{"id":2823,"title":"BURGLARY (HOUSEBREAKING) INSURANCE PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"generali-central-insurance","name":"Generali Central Insurance Company Limited"},"source_pdf":"https://www.generalicentralinsurance.com/downloads/commercial-insurance/burglary-(housebreaking)-insurance/proposal-forms/burglary-housebreaking-insurance-commercial-proposal-form.pdf","sha256":"5ccba9b27febed01f6748cf0d07f2472e1f782e9c9d4b1b347dc82fc3b93e50a","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for burglary (housebreaking) insurance coverage for specified premises and contents.","notes":["Read prospectus/key features/policy wordings before filling the form.","Disclose all material facts fully and do not suppress any information.","Attach separate signed sheet if space is insufficient for answers.","Cover starts only after acceptance and premium receipt.","To get full indemnity, insure for full value of property.","Use original bills and documents as required for claims (implied from context).","No rebates or inducements are allowed as per Section 41 of Insurance Act, 1938."],"title":"BURGLARY (HOUSEBREAKING) INSURANCE PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer and Insurance Details","fields":[{"help":"Start date and time of insurance coverage","type":"date","label":"Period of Insurance From AM/PM of","options":[],"required":true,"pdf_field":""},{"help":"End date of insurance coverage","type":"date","label":"To midnight of","options":[],"required":true,"pdf_field":""},{"help":"Full name and current address of the proposer","type":"text","label":"Name and Present address of the Proposer (in full)","options":[],"required":true,"pdf_field":""},{"help":"Permanent address if different from present address","type":"text","label":"Permanent address of the Proposer (in full) (if left blank, will be construed as being same as Present Address)","options":[],"required":false,"pdf_field":""},{"help":"Name of any financial institution with interest in the insured property","type":"text","label":"Name of the Financial Institution/s (if any financial interest is involved)","options":[],"required":false,"pdf_field":""},{"help":"Central KYC Registry number if available","type":"text","label":"CKYC Number (if available)","options":[],"required":false,"pdf_field":""},{"help":"Type of business or trade of the proposer","type":"text","label":"Nature of Trade or Business","options":[],"required":true,"pdf_field":""},{"help":"Full address of the premises to be insured","type":"text","label":"Address of the Premises to be Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premises and Security Details","fields":[{"help":"Specify the type of premises","type":"text","label":"Whether Warehouse, Godown, Shop or Office?","options":[],"required":true,"pdf_field":""},{"help":"Duration of occupancy at the premises","type":"text","label":"How long have you been an occupant of premises?","options":[],"required":true,"pdf_field":""},{"help":"Indicate if you are the only occupant","type":"yes-no","label":"Are you the sole occupant? YES NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Names or description of other occupants if any","type":"text","label":"If not, who are other occupants?","options":[],"required":false,"pdf_field":""},{"help":"Describe security measures for doors, windows, other openings and special precautions","type":"text","label":"What protection is provided to a) Doors? b) Windows? c) Skylights, Ventilators, Exhaust Fans, Lights, Air conditioners, Trap doors? d) Any Other openings? e) Mention any special precautions you have adopted for safeguarding your property.","options":[],"required":true,"pdf_field":""},{"help":"Indicate if you occupy the premises at night or who does","type":"yes-no","label":"Are the premises occupied by you at night? If not, by whom? YES NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Indicate if premises will be left unoccupied at any time","type":"yes-no","label":"Will the Premises at any time be left unoccupied? YES NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Frequency and duration of unoccupied periods","type":"text","label":"If so, how often and for how long?","options":[],"required":false,"pdf_field":""},{"help":"Details of safes used to secure valuables","type":"text","label":"Are all valuables secured in safe(s), outside business hours? Give (1) Maker’s name (2) Height (3) Width (4) Weight of Safe(s)","options":[],"required":true,"pdf_field":""},{"help":"Key details and opening mechanism of safes","type":"text","label":"How many keys are there to the safe(s) and with whom are they kept? Can the safe(s) be opened by a single key or by a combination of two or more keys?","options":[],"required":true,"pdf_field":""},{"help":"Indicate if stock and sales books are maintained and frequency of entries","type":"yes-no","label":"Are Stock and Sales books maintained? How frequently are these entered? YES NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Frequency of stock taking","type":"text","label":"How often is stock taken?","options":[],"required":true,"pdf_field":""},{"help":"Location of stock and sales books after business hours","type":"text","label":"Where are these books kept outside business hours?","options":[],"required":true,"pdf_field":""},{"help":"Details of any past burglary incidents","type":"text","label":"Have any premises occupied by you been entered by thieves? If YES, give full particulars stating when and how access was obtained and the extent of the loss.","options":[],"required":true,"pdf_field":""},{"help":"Precautions taken after any burglary","type":"yes-no","label":"What precautions have been adopted to prevent such a recurrence? YES NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Details of any existing burglary insurance","type":"text","label":"Is the risk currently insured against Burglary? If so: a) The name of Insurance Company. b) Policy No. c) Period","options":[],"required":false,"pdf_field":""},{"help":"Indicate if any insurer declined, cancelled, or accepted with special terms","type":"yes-no","label":"Has any Company in respect of your Burglary Insurance (1) Declined your proposal? (2) Cancelled or refused to renew your policy? (3) Accepted your proposal on special terms and conditions YES NO","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Details of any past burglary claims","type":"text","label":"Have you ever claimed upon any Company for loss by Burglary or House Breaking? If so, give details.","options":[],"required":false,"pdf_field":""},{"help":"Current fire insurance coverage details for contents","type":"text","label":"Amount for which contents are currently Insured against Fire and name of the Company.","options":[],"required":false,"pdf_field":""},{"help":"Description of property to be insured","type":"text","label":"Give full description of contents (i.e. the property to be Insured) of the premises.","options":[],"required":true,"pdf_field":""},{"help":"Indicate if additional cover is required","type":"yes-no","label":"Do you need cover against Riot and Strike, terrorist activities on payment of additional Premium? YES NO","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Property to be Insured and Payment Details","fields":[{"help":"Value of stocks-in-trade","type":"amount","label":"PROPERTY TO BE INSURED (Give full details) a) Stocks-in-Trade (as described in 14 above)","options":[],"required":true,"pdf_field":""},{"help":"Value of goods held in trust or commission","type":"amount","label":"b) Goods held by the Proposer in trust or on commission for which he is responsible.","options":[],"required":true,"pdf_field":""},{"help":"Value of furniture, fixtures, fittings, utensils and appliances","type":"amount","label":"c) Furniture, Fixtures, Fittings, Utensils? And Appliances in trade.","options":[],"required":true,"pdf_field":""},{"help":"Value of coins and currency notes in safe","type":"amount","label":"d) Coins and/or Currency Notes in Locked safe.","options":[],"required":true,"pdf_field":""},{"help":"Value of other property to be insured","type":"amount","label":"e) Others (To be specified)","options":[],"required":false,"pdf_field":""},{"help":"Total insured sum for all property","type":"amount","label":"Total Sum Insured","options":[],"required":true,"pdf_field":""},{"help":"Select mode of premium payment","type":"choice","label":"Mode of Payment","options":[],"required":true,"pdf_field":""},{"help":"Details of payment made","type":"text","label":"Payment Details","options":[],"required":true,"pdf_field":""},{"help":"Amount paid as premium","type":"amount","label":"Amount in (₹)","options":[],"required":true,"pdf_field":""},{"help":"Date when premium was paid","type":"date","label":"Date of Payment (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Permanent Account Number if premium is 100,000 or more","type":"text","label":"PAN (If premium is 1 Lac and Above.)","options":[],"required":false,"pdf_field":""},{"help":"GST Identification Number(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 for refunds or claims","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":true,"pdf_field":""},{"help":"Bank name and branch","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 of nominee to proposer","type":"text","label":"Relationship with the proposer","options":[],"required":true,"pdf_field":""},{"help":"Nominee's mobile phone number","type":"phone","label":"Mobile Number","options":[],"required":false,"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 if different","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":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":"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 and Signature","fields":[{"help":"Date of signing the proposal","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing the proposal","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Signature of proposer or authorized signatory","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 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":"Burglary (Housebreaking) Insurance","attachments":["Separate signed and dated sheet if insufficient space to answer any question","Annexure with details if more than one GSTIN"],"declarations":["The statements made in the proposal are true and complete and form the basis of the insurance contract.","If any information is found untrue, the policy will be void and premium forfeited.","Premium is paid from legally declared income and not from proceeds of crime; company may verify source of funds and reject proposal if found otherwise.","Premium payment may be made by a person with insurable interest; refunds will be processed to proposer’s bank account.","Proposer may be a High Net Worth Individual, Non-Resident Indian, Politically Exposed Person, or NGO as applicable.","Proposer agrees to receive service-related information electronically including WhatsApp.","Information provided will be stored and used for insurance purposes and servicing policies.","Proposer consents to CKYC record verification and receiving related communications.","Information will be processed as per the company’s privacy policy."],"dropped_labels":2},"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/2823-burglary-housebreaking-insurance-proposal-form"}