{"id":5528,"title":"Home Secure - Excel 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/Home_Secure_Exel_Proposal_Form_ZK_V2_24_25_12122024_78c43f9e1d.pdf","sha256":"6fa6bc60499ffc8a9523044f45706bb90b68e1b9a0b1e5ddff7231793b8e8d3a","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals proposing to purchase the Home Secure insurance policy from Zurich Kotak General Insurance Company. The proposer fills it to provide personal, property, and coverage details for underwriting.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","Liability of the company starts only after acceptance of proposal and receipt of premium.","Provide all information fully, accurately and correctly; non-disclosure or misrepresentation may void the policy.","Attach additional sheets if space is insufficient, indicating question number.","Use original documents for proof of identity and address.","Policy period for long term policies shall not exceed 10 years.","Building construction type must be specified as Kutcha or Pucca.","Total nominee share cannot exceed 100%.","Electronic Insurance Account email id is mandatory if opting for EIA.","Submission of proposal or payment does not oblige the company to issue a policy.","Premium must be received in full and in time for policy to be effective.","NEFT transaction may fail; company not liable for such failures."],"title":"Home Secure - Excel Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer’s Information","fields":[{"help":"","type":"choice","label":"Proposal for*","options":["New Property","Old Property","Endorsement","Renewal"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Type of House*","options":["Flat / Apartment","Independent Building"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Type of Ownership*","options":["Owner","Tenant"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Quote No.*","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Quote Date*","options":[],"required":true,"pdf_field":""},{"help":"First Name, Middle Name, Last Name","type":"text","label":"Name*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Occupation*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Profession","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Phone","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Gender*","options":["Male","Female","Others"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Nationality","options":["Indian","Non-Indian","NRI"],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status","options":["Single","Married","Others"],"required":false,"pdf_field":""},{"help":"Address Line 1, Line 2, Nearest Landmark, City/District, State, Pin Code, Country","type":"text","label":"Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is Correspondence Address same as Permanent Address?*","options":[],"required":true,"pdf_field":""},{"help":"If different from Permanent Address; Address Line 1, Line 2, Nearest Landmark, City/District, State, Pin Code, Country","type":"text","label":"Correspondence Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Mobile*","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"Email*","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Title Mr. / Miss / Mrs. / M/s / Others","options":["Mr.","Miss","Mrs.","M/s","Others"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you an existing customer of Kotak Mahindra Bank Ltd. / Kotak Mahindra Prime Ltd.?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Any existing policy from Us","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If yes, Employee ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Zurich/Kotak Group Employees","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If yes, CRN","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If yes, Policy No.","options":[],"required":false,"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":"choice","label":"Business","options":["Salaried","Professionals","Student","Housewife","Retired","Others"],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"CA","options":["Paramilitary Services","Govt. Teacher","Govt. Employee","Medical Doctor","Others"],"required":false,"pdf_field":""},{"help":"Tick applicable documents","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":"Permanent Account Number","type":"text","label":"PAN*:","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured (Applicable to Burglary & Theft)","fields":[{"help":"","type":"choice","label":"Basis of Sum Insured:","options":["Structure","Contents"],"required":true,"pdf_field":""},{"help":"Enter percentage if First Loss basis selected","type":"number","label":"If First Loss basis is selected, First loss %","options":[],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Agreed Value","options":["New for Old","Indemnity Value","Reinstatement Value"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you want to opt for Escalation Provision (Applicable for Structure)?","options":[],"required":false,"pdf_field":""},{"help":"Maximum up to 25% per year","type":"number","label":"If Yes, Please mentioned the Escalation %:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Covers Opted","fields":[{"help":"","type":"yes-no","label":"Is there any policy in place for the same property?","options":[],"required":false,"pdf_field":""},{"help":"Provide existing policy details","type":"text","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Tick applicable covers","type":"checkbox","label":"Cover/s required:","options":["Home Building & Home Contents","Home Building Only","Home Contents Only","Burglary and Theft (Cover restricted within premises)"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Location of Home Building","fields":[{"help":"Include full address and pin code","type":"text","label":"Location of Home Building - Full postal address with Pin Code.","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Pin Code:","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Is it in a multi-storey building or is it a standalone house?","options":["Multi-storey building","Standalone house"],"required":true,"pdf_field":""},{"help":"","type":"number","label":"In case of multi-storey building, please provide the floor number of Your house","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is there a basement to Your house?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Home Building","fields":[{"help":"Describe any additional structures on site","type":"text","label":"Additional Structure","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Policy to be issued in favour of (list out all the parties who have insurable interest) including the financial institutions","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Other Details","fields":[{"help":"Strike out what is not applicable for Walls, Floor, Roof","type":"choice","label":"Construction*","options":["Kutcha","Pucca"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Age of Home Building","options":["Less than 5 years","5-10 years","10-20 years","Above 20 years"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Home Contents","fields":[{"help":"","type":"amount","label":"Electrical / Electronic","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Others","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"In case of Basement, If there are contents in it, please provide the Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Attach list of items and valuation certificate if Sum Insured > 5 Lakh or item value > 1 Lakh","type":"yes-no","label":"Do You require ‘Cover for Valuable Contents on Agreed Value Basis (under Home Contents cover)’","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Valuation certificate attached? (Yes/No)","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do You require ‘Personal Accident Cover’ for Yourself and Your spouse?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If Yes, Name & age of Your spouse","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Your age","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Please specify details of any loss to the proposed Property in last 3 years: Date of Loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Cause of Loss","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Claimed Amount","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Settled Amount /please specify if claim is outstanding","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any other insurance company in respect of Insurance: Declined Your Proposal?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any other insurance company in respect of Insurance: Cancelled or refused to renew Your policy?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any other insurance company in respect of Insurance: Accepted Your Proposal on special terms and condition?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Cover","fields":[{"help":"","type":"number","label":"Indemnity Period","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured* (`)","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":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":false,"pdf_field":""},{"help":"If Yes, please fill up Insurance Repository Application form","type":"yes-no","label":"If No, do you want Us to create an EIA account for you","options":[],"required":false,"pdf_field":""},{"help":"Mandatory","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"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":"","type":"text","label":"Where Nominee is a minor, give details of Appointee: 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":"Declarations and Signatures","fields":[{"help":"","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"","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 person with disability authorized representative","type":"signature","label":"Signature of Authorised Representative*","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer and intermediary"},{"title":"Payment Details","fields":[{"help":"Name of payer","type":"text","label":"Received from Ms./Mrs./ Mr","options":[],"required":false,"pdf_field":""},{"help":"Amount paid","type":"amount","label":"a sum of `","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Through Cheque/DD","options":["Cheque","Demand Draft"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Cheque / D.D#","options":[],"required":false,"pdf_field":""},{"help":"Bank name","type":"text","label":"Drawn To","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank and Branch Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"For Credit / Debit Card: Transaction Reference No","options":[],"required":false,"pdf_field":""},{"help":"","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":"Annexure - Contents Details","fields":[{"help":"Provide item description, age, identification/serial, sum insured for each category: Electronic Equipment, Domestic Appliances, Portable Equipment, Furniture & Fixtures, Any Other Item","type":"table","label":"Description of the Item","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Home Secure insurance policy proposal","attachments":["Additional sheets if more space is needed for answers","Valuation certificate for Valuable Contents if Sum Insured > 5 Lakh or individual item value > 1 Lakh","List of items and Sum Insured for Valuable Contents if opting for Agreed Value Basis"],"declarations":["Statements made in this Proposal Form are true to the best of knowledge and belief and form the basis of the contract.","Any additions or alterations in the risk after submission must be conveyed 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 specified government portals for KYC.","All premiums paid are from bonafide sources and not from proceeds of crime; company may call for documents to establish source of funds.","Insurance company may cancel contract if found guilty under money laundering laws.","Declaration if proposer or relatives are Politically Exposed Persons (PEP).","Declaration if proposer is a Non-Profit Organization (entity only).","Vernacular declaration that contents and terms have been explained in language understood by proposer.","Declaration for agent that policy features and terms have been explained to proposer.","Declaration in case proposer is a person with disability authorizing a representative to assist."],"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/5528-home-secure-excel-proposal-form"}