{"id":5493,"title":"Burglary Secure 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/Burglary_Secure_Proposal_Form_ZK_v1_24_25_06062024_2fb9536442.pdf","sha256":"e5da252b81407631e6484c8ce8b0b0961cc2d9bdc38f7eeeea35b3221ec3f0e2","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for burglary insurance to be filled by the proposer who wants to insure property against burglary risks.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","The company’s liability starts only after acceptance of the proposal and receipt of premium.","Provide all information fully, accurately and correctly; non-disclosure may void the policy.","Attach additional sheets if needed and indicate question number.","Use original documents for proofs and attach as required.","Submission of proposal or payment does not oblige the company to issue a policy.","The company may cancel the contract if premium is not received in full and on time.","Statutory warning about prohibition of rebates under Section 41 of Insurance Act 1938.","Vernacular declaration confirms explanation of form contents in language understood by proposer."],"title":"Burglary Secure 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":"Proposal Details and Proposer Details","fields":[{"help":"","type":"choice","label":"Proposal for*","options":["New Property","Rollover","Endorsement","Renewal"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"First Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Middle 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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":"Registered Office Address / Permanent Address*","options":[],"required":true,"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 communication address details if different","type":"text","label":"If ‘No’, please provide below","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Communication (Postal) Address*","options":[],"required":true,"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":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN*:","options":[],"required":true,"pdf_field":""},{"help":"","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 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","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Authorised Signatory","type":"text","label":"Designation:","options":[],"required":null,"pdf_field":""},{"help":"Authorised Signatory","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"*Is the Insured is same as Proposer / Owner?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured & Risk Details","fields":[{"help":"","type":"choice","label":"Type of Client","options":["Individual","Non-Individual","Government"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Paid-up Capital","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Business Sector","options":["Urban","Rural"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Type of Individual","options":["Salarised","Self-Employed","Professional"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"If entity, Type of entity","options":["Partnership firm","Company","Others (Please specify)"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"PAN","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Kotak Group Employee","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If Yes, Employee ID","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":"Columns: Policy No, Policy period, Description of property, Causes of loss, Amount of loss, Sum Insured (`), Premium (`), Insurer","type":"table","label":"Details of previous insurance (if any)(Kindly attach the list of locations along with the Sum Insured)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Kindly provide details of Insured Premise","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Roof","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Floor","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Compound wall /Fencing","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Wall","options":[],"required":null,"pdf_field":""},{"help":"Include type, year of construction, built up area, type of building, adjoining area, floor location","type":"text","label":"Nature of construction of the Insured Premise","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you an existing customer of Kotak Mahindra Bank Ltd. / Kotak Mahindra Prime Ltd.?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Customer Relationship Number","type":"text","label":"If Yes, CRN.","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether Insurance was declined by any other Company or imposed any Special Conditions","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If Yes, kindly share the details","options":[],"required":null,"pdf_field":""},{"help":"Start date","type":"date","label":"Period of insurance: From","options":[],"required":null,"pdf_field":""},{"help":"End date","type":"date","label":"To Midnight","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please furnish the premium vis- a-vis claim details for the past 36 months or for lesser period","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Whether you have insured the same property with any other Insurance Company with the same type of coverage","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If Yes, kindly share the details","options":[],"required":null,"pdf_field":""},{"help":"Include Address Line 1, Line 2, Nearest Landmark, City/District, State, Area, Pin Code, Country","type":"text","label":"Insured Premises Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"checkbox","label":"Is Security available for the Property?","options":["Security Guard","Electronic Device(CCTV/Burglary Alarm)","Common watchman","Building boundary wall","None"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured and Cover Details","fields":[{"help":"Columns: Cover, Sum Insured, Stock (Description required), Goods held by the proposer in trust or commission, Machinery, Furniture, Fixtures and Fittings, Money in locked Safe, Others – Specify, Maker’s name and specification of safe (Height,width,depth and weight)","type":"table","label":"Sum Insured Details","options":[],"required":null,"pdf_field":""},{"help":"Select deductible amount to avail discount","type":"choice","label":"Do you want to opt for voluntary deductible? If yes, specify the deductible amount.","options":["50,000","100,000","150,000","300,000","500,000","> 500,000"],"required":null,"pdf_field":""},{"help":"Use additional sheet if needed","type":"text","label":"Are these assets covered under insurance taken from other insurance? If yes, then provide the details below.","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you the sole owner/occupant of the premises","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If No, who are the other occupants?","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"How long have you been an occupant of the premises","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Mention whether books of accounts properly maintained","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Occupancy of Risk","options":["Residential","Shop","Office","Manufacturing Unit","Warehouse/Godown"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If you want add on covers by the payment of additional premium, please specify:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If Yes, please furnish the addresses of the Locations over which the stock will be floating","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No for each add-on","type":"checkbox","label":"Do you want to opt for any Add-on Covers/Endorsements ? Please select:","options":["Theft Cover","Riot, Strike and Malicious damage","Agreed Bank Clause","Designation of Property Clause","Reinstatement Value Policies Clause","Floater Clause","Declaration Clause","First Loss Clause","Contract Price Clause","Local Authority Clause","Escalation Clause","Police Intimation Clause","Injury during Burglary and/or Housebreaking Deletion Endorsement","Clothing and Personal Effects Deletion Endorsement (Applicable only for Commercial Customers)","Money Deletion Endorsement"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Consent","fields":[{"help":"","type":"signature","label":"Signature / Thumb impression 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":""},{"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":"For entities only","type":"yes-no","label":"Are you a Non-Profit Organization?*(only in case of an entity)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"In case of entity, Type of Organisation making the payment:","options":["Limited Company","International Organisation","Trust","Partnership","Section 25 Company","Non-Government Organisation (NGO)","Society","Others","Government Organisation","Co-operatives"],"required":null,"pdf_field":""},{"help":"Electronic Insurance Account","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":"","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":null,"pdf_field":""},{"help":"","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":"Mandatory for EIA","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"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":"Transaction date","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"IFSC/MICR Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Drawn Amount","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Transaction Date","options":[],"required":null,"pdf_field":""},{"help":"Include Account Number, Bank Name, Account Holder name","type":"text","label":"BANK ACCOUNT DETAILS","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Burglary Secure insurance policy","attachments":["Proof of Identity (POI) and Proof of Address (POA)","List of locations along with the Sum Insured for previous insurance","Additional sheets if space is insufficient"],"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.","Any additions or alterations after submission must be conveyed to the insurer immediately.","Policy and service communications will be sent in soft copy to the email provided unless physical copy is requested.","Consent is given to verify identity/address through official registries for KYC purposes.","The proposer confirms premiums are paid from bonafide sources and understands the insurer’s rights under AML 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 understanding of the policy features and terms as explained by the intermediary or agent."],"dropped_labels":3},"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/5493-burglary-secure-proposal-form"}