are the premises fenced and/or locked?","options":[],"required":null,"pdf_field":""},{"help":"Provide pipeline details if applicable","type":"text","label":"If by pipeline, state - (i) dimensions of the pipe (ii) total length of the pipe (iii) terminal points (iv) whether underground/overhead/submerged (v) system of supervision and monitoring pipelines against leakage/damage (vi) Lay out of pipeline showing surrounding areas alongside the route","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Questionnaire for Accidental Pollution Liability Cover","fields":[{"help":"Describe activities and product turnover percentages","type":"text","label":"1. Activity, production program, main products in percentage of turnover.","options":[],"required":null,"pdf_field":""},{"help":"Provide location details","type":"text","label":"2. Situation of risk - 2.1. Location","options":[],"required":null,"pdf_field":""},{"help":"State if located in protected zones","type":"text","label":"2.2. Whether situated in vulnerable water protection Zone, water conservation areas","options":[],"required":null,"pdf_field":""},{"help":"Describe surroundings within 2 km","type":"text","label":"2.3. Surroundings (urban, semi urban, countryside, recreation and tourist area) within 2 kilometres radius","options":[],"required":null,"pdf_field":""},{"help":"Describe surroundings within 5 km","type":"text","label":"2.3. Surroundings (urban, semi urban, countryside, recreation and tourist area) within 5 kilometres radius","options":[],"required":null,"pdf_field":""},{"help":"Provide pipe system details","type":"text","label":"3. Pipe systems exceeding 10 meters outside Insured’s premises, reservoirs, exceeding 20,000 litres (number, contents, total capacity)","options":[],"required":null,"pdf_field":""},{"help":"Describe waste treatment systems","type":"text","label":"4. Treatment/Disposal and control systems for solid, liquid and gaseous waste or effluents","options":[],"required":null,"pdf_field":""},{"help":"Confirm regulatory compliance","type":"text","label":"5. (a) Whether equipment, operations and processes are in accordance with official regulations","options":[],"required":null,"pdf_field":""},{"help":"Specify production mode","type":"text","label":"7. Prevailing mode of production whether continuous or batch","options":[],"required":null,"pdf_field":""},{"help":"Provide policy details","type":"text","label":"9. Particulars of present and former policies covering public liability including pollution","options":[],"required":null,"pdf_field":""},{"help":"Describe prevention program and emergency provisions","type":"text","label":"10. Is there a program for the prevention of fire, explosion, chemical incidents? If yes, please indicate - type of detection and alarm system, availability of service organization in case of such incidents (fire brigade, specialists in environmental protection and toxicology), provisions made for the supply of energy, water etc. (in an emergency)","options":[],"required":null,"pdf_field":""},{"help":"Attach latest consent letter","type":"attachment","label":"11. Whether the plant has the consent of the Pollution Control Board (copy of the latest consent letter should be attached)","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 details","type":"text","label":"Payment Details","options":[],"required":null,"pdf_field":""},{"help":"Enter amount paid","type":"amount","label":"Amount in (₹)","options":[],"required":null,"pdf_field":""},{"help":"Enter payment date","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 Details of Proposer","fields":[{"help":"Provide bank account holder name","type":"text","label":"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":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Nominee full name","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"Nominee date of birth","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"Specify relationship","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 Signature","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","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":"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":null,"pdf_field":""},{"help":"Code of intermediary","type":"text","label":"Intermediary’s Code","options":[],"required":null,"pdf_field":""},{"help":"Signature of intermediary","type":"signature","label":"Intermediary’s Signature","options":[],"required":null,"pdf_field":""}],"filled_by":"intermediary"}],"deadlines":[],"applies_to":"Public Liability Policy for Industrial Risks","attachments":["Lay-Out Plans of the manufacturing units proposed for Insurance","Certified copy of the receipt for payment of premium excluding the contribution to the Environmental Relief Fund","Copy of the latest consent letter from Pollution Control Board","Additional questionnaire for Accidental Pollution Liability Cover (if applicable)","Request for authorization form to receive Claim/Refund payments through NEFT (if premium paid is more than Rs 10000/-)"],"declarations":["All statements and information provided in this proposal are complete and accurate with no material facts withheld.","If misrepresentation or suppression of material facts is found, the policy may be void and premium forfeited.","The insurer adheres to anti-financial crime practices and the proposer agrees to assist with relevant information.","Premium is paid from legitimate sources in compliance with law; insurer may verify source and reject policy if otherwise.","Consent to receive policy communications electronically and for insurer to process personal data as per privacy policy.","Consent for insurer to access CKYC records for verification and updates.","Insurer may reject proposal or terminate contract if proposer or associates are named in any recognized sanctions list."],"dropped_labels":38},"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/2816-public-liability-policy-industrial-risks-proposal-form"}