{"id":5491,"title":"Advance Loss of Profits Insurance Proposal Form","purpose":"proposal","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/Advance_Loss_of_Profits_Insurance_Proposal_Form_ZK_26_27_v1_17032026_461c965f5a.pdf","sha256":"2e60f95b947fd02f7fa19f22bf687496c6bf8e45c7da0fd8da172ddfd67b2a94","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (policyholder) to apply for Advance Loss of Profits Insurance coverage from Zurich Kotak General Insurance Company.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","Provide full, accurate, and correct information; non-disclosure or misrepresentation may void the policy.","Attach additional sheets if more space is needed, indicating the question number.","Use original documents where required.","Policy liability starts only after acceptance and premium receipt.","Policy and service communications will be sent by email unless physical copy is requested."],"title":"Advance Loss of Profits Insurance Proposal Form","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":"","type":"text","label":"Quote No.*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch Code","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","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":""},{"help":"","type":"text","label":"Nearest Landmark","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":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"Valid email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Goods and Services Tax Identification Number","type":"text","label":"GSTIN","options":[],"required":null,"pdf_field":""},{"help":"","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":"Include country and area code if applicable","type":"phone","label":"Contact No.","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":"City / District","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Registered Office Address / Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Communication (Postal) Address*","options":[],"required":true,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"For Corporate customers, please share below details: PAN*:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"GSTIN:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please share the below details for the Authorised Signatory: Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Designation:","options":[],"required":null,"pdf_field":""},{"help":"Central KYC Registry number","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"6 digit postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country","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":"City / District","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If ‘Yes’, Policy No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Hypothecation Details: Bank Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Paid up Capital of the firm","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Period of Insurance for Terrorism Cover: From","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"To","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details","fields":[{"help":"","type":"text","label":"Brief description of construction/ erection works to be carried out","options":[],"required":null,"pdf_field":""},{"help":"Attach site layout plan if yes","type":"yes-no","label":"Any existing plant or surrounding property in processor’s possession or care, custody or control on the above site(s) or adjacent to it (them). Please attach site layout plan","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"The project is","options":["The extension of existing works","A new venture"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Loss or damage to existing plant or surrounding property arising out of the construction / Erection activities which such activities are likely to Cause. If so, please specify.","options":[],"required":null,"pdf_field":""},{"help":"Attach flow sheet","type":"text","label":"Brief description of the process or services, making special mention of bottlenecks. (Please attach flow sheet)","options":[],"required":null,"pdf_field":""},{"help":"Number of years","type":"text","label":"Has the method of production or services Been employed by the proposer previously. If so, for how many years?","options":[],"required":null,"pdf_field":""},{"help":"Fill hours and shifts per day, per week, per year","type":"table","label":"Intended normal working hours","options":[],"required":null,"pdf_field":""},{"help":"Provide monthly figures","type":"text","label":"Loss of Profit Questionnaire (a) Anticipated gross profit (Annual turnover less costs of supplies of goods, raw material, electricity, water gas, etc.) for first year of operation (monthly figures)","options":[],"required":null,"pdf_field":""},{"help":"Specify indemnity period","type":"text","label":"(b) If indemnity period required longer than 12 months Indemnity period required:","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Gross profit of required period:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"(c) Are there seasonal events likely to affect the gross profit? If so, please give details.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Describe time excess (min one week per 6 months of construction/erection period)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Maximum indemnity period required to be insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"section","label":"This question is only in respect of power generation equipment at the plant to be insured supplying power to this plant and is only to be answered if electricity can be drawn from the public power network in the event of damage to the power generation equipment at the plant to be insured.","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"(a) Is the additional expenditure caused by using external power supply to be Insured?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify power in kW and kWh per annum","type":"text","label":"(b) Power requirements of the plant (kW, kWh pa)","options":[],"required":null,"pdf_field":""},{"help":"Percentage value","type":"number","label":"(c) Percentage of the requirements met by the plant's own power generation equipment","options":[],"required":null,"pdf_field":""},{"help":"Specify kW","type":"number","label":"(d) To what extent (kW) may electricity be drawn from an external source?","options":[],"required":null,"pdf_field":""},{"help":"Attach copy of contract","type":"text","label":"(e) What is the maximum demand charge per kW and within which period is it due? (Please attach copy of contact)","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"(f) Annual maximum demand charges","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Time related information (a) Date of Inception of EAR/CAR cover","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"(b) Date of commencement of works","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of any penalty agreements in connection with the contract works?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Any other information that you feel is important and is relevant for this Insurance proposal:","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Costs of kWh of power: Drawn from own plant:","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Drawn from external plant:","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"To","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Tick if cancelled cheque submitted","type":"checkbox","label":"Details as per premium cheque to be used for electronic fund transfer; Cancelled cheque submitted of other bank","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Account Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Account Holder name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cheque / D.D#","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Drawn To","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank and Branch Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"For Credit / Debit Card Transaction Reference No","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Bank code","type":"text","label":"IFSC/MICR Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Drawn Amount","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Transaction Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"BANK DETAILS","options":["Cheque","Demand Draft","Credit / Debit Card","Online Payment"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Acknowledgement","fields":[{"help":"","type":"text","label":"Received from Ms./Mrs./ Mr.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Through Cheque/DD","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"sum of `","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Zurich Kotak General Insurance Company (India) Limited Official / Intermediary","options":[],"required":null,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Zurich Kotak General Insurance Company (India) Limited Official/Intermediary Name","options":[],"required":null,"pdf_field":""},{"help":"Format HH:MM","type":"text","label":"Time","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"insurance company official / intermediary"},{"title":"Electronic Insurance Account Details of Proposer","fields":[{"help":"","type":"yes-no","label":"Do you have an EIA Account","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":null,"pdf_field":""},{"help":"Mandatory","type":"email","label":"Email id (to be registered with Insurance Repository)","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"If No, do you want Us to create an EIA account for you (If Yes, please fill up Insurance Repository Application form)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Vernacular Declaration","fields":[{"help":"","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary and proposer"},{"title":"Declarations by Proposer","fields":[{"help":"","type":"signature","label":"Signature/Thumb impression of Proposer*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"In case of entity, Type of Organisation making the payment:","options":["Limited Company","International Organisation","Trust","Partnership","Non-Government Organisation (NGO)","Section 25 Company","Society","Others","Government Organisation","Co-operatives"],"required":null,"pdf_field":""},{"help":"PEP means individuals with prominent public functions","type":"yes-no","label":"Are You or any of the proposed applicants or close relatives is/are associated to Politically Exposed Person (PEP)?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Non-profit organization as defined under Income-tax Act","type":"yes-no","label":"Are you a Non-Profit Organization?*(only in case of an entity)","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration for Agent","fields":[{"help":"","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":"","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""}],"filled_by":"insurance advisor / agent"}],"deadlines":[],"applies_to":"Advance Loss of Profits Insurance","attachments":["Site layout plan (if applicable)","Flow sheet describing process or services","Copy of contract for maximum demand charge (if applicable)","Phase diagram of construction (if applicable)","Cancelled cheque (if premium payment by electronic fund transfer)","Insurance Repository Application form (if EIA account creation requested)"],"declarations":["The statements made in this Proposal Form are true to the best of the proposer’s knowledge and belief and form the basis of the contract.","The proposer consents to verification of identity/address through various government portals for KYC purposes.","All premiums are paid from bonafide sources and not from proceeds of crime; the company may cancel the contract if found otherwise.","The insurance company is not liable if NEFT transactions do not complete.","Submission of the proposal or payment does not oblige the company to issue a policy; acceptance is at the company’s sole discretion.","The insurance advisor declares that the policy features and terms have been explained to the proposer in detail."],"dropped_labels":6},"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/5491-advance-loss-of-profits-insurance-proposal-form"}