{"id":5515,"title":"Group Smart Cash 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/Group_Smart_Cash_GO_GREEN_Proposal_Form_ZK_V1_25_26_11082025_6b57b81e0d.pdf","sha256":"e7619b70360bdc2755f965410682d88b1abc0ccbf3762dc9fe15ddd7f118efc0","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used to apply for the Group Smart Cash insurance policy from Zurich Kotak General Insurance Company. It is filled by the proposer or group administrator.","notes":["Fill the form in BLOCK LETTERS.","Fields marked with * are mandatory.","Attach additional sheets if more space is needed, indicating question number.","Information provided will be treated in strict confidence.","Policy issuance is subject to underwriting and receipt of premium.","Use original documents and accurate information to avoid policy voidance.","Electronic fund transfer is mandatory for payments and claims as per regulatory requirements."],"title":"Group Smart Cash Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer's Information","fields":[{"help":"Enter the full name of the proposer or group administrator","type":"text","label":"Name of the Proposer/ Group Administrator/ Bank/ Financial Institution (Organisation/ Institute/ Association)*","options":[],"required":true,"pdf_field":""},{"help":"Describe the trade, business or activity of the proposer","type":"text","label":"Proposer’s Trade/ Business/ Activity*","options":[],"required":true,"pdf_field":""},{"help":"Enter the first line of the address","type":"text","label":"Address (Line 1)","options":[],"required":null,"pdf_field":""},{"help":"Enter the second line of the address","type":"text","label":"Address (Line 2)","options":[],"required":null,"pdf_field":""},{"help":"Provide a nearby landmark for the address","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"Enter the city or district","type":"text","label":"City / District","options":[],"required":null,"pdf_field":""},{"help":"Enter the state","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Provide the registered office address","type":"text","label":"Proposer’s Registered Office Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter the country","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"Enter the postal pin code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is the Mailing Address same as the Registered Office Address?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If mailing address differs, provide it here","type":"text","label":"Proposer’s Mailing Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter a valid email address","type":"email","label":"Email ID*","options":[],"required":true,"pdf_field":""},{"help":"Enter a contact phone number","type":"phone","label":"Contact No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter a mobile phone number","type":"phone","label":"Mobile No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter GST Identification Number if applicable","type":"text","label":"GSTIN","options":[],"required":null,"pdf_field":""},{"help":"Enter Permanent Account Number","type":"text","label":"PAN*","options":[],"required":true,"pdf_field":""},{"help":"Enter CKYC number if available","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":null,"pdf_field":""},{"help":"Indicate if you have any existing policy with the company","type":"choice","label":"Any existing policy from Us","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide existing policy number if applicable","type":"text","label":"If Yes Policy Number","options":[],"required":null,"pdf_field":""},{"help":"Select preferred installment frequency","type":"choice","label":"Installment Option*","options":["Monthly","Quarterly","Half yearly"],"required":true,"pdf_field":""},{"help":"Define family members covered if applicable","type":"text","label":"Family Definition","options":[],"required":null,"pdf_field":""},{"help":"List relationships covered under the policy","type":"text","label":"Relationships Covered","options":[],"required":null,"pdf_field":""},{"help":"Applicable only to credit linked policies","type":"text","label":"Type of Credit #","options":[],"required":null,"pdf_field":""},{"help":"Specify categories of insured persons","type":"text","label":"Categories of proposed Insured (Add more categories if needed) – (senior management, middle management, management trainee, etc.)","options":["Cat 1","Cat 2","Cat 3","Cat 4","Cat 5"],"required":null,"pdf_field":""},{"help":"Enter policy start date in DD/MM/YYYY format","type":"date","label":"Policy Period From:","options":[],"required":true,"pdf_field":""},{"help":"Select policy category","type":"choice","label":"Policy Category: Individual/Family Floater","options":["Individual","Family Floater"],"required":true,"pdf_field":""},{"help":"Enter total number of persons to be insured","type":"number","label":"Number of Persons to be insured","options":[],"required":true,"pdf_field":""},{"help":"Enter quote number","type":"text","label":"Quote No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter branch code","type":"text","label":"Branch Code","options":[],"required":null,"pdf_field":""},{"help":"Enter quote date in DD/MM/YYYY format","type":"date","label":"Quote Date*","options":[],"required":true,"pdf_field":""},{"help":"Enter sales manager code","type":"text","label":"Sales Manager Code","options":[],"required":null,"pdf_field":""},{"help":"Enter intermediary code","type":"text","label":"Intermediary Code","options":[],"required":null,"pdf_field":""},{"help":"Enter intermediary service RM","type":"text","label":"Intermediary Service RM","options":[],"required":null,"pdf_field":""},{"help":"Enter intermediary branch code","type":"text","label":"Intermediary Branch code","options":[],"required":null,"pdf_field":""},{"help":"Enter intermediary business vertical","type":"text","label":"Intermediary business vertical","options":[],"required":null,"pdf_field":""},{"help":"Enter intermediary client reference number","type":"text","label":"Intermediary Client Ref. No.","options":[],"required":null,"pdf_field":""},{"help":"Enter SP name or code","type":"text","label":"SP Name/Code","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Benefit Details","fields":[{"help":"Enter daily cash amount and number of days","type":"amount","label":"Hospital Daily Cash Benefit","options":[],"required":null,"pdf_field":""},{"help":"Enter deductible or franchise days","type":"number","label":"Deductible - ____ days or Franchise - ____ days","options":[],"required":null,"pdf_field":""},{"help":"Enter daily cash amount and number of days","type":"amount","label":"Accident Daily Cash Benefit","options":[],"required":null,"pdf_field":""},{"help":"Enter daily cash amount and number of days","type":"amount","label":"ICU Daily Cash Benefit","options":[],"required":null,"pdf_field":""},{"help":"Enter amount for convalescence benefit","type":"amount","label":"Convalescence Benefit","options":[],"required":null,"pdf_field":""},{"help":"Enter number of days for companion benefit","type":"number","label":"Companion Benefit","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Joint Hospitalisation","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter number of days for parent accommodation","type":"number","label":"Parent Accommodation","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Day Care Procedure Benefit","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Surgery Benefit","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Accidental Hospitalisation Benefit","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Broken Bones","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Burns","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter number of days for maternity benefit","type":"number","label":"Maternity Benefit","options":[],"required":null,"pdf_field":""},{"help":"Enter number of days for newborn baby benefit","type":"number","label":"New Born Baby Benefit","options":[],"required":null,"pdf_field":""},{"help":"Enter number of days for worldwide cover","type":"number","label":"Worldwide Cover","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Personal Accident Benefit","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Critical Illness Benefit","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select applicable option","type":"choice","label":"Pre-existing Disease Waiting Period Waiver","options":["NA","Yes","No"],"required":null,"pdf_field":""},{"help":"Select applicable option","type":"choice","label":"30 days Waiting Period Waiver","options":["NA","Yes","No"],"required":null,"pdf_field":""},{"help":"Select applicable option","type":"choice","label":"Maternity Benefit Waiting Period Waiver","options":["NA","Yes","No"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Specified disease/procedure waiting period waiver","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured Details","fields":[{"help":"Enter membership or employee number; applicable for credit linked policies","type":"text","label":"Membership ID/ Employee Number/ Account Number pertaining to Credit (#)","options":[],"required":true,"pdf_field":""},{"help":"Enter financier name; applicable for credit linked policies","type":"text","label":"Name of the Financier (#)","options":[],"required":true,"pdf_field":""},{"help":"Enter credit tenure; applicable for credit linked policies","type":"text","label":"Credit Tenure (#)","options":[],"required":true,"pdf_field":""},{"help":"Enter full name of insured person","type":"text","label":"Name of the Insured Person","options":[],"required":true,"pdf_field":""},{"help":"Select category of insured person","type":"choice","label":"Category","options":["Applicant","Co-applicant"],"required":true,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of Birth DD/MM/YYYY","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female","Other"],"required":true,"pdf_field":""},{"help":"Enter credit sanctioned date; applicable for credit linked policies","type":"date","label":"Credit sanctioned date (#)","options":[],"required":true,"pdf_field":""},{"help":"Enter credit amount; applicable for credit linked policies","type":"amount","label":"Credit Amount / outstanding credit amount (#)","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship with insured person","type":"text","label":"Relationship with the Insured Person","options":[],"required":true,"pdf_field":""},{"help":"Enter designation or occupation","type":"text","label":"Designation/ Occupation","options":[],"required":true,"pdf_field":""},{"help":"Mention any existing illness","type":"text","label":"Any existing illness","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Previous Policy Details","fields":[{"help":"Provide policy period for past 3 policy periods or lesser","type":"text","label":"Policy Period From - To","options":[],"required":null,"pdf_field":""},{"help":"Enter insurer name","type":"text","label":"Name of the Insurer","options":[],"required":null,"pdf_field":""},{"help":"Enter policy number","type":"text","label":"Policy number","options":[],"required":null,"pdf_field":""},{"help":"Enter number of members covered","type":"number","label":"Number of members covered","options":[],"required":null,"pdf_field":""},{"help":"Enter total premium paid","type":"amount","label":"Total premium (`)","options":[],"required":null,"pdf_field":""},{"help":"Enter total claims amount","type":"amount","label":"Total amount of claims (Paid + Outstanding) (`)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Enter cheque or demand draft number","type":"text","label":"Cheque / DD#","options":[],"required":null,"pdf_field":""},{"help":"Enter payment amount","type":"amount","label":"Amount","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name on which cheque/DD is drawn","type":"text","label":"Drawn On","options":[],"required":null,"pdf_field":""},{"help":"Enter cheque/DD date","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch","type":"text","label":"Branch","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":null,"pdf_field":""},{"help":"Enter transaction reference number if paid by card","type":"text","label":"For Credit/Debit Card Transaction Reference No.","options":[],"required":null,"pdf_field":""},{"help":"Enter transaction date if paid by card","type":"date","label":"Transaction Date","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Enter name of insured","type":"text","label":"Insured Name*","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's full name","type":"text","label":"Nominee Name*","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship of nominee with proposer","type":"text","label":"Relationship of Nominee with Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's date of birth","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's mobile number","type":"phone","label":"Nominee Mobile Number","options":[],"required":null,"pdf_field":""},{"help":"Enter nominee's email address","type":"email","label":"Nominee Email ID","options":[],"required":null,"pdf_field":""},{"help":"Enter nominee's present address","type":"text","label":"Nominee Present Address","options":[],"required":null,"pdf_field":""},{"help":"Enter nominee's permanent address","type":"text","label":"Nominee Permanent Address","options":[],"required":null,"pdf_field":""},{"help":"Provide nominee's bank details for claim payment","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":null,"pdf_field":""},{"help":"Enter percentage share of claim for nominee","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":null,"pdf_field":""},{"help":"Enter name of appointee","type":"text","label":"Name of the Appointee","options":[],"required":null,"pdf_field":""},{"help":"Specify relationship of appointee with nominee","type":"text","label":"Relationship with the Nominee","options":[],"required":null,"pdf_field":""},{"help":"Re-enter nominee's name","type":"text","label":"Name of the Nominee","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Account Details","fields":[{"help":"Enter bank account number for electronic fund transfer","type":"text","label":"Account No.","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":null,"pdf_field":""},{"help":"Enter name of account holder","type":"text","label":"Account Holder Name","options":[],"required":null,"pdf_field":""},{"help":"Tick if no existing bank account","type":"checkbox","label":"No existing Bank Account","options":[],"required":null,"pdf_field":""},{"help":"Tick if cancelled cheque from other bank is submitted","type":"checkbox","label":"Cancelled Cheque submitted of Other Bank","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"ASBA Declaration","fields":[{"help":"Enter place of signing","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Sign the form","type":"signature","label":"Signature of Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"Agent to sign and stamp","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":"Proposer to sign and stamp","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Authorized representative to sign","type":"signature","label":"Signature of Authorised Representative*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and agent"},{"title":"Additional Questions","fields":[{"help":"Select Yes or No","type":"choice","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":"Select the type of organization","type":"choice","label":"Are you a Non-Profit Organization?* (only in case of an entity)","options":["Limited Company","International Organisation","Trust","Partnership","Section 25 Company","Non-Government Organisation (NGO)","Society","Others","Government Organisation","Co-operatives"],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Group Smart Cash insurance policy proposals","attachments":["Additional sheets if more space is needed to answer questions","Cancelled Cheque for bank account verification"],"declarations":["The information provided is true, complete and accurate to the best of the proposer's knowledge.","The policy will be issued only after acceptance by the company and full premium payment.","The proposer will notify any changes in occupation or health before risk acceptance.","Consent is given to the company to seek medical and insurance information for underwriting and claims.","Consent is given to share proposal and medical information with government and regulatory authorities.","Policy and service communications will be sent by email unless physical copies are requested.","Consent is given to verify identity/address through government or regulatory portals for KYC.","All premiums are paid from bonafide sources and not from proceeds of crime as per AML regulations.","The company may cancel the contract if found guilty under money laundering laws.","Agent declares that policy features and terms were explained to the proposer.","No rebates or inducements are allowed as per Insurance Act Section 41.","If proposer is a person with disability, an authorized representative may assist in completing the form.","Vernacular declaration confirms proposer understood the form and terms in their language."],"dropped_labels":9},"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/5515-group-smart-cash-proposal-form"}