{"id":5496,"title":"Contractor’s Plant And Machinery 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/CONTRA_1_b9214e7d94.PDF","sha256":"584cb3c89bc211a0c8cf51a76aff979cce7644f9b3db2fdcbf24b3595f17c902","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or corporate proposers to apply for Contractor’s Plant and Machinery Insurance coverage by providing detailed information about themselves, the machinery to be insured, and related risk factors.","notes":["Fill the form in BLOCK LETTERS.","Fields marked with * are mandatory.","Attach additional sheets if space is insufficient, indicating question number.","Use original and accurate information to avoid policy voidance.","Nominee total claim share must not exceed 100%.","Email ID is mandatory for Electronic Insurance Account registration.","Submission of proposal or payment does not guarantee policy issuance.","NEFT transaction may fail without liability to the insurer."],"title":"Contractor’s Plant And Machinery Insurance Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer/Owner’s Details","fields":[{"help":"Enter 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":"text","label":"Location of Operation (site of property to be insured)*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Nearest Railway station and distance","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Contact No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 1)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 2)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nearest Landmark","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Registered Office Address / Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":false,"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":false,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 2)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nearest Landmark","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Communication (Postal) Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Hypothecation Details: Bank Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Fill only if existing policy is held","type":"text","label":"If ‘Yes’, Policy No","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you a Non-profit Organization?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"/ Form 60 (only in case the customer does not have PAN No.)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"section","label":"For Individual customers, please share below details:","options":[],"required":null,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Occupation","options":["Business","Salaried","Professionals","Student","Housewife","Retired","Others"],"required":false,"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":false,"pdf_field":""},{"help":"","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"Tick applicable proofs","type":"checkbox","label":"Please share the following for authentication purpose: 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":false,"pdf_field":""},{"help":"","type":"section","label":"For Corporate customers, please share below details:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"PAN*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"","type":"section","label":"Please share the below details for the Authorised Signatory:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Designation:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Quote No.*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch Code","options":[],"required":false,"pdf_field":""},{"help":"dd/mm/yyyy","type":"date","label":"Quote Date*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Sales Manager Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Service RM","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Branch code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Intermediary business vertical","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Client Ref. No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"SP Name/Code","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Equipment and Site Details","fields":[{"help":"","type":"yes-no","label":"Are you the owner of the proposed equipment?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"If yes, will you be hiring out?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is maintenance and operation your responsibility?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are the premises where the equipment operates well-guarded?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"What is the site condition where the equipment will be utilized","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are the equipment likely to operate on reclaimed or soft ground?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are the equipments likely to operate underground?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are ground condition such that equipment are exposed to the risk of toppling over?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Explain risk of toppling if applicable","type":"text","label":"If so, give details?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Will equipment belonging to other contractors operate on the same site?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"List equipment requiring statutory inspection","type":"text","label":"Which of the equipments are required to be inspected and certified for operation by statutory rules?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has your machinery sustained any damage from breakdown or other cause during last 3 years?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of damages and costs","type":"text","label":"If so, give details of damage/s and Repairing cost","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is regular periodical inspection of the machinery carried out?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide inspector name and inspection frequency","type":"text","label":"If so, by whom and at what intervals?","options":[],"required":false,"pdf_field":""},{"help":"","type":"section","label":"On payment of additional premium do you wish to cover the following? If yes, provide limits of indemnity","options":[],"required":false,"pdf_field":""},{"help":"Enter limit in INR","type":"amount","label":"Express Freight (excluding Air Freight)","options":[],"required":false,"pdf_field":""},{"help":"Enter limit in INR","type":"amount","label":"Overtime and Holiday rates of Wages","options":[],"required":false,"pdf_field":""},{"help":"Enter limit in INR","type":"amount","label":"Air Freight","options":[],"required":false,"pdf_field":""},{"help":"Enter limit in INR","type":"amount","label":"Owners surrounding property","options":[],"required":false,"pdf_field":""},{"help":"Enter limit in INR","type":"amount","label":"Clearance & Removal of Debris","options":[],"required":false,"pdf_field":""},{"help":"Enter limit in INR","type":"amount","label":"Additional Customs Duty","options":[],"required":false,"pdf_field":""},{"help":"Enter limit in INR","type":"amount","label":"Escalation","options":[],"required":false,"pdf_field":""},{"help":"Enter limit in INR","type":"amount","label":"Third Party Liability For any one accident","options":[],"required":false,"pdf_field":""},{"help":"Specify other covers and limits","type":"text","label":"Any other Additional Cover you wish to opt for Please specify","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History and Other Details","fields":[{"help":"","type":"yes-no","label":"Do the items listed represent the entire machinery used by you at the above location?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you at present Insured?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Name of current insurer","type":"text","label":"If so, with whom?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any company Declined to insure any of the Machinery now proposed","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Required an increased premium or imposed special conditions","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Requested for repairs or made other special stipulations for risk improvement?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you aware of any defects/ damages existing in the machinery?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Describe defects or damages","type":"text","label":"If so, give details thereof","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you own or use any equipment other than that described above working on the same site?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide other insurance details","type":"text","label":"Covered by any other insurance? If so give details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Period of Insurance and Schedule of Machinery","fields":[{"help":"dd/mm/yyyy","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""},{"help":"dd/mm/yyyy","type":"date","label":"To","options":[],"required":true,"pdf_field":""},{"help":"Columns: S.No, Quantity, Description/type/model/capacity/serial no./HP/KVA/Volts/Amps/RPM, Maker’s Name and Country of origin, Year of Make, Sum Insured (INR)","type":"table","label":"SCHEDULE OF MACHINERY TO BE INSURED –","options":[],"required":true,"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":false,"pdf_field":""},{"help":"","type":"text","label":"Account Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Account Holder name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Cheque / D.D#","options":[],"required":false,"pdf_field":""},{"help":"Bank and Branch Name","type":"text","label":"Drawn To","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"For Credit / Debit Card Transaction Reference No","options":[],"required":false,"pdf_field":""},{"help":"Transaction date","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details (Applicable for individual customers)","fields":[{"help":"","type":"text","label":"Nominee Name*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Relationship of Nominee with Proposer*","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Nominee Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Nominee Email ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Present Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":false,"pdf_field":""},{"help":"Total share cannot exceed 100%","type":"number","label":"% of claim share*","options":[],"required":true,"pdf_field":""},{"help":"Provide appointee details if nominee is minor","type":"text","label":"Where Nominee is a minor, give details of Appointee","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Date of Birth DD/MM/YYYY","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the Nominee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details of Proposer","fields":[{"help":"","type":"yes-no","label":"Do you have an EIA Account","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":false,"pdf_field":""},{"help":"Mandatory","type":"email","label":"Email id (to be registered with Insurance Repository)","options":[],"required":true,"pdf_field":""},{"help":"If yes, fill Insurance Repository Application form","type":"yes-no","label":"If No, do you want Us to create an EIA account for you","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","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":"dd/mm/yyyy","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"For vernacular declaration","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"For vernacular declaration","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":true,"pdf_field":""},{"help":"Declaration for agent","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 PWD declaration","type":"signature","label":"Signature of Authorised Representative*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and intermediary"}],"deadlines":[],"applies_to":"Contractor’s Plant and Machinery Insurance","attachments":["Additional sheets if more space is needed for answers","Cancelled cheque for electronic fund transfer","Insurance Repository Application form (if EIA account creation requested)"],"declarations":["The information provided is true, complete and forms the basis of the contract.","Policy liability starts only after acceptance and premium receipt.","The company may void the policy for any misrepresentation or non-disclosure.","Policy and service communication will be sent by email unless physical copy requested.","Consent given to verify identity/address through official registries for KYC.","Proposer may be classified as High Net Worth Individual if declared.","Premiums paid are from bonafide sources and not from proceeds of crime.","Company may cancel contract if found guilty under money laundering laws.","No rebates or inducements are allowed under Insurance Act 1938.","Proposer with disability may authorize a representative to assist in form completion."],"dropped_labels":5},"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/5496-contractors-plant-and-machinery-insurance-proposal-form"}