{"id":5502,"title":"Electronic Equipment 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/EEI_Proposal_Form_ZK_V2_24_25_12122024_a5dc961140.pdf","sha256":"8c5d945e9dafcaf48a0ab662e6e6d7bb95f534092ce4fa714641ee83b2840a6d","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or corporate proposers to apply for electronic equipment insurance coverage by providing detailed information about the equipment, proposer, and risk factors.","notes":["Fill the form in BLOCK LETTERS.","Fields marked with * are mandatory.","Attach additional sheets if space is insufficient and indicate question number.","Information will be treated in strict confidence.","Submission of proposal or payment does not oblige the company to issue a policy.","Policy becomes voidable if any information is untrue or incomplete.","Policy and service communication will be sent in soft copy to the email provided unless physical copy is requested.","Use original documents for proofs and payments.","Nominee details are applicable for individual customers only.","Total nominee share cannot exceed 100%.","For EDP system rented, attach lease contract if available.","For electronic fund transfer, submit cancelled cheque of the bank account."],"title":"Electronic Equipment 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":"Date of proposal submission","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":"Full name of the proposer","type":"text","label":"Proposer’s Name*","options":[],"required":true,"pdf_field":""},{"help":"Nature of business or trade","type":"text","label":"Proposer's Trade or Business*","options":[],"required":true,"pdf_field":""},{"help":"Phone number of proposer","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Primary address line","type":"text","label":"Address (Line 1)","options":[],"required":null,"pdf_field":""},{"help":"Secondary address line","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":"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":"Communication (Postal) Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"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":"Tick if applicable","type":"checkbox","label":"/ Form 60 (only in case the customer does not have PAN No.)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN*","options":[],"required":true,"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":"","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":"Authorised Signatory Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Designation","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":""}],"filled_by":"proposer"},{"title":"Equipment and Risk Details","fields":[{"help":"","type":"text","label":"Location of equipment to be insured (address of building/storey)","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Structure of building","options":["Steel skeleton","Brickwork","Concrete","Wood"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any of the equipment to be insured, previously been covered at any time by other Insurance Companies?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Start date of insurance","type":"date","label":"State when the insurance is to commence?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is all the equipment to be insured new?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"What equipment can still be obtained ex works? (State items of the specification)","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the equipment maintained in accordance with the manufacturer’s instructions?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Have operators been trained with manufacturer?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are dangerous materials used in the vicinity?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick applicable materials","type":"checkbox","label":"If so, specify","options":["Acids","Prepared or sensitized papers","Dyes","Test solutions","Developers","Explosives","Isotopes","Others"],"required":null,"pdf_field":""},{"help":"Attach copy if yes","type":"yes-no","label":"Valid Maintenance Contract in force?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Air conditioning 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account","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Your address details as mentioned in the EIA account shall override the address provided in this application for Insurance.","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":"","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":null,"pdf_field":""},{"help":"","type":"email","label":"Nominee Email 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1938.","The proposer may be classified as High Net Worth Individual only if declared.","The proposer authorizes a representative to assist if person with disability."],"dropped_labels":13},"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/5502-electronic-equipment-insurance-proposal-form"}