{"id":5509,"title":"Fire 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/Fire_Secure_Proposal_Form_ZK_v2_24_25_13122024_f93b0e42ea.pdf","sha256":"a464029c26268d25321bcb2cd634966a2f9c51271030714c27eec4b31b4fe137","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or corporate entities to apply for Fire Secure insurance coverage from Zurich Kotak General Insurance Company. The proposer or owner fills it.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","Provide all information fully, accurately and correctly; non-disclosure or misrepresentation may void the policy.","Attach additional sheets if space is insufficient, indicating the question number.","Buildings with certain materials are treated as 'Kutcha' construction and must be declared.","Minimum sum insured for stocks on declaration basis is ₹1 Crore; policy not issued on short period basis.","Minimum sum insured for stocks on floater declaration basis is ₹2 Crore.","Stocks in process and stocks stored at Railway sidings are not covered under stock special coverage.","Use original documents and proofs as required.","Submission of proposal or payment does not oblige the Company to issue a policy; acceptance is at Company’s discretion.","Premium must be received in full and in time for policy liability to commence.","Policy terms and conditions apply as per Fire Secure policy document."],"title":"Fire 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":"Proposer / Owner’s Details","fields":[{"help":"","type":"choice","label":"Title","options":["Mr.","Ms.","Dr.","M/s","Others"],"required":null,"pdf_field":""},{"help":"Full name in block letters","type":"text","label":"Name*","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Contact No.","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":"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":"Provide 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":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"","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":"","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":"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":"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":"text","label":"Occupation","options":[],"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":"","type":"choice","label":"Business","options":["Salaried","Professionals","Student","Housewife","Retired","Others"],"required":null,"pdf_field":""},{"help":"","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":"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":null,"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":null,"pdf_field":""},{"help":"","type":"text","label":"Designation:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","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":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured & Risk Details","fields":[{"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 Reference Number","type":"text","label":"If ‘Yes’, CRN","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Zurich/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":"","type":"text","label":"Policy to be issued in favor of (list out all the parties who have insurable interest) including the financial institutions","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Location of risk to be covered - 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policy proposal","attachments":["Additional sheets if more space is required to answer questions","Detailed block plan showing various facilities if Industrial Manufacturing unit","Cancelled cheque for electronic fund transfer","Insurance Repository Application form if EIA account to be created"],"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.","Policy and service related communication will be sent in soft copy to the email ID mentioned unless physical copy is requested.","Consent is given to verify identity/address through Central KYC Registry or other government portals for KYC purposes.","Proposer declares if they qualify as a High Net Worth Individual (HNI) with net worth of ₹50 crore or more by ticking the box.","All premiums have been/will be paid from bonafide sources and not from proceeds of crime as per Prevention of Money Laundering Act.","The Company may cancel the insurance contract if found guilty under money laundering laws.","The proposer declares if they or close relatives are associated with Politically Exposed Persons (PEP).","The proposer declares if they are a Non-Profit Organization (entity only).","Agent declares that the policy features and terms have been explained to the proposer who has signed after understanding.","Vernacular declaration confirms contents of the proposal form and policy terms have been explained in a language understood by the proposer.","Person with disability may authorize a representative to assist in completing the proposal form."],"dropped_labels":4},"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/5509-fire-secure-proposal-form"}