{"id":5489,"title":"All Risks Secure Proposal Form & Questionnaire","purpose":"proposal","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/All_Risks_Secure_Proposal_Form_and_Questionnaire_ZK_V2_24_25_12122024_3545115445.pdf","sha256":"0c4dede2dff7dc72d51abc29ab1c4c85007ec00d1f7afcfb76ad68755fb96f6e","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or corporate customers to apply for All Risks Secure insurance coverage by Zurich Kotak General Insurance Company. The proposer (applicant) fills it.","notes":["Fill the proposal form in BLOCK LETTERS.","All fields marked with * are mandatory.","Attach additional sheets if space is insufficient and indicate question number.","Use original documents for proofs and valuation certificates.","Submission of proposal or payment does not oblige the company to issue a policy.","Policy issuance is subject to underwriting and receipt of full premium.","If proposal is not accepted, payment will be refunded without interest.","Electronic Insurance Account email ID is mandatory if EIA account exists or is created.","NEFT transactions may fail without liability to the insurer."],"title":"All Risks Secure Proposal Form & Questionnaire","submit":{"to":"Zurich Kotak General Insurance Company (India) Limited","how":"","address":"401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai - 400063. Maharashtra, India"},"purpose":"proposal","sections":[{"title":"Proposer / Owner’s Details","fields":[{"help":"Fill in full name in block letters","type":"text","label":"Proposer’s Name*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Proposer's Trade or Business*","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"GSTIN","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 1)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 2)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City / District","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Registered Office Address / Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the Communication Address same as the Registered Office Address / Permanent Address?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Fill only if communication address differs","type":"text","label":"If ‘No’, please provide below Address (Line 1)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 2)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City / District","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Communication (Postal) Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Permanent Account Number for individuals","type":"text","label":"PAN*:","options":[],"required":true,"pdf_field":""},{"help":"Tick if Form 60 submitted instead of PAN","type":"yes-no","label":"/ Form 60 (only in case the customer does not have PAN No.)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"GSTIN:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Occupation","options":["Business","Salaried","Professionals","Student","Housewife","Retired","Others"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Nationality*","options":["Indian","Non-Indian","NRI"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Annual Income","options":["Upto 2.5 lacs","2.5 - 6 lacs","6 - 10 lacs","10 - 15 lacs","15 - 20 lacs","20 - 25 lacs","> 25 lacs"],"required":null,"pdf_field":""},{"help":"Central KYC Registry number","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":null,"pdf_field":""},{"help":"Tick all applicable proofs","type":"checkbox","label":"Proof of Identity (POI) and Proof of Address (POA) [(ü) Tick whichever is applicable]","options":["PAN","Aadhaar","Passport","Driving Licence","Voter ID Card","Others (Please specify)"],"required":null,"pdf_field":""},{"help":"For corporate customers","type":"text","label":"PAN*:","options":[],"required":true,"pdf_field":""},{"help":"For corporate customers","type":"text","label":"GSTIN:","options":[],"required":null,"pdf_field":""},{"help":"Authorised Signatory name","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Authorised Signatory designation","type":"text","label":"Designation:","options":[],"required":null,"pdf_field":""},{"help":"Authorised Signatory CKYC number","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":null,"pdf_field":""},{"help":"Bank name for hypothecation","type":"text","label":"Hypothecation Details: Bank Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Existing policy number if applicable","type":"text","label":"If ‘Yes’, Policy No","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you a Non-profit Organization?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Quote No.*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch Code","options":[],"required":null,"pdf_field":""},{"help":"Date of quote","type":"date","label":"Quote Date*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Sales Manager Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Service RM","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Branch code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary business vertical","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Client Ref. No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"SP Name/Code","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance Details and Risk Information","fields":[{"help":"Specify risks to be insured","type":"text","label":"Contingencies to be covered (Eg- Fire, Burglary etc) (Please specify)","options":[],"required":null,"pdf_field":""},{"help":"Specify any additional coverage extensions","type":"text","label":"Extensions required (Please specify)","options":[],"required":null,"pdf_field":""},{"help":"Attach valuation certificate if yes","type":"yes-no","label":"Has the valuables including jewellery been recently examined and Valued by an approved Valuer? (If so, furnish The Valuation Certificate.)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if yes","type":"yes-no","label":"Whether cover is also required outside India. If Yes, give details.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of current insurer if applicable","type":"text","label":"Is the risk currently insured against Fire, Theft, Or All Risks? If so, a) The name of the Insurance Company","options":[],"required":null,"pdf_field":""},{"help":"Current policy number","type":"text","label":"b) Policy No.","options":[],"required":null,"pdf_field":""},{"help":"Policy period","type":"text","label":"c) Period","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you suffered any loss of or damage to jewellery and/or other valuables in the past? (irrespective of whether insured or not)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Columns: Date of Occurrence, Details of Loss, Amount of Loss (`), Name of the Insurers","type":"table","label":"If so, give full details thereof as under:","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any Company in respect of All Risks Insurance a) Declined your Proposal?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"b) Cancelled or refused to renew your Policy?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"c) Accepted your Proposal on special terms and condition?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify start and end dates","type":"date","label":"Period of Insurance IN MONTHS FROM TO","options":[],"required":null,"pdf_field":""},{"help":"List insured items with sum insured","type":"table","label":"Property to be insured Sr. No. Description of Insured Item Sum Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details (Applicable for individual customers)","fields":[{"help":"Full name of nominee","type":"text","label":"Nominee Name*","options":[],"required":true,"pdf_field":""},{"help":"Relationship to proposer","type":"text","label":"Relationship of Nominee with Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Date of birth of nominee","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Nominee Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Nominee Email ID","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nominee Present Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nominee Permanent Address","options":[],"required":null,"pdf_field":""},{"help":"Bank details for claim payment","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":null,"pdf_field":""},{"help":"Total share must not exceed 100%","type":"number","label":"% of claim share*","options":[],"required":true,"pdf_field":""},{"help":"Name of appointee if nominee is minor","type":"text","label":"Where Nominee is a minor, give details of Appointee Name of the Appointee","options":[],"required":null,"pdf_field":""},{"help":"DOB of appointee","type":"date","label":"Date of Birth DD/MM/YYYY","options":[],"required":null,"pdf_field":""},{"help":"Relationship of appointee to nominee","type":"text","label":"Relationship with the Nominee","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"Sign or stamp to declare accuracy","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details of Proposer","fields":[{"help":"Electronic Insurance Account existence","type":"yes-no","label":"Do you have an EIA Account","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"EIA account number","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":null,"pdf_field":""},{"help":"Name of insurance repository","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":null,"pdf_field":""},{"help":"Tick if want new EIA account","type":"yes-no","label":"If No, do you want Us to create an EIA account for you","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Email for EIA account","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""},{"help":"Bank account number for EFT","type":"text","label":"Account Number","options":[],"required":null,"pdf_field":""},{"help":"Bank name for EFT","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Name of bank account holder","type":"text","label":"Account Holder name","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Cheque or demand draft number","type":"text","label":"Cheque / D.D#","options":[],"required":null,"pdf_field":""},{"help":"Name on cheque/DD","type":"text","label":"Drawn To","options":[],"required":null,"pdf_field":""},{"help":"Bank branch details","type":"text","label":"Bank and Branch Name","options":[],"required":null,"pdf_field":""},{"help":"Card transaction reference","type":"text","label":"For Credit / Debit Card Transaction Reference No","options":[],"required":null,"pdf_field":""},{"help":"Date of transaction","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":null,"pdf_field":""},{"help":"Amount paid","type":"amount","label":"Drawn Amount","options":[],"required":null,"pdf_field":""},{"help":"Date of payment","type":"date","label":"Transaction Date","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations for Intermediaries and Persons with Disability","fields":[{"help":"Intermediary signature","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":true,"pdf_field":""},{"help":"Proposer signature","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"Agent signature","type":"signature","label":"Signature & Stamp as applicable of the Insurance Advisor/Specified person of Corporate Agent/Authorised Employee of Broker/Sales person*","options":[],"required":true,"pdf_field":""},{"help":"For proposer with disability, authorized rep signature","type":"signature","label":"Signature of Authorised Representative*","options":[],"required":null,"pdf_field":""},{"help":"Proposer signature or thumb impression","type":"signature","label":"Signature/Thumb impression of Proposer","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place*","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date*","options":[],"required":null,"pdf_field":""}],"filled_by":"intermediary / proposer / authorized representative"}],"deadlines":[],"applies_to":"All Risks Secure insurance policies","attachments":["Valuation Certificate (if valuables have been recently examined and valued)","Additional sheets if more space is needed for answers","Insurance Repository Application form (if EIA account creation requested)"],"declarations":["The statements made in this proposal form are true, complete and form the basis of the insurance policy.","The company’s liability starts only after acceptance of the proposal and receipt of premium.","The proposer consents to verification of identity/address through official registries for KYC purposes.","The proposer confirms payment of premiums from bonafide sources and compliance with anti-money laundering laws.","The proposer declares if they qualify as a High Net Worth Individual (HNI) with net worth of ₹50 crore or more.","The proposer confirms whether they or close relatives are politically exposed persons (PEP).","The proposer declares if they are a Non-Profit Organization (if applicable).","The proposer agrees that policy and service communications will be sent electronically unless physical copy is requested.","Intermediaries declare they have explained policy features and terms to the proposer who has understood before signing.","For persons with disability, an authorized representative may assist and sign on their behalf."],"dropped_labels":1},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"email","value":"care@zurichkotak.com","label":"Email Address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/customer-support/grievance-redressal-process","quote":"in\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be used for calls. This is chat only number.\nAccessibility\nZoom in page\nZoom out page\nIncrea","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800 2120","label":"Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/customer-support/grievance-redressal-process","quote":"age claims\nCustomer support\nGrievance redressal\nLogin\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be used for calls. This is cha","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"+91-22-69417220","label":"Toll Number (INDIA And Overseas)","level":null,"hours":"IST 8 am to 8 pm","applies_to":"all","source_url":"https://www.zurichkotak.com/customer-support/grievance-redressal-process","quote":"Download policy\nManage policy\nManage claims\nCustomer support\nGrievance redressal\nLogin\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"whatsapp","value":"7998879988","label":"WhatsApp Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/customer-support/grievance-redressal-process","quote":"t\nGrievance redressal\nLogin\nToll Number (INDIA And Overseas)\n+91-22-69417220\nToll Free Number\n1800 2120\nWhatsApp Number\n7998879988\nEmail Address\ncare@zurichkotak.com\nOur WhatsApp number cannot be used for calls. This is chat only number.\nAccessibilit","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"grievanceofficer@zurichkotak.com","label":"Grievance Officer","level":1,"hours":null,"applies_to":"all","source_url":"https://cms.zurichkotak.com/uploads/Policy_Wordings_CPI_dc7b416cf1.pdf","quote":"om .\nIn case the I nsured is not satisfied with the response, I nsured may contact the Grievance Officer of the ZKGI at grievanceofficer@zurichkotak.com . In case if the I nsured is not satisfied with the solution the\nGrievance Officer has provided, | I nsured | can write","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Unit no. 401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East) Mumbai- 400063. Maharashtra, India.","label":"Registered & Corporate Office","level":null,"hours":null,"applies_to":"all","source_url":"https://www.zurichkotak.com/","quote":"ker\nHealth portability\nResearch & Reports\nCorrespondence Address\nZurich Kotak General Insurance Company (India) Limited\nUnit no. 401, 4th Floor, Silver Metropolis,\nJai Coach Compound, Off Western Express Highway,\nGoregaon (East) Mumbai- 400063. Maharashtra, India.\nConnect with us\n: 022 - 69417220 (Toll number)\n: 1800 2120 (Toll free)\n+91-22-69417220 (IST 8 am to 8 pm)\nwww.zurichkot","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"care@zurichkotak.com","label":"Customer Care Email","level":null,"hours":null,"applies_to":"all","source_url":"https://cms.zurichkotak.com/uploads/Policy_Wordings_CPI_dc7b416cf1.pdf","quote":"may contact the respective branch office of the ZKGI or may call toll free number 1800 2120 or may write an e - mail at care@zurichkotak.com .\nIn case the I nsured is not satisfied with the response, I nsured may contact the Grievance Officer of the ZKGI at gr","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"www.zurichkotak.com","label":"Grievance Redressal Process","level":null,"hours":null,"applies_to":"all","source_url":"https://cms.zurichkotak.com/uploads/Policy_Wordings_CPI_dc7b416cf1.pdf","quote":"nder.\nThe details of the Insurance Ombudsman/ complete Grievance Redressal Process is also available at ZKGI’s website: www.zurichkotak.com\nThe updated details of Insurance Ombudsman offices are also available on the website of | Council for\nInsurance Ombudsm","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/zurich-kotak-general-insurance/5489-all-risks-secure-proposal-form-and-questionnaire"}