{"id":5530,"title":"Home Secure - Premium 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_Premium_Proposal_Form_ZK_V2_24_25_12122024_871cbb9ee4.pdf","sha256":"78168a37713fc51c94704f488f6481de3cc119b8bda60ce476849a30f0edda4e","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or entities proposing to purchase the Home Secure insurance policy. 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 the proposal and receipt of premium.","Provide all information fully, accurately and correctly; non-disclosure may void the policy.","Attach additional sheets if more space is needed, indicating question number.","Sum insured for contents must not be less than 10% of structure sum insured or minimum ₹5 Lakhs.","If contents value is less than ₹5 Lakhs, declare individual values in an annexure.","Use original documents for proofs and valuation reports.","Electronic fund transfer details must be accurate; insurer not liable if NEFT fails.","Submission of proposal or payment does not oblige insurer to issue policy; acceptance is at insurer’s discretion."],"title":"Home Secure - Premium Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer’s Information","fields":[{"help":"Enter your occupation","type":"text","label":"Occupation*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Profession","options":[],"required":false,"pdf_field":""},{"help":"Enter phone number","type":"phone","label":"Phone","options":[],"required":false,"pdf_field":""},{"help":"Enter full name","type":"text","label":"Name*","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender*","options":["Male","Female","Others"],"required":true,"pdf_field":""},{"help":"Select nationality","type":"choice","label":"Nationality","options":["Indian","Non-Indian","NRI"],"required":false,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"Marital Status","options":["Single","Married","Others"],"required":false,"pdf_field":""},{"help":"Enter full permanent address","type":"text","label":"Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Is Correspondence Address same as Permanent Address?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Fill only if correspondence address differs","type":"text","label":"Correspondence Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile*","options":[],"required":true,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email*","options":[],"required":true,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"Select title","type":"choice","label":"Title Mr. / Miss / Mrs. / M/s / Others","options":["Mr.","Miss","Mrs.","M/s","Others"],"required":false,"pdf_field":""},{"help":"Enter CKYC number if available","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"Enter GSTIN if applicable","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Are you an existing customer of Kotak Mahindra Bank Ltd. / Kotak Mahindra Prime Ltd.?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter employee ID if applicable","type":"text","label":"If yes, Employee ID","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Zurich/Kotak Group Employees","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter CRN if applicable","type":"text","label":"If yes, CRN","options":[],"required":false,"pdf_field":""},{"help":"Enter policy number if applicable","type":"text","label":"If yes, Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Select annual income range","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":"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":"Enter PAN number","type":"text","label":"PAN*:","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":false,"pdf_field":""},{"help":"Enter quote date","type":"date","label":"Quote Date*","options":[],"required":true,"pdf_field":""},{"help":"Enter sales manager code","type":"text","label":"Sales Manager Code","options":[],"required":false,"pdf_field":""},{"help":"Enter intermediary code","type":"text","label":"Intermediary Code","options":[],"required":false,"pdf_field":""},{"help":"Enter service RM","type":"text","label":"Intermediary Service RM","options":[],"required":false,"pdf_field":""},{"help":"Enter branch code","type":"text","label":"Intermediary Branch code","options":[],"required":false,"pdf_field":""},{"help":"Enter business vertical","type":"text","label":"Intermediary business vertical","options":[],"required":false,"pdf_field":""},{"help":"Enter client reference number","type":"text","label":"Intermediary Client Ref. No.","options":[],"required":false,"pdf_field":""},{"help":"Enter SP name or code","type":"text","label":"SP Name/Code","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured Information","fields":[{"help":"Enter full insured premises address","type":"text","label":"Insured Premises address*","options":[],"required":true,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Is Insured Premises Address same as Permanent Address / Correspondence Address?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter age in years and months","type":"number","label":"Age of Structure","options":[],"required":false,"pdf_field":""},{"help":"Describe construction type","type":"text","label":"Type of Construction","options":[],"required":false,"pdf_field":""},{"help":"Select wall material","type":"choice","label":"Walls made of","options":["Burned Brick","Bricks","Reinforced Concrete","Cement","RCC","Stone","Mud","Clay","Wood","Any other item"],"required":false,"pdf_field":""},{"help":"Select roof material","type":"choice","label":"Roof made of","options":["Tiles","Concrete","RCC","Asbestos","Corrugated","Cement","Wood","Thatched","Any other item"],"required":false,"pdf_field":""},{"help":"Provide bank, loan account, amount, tenure, EMI","type":"text","label":"Hypothecation Details (if any)","options":[],"required":false,"pdf_field":""},{"help":"Tick applicable appliances","type":"checkbox","label":"Fire Extinguishing Appliance Installed","options":["Hydrant & Sprinkler","Sprinkler Only","Portable Extinguishing","Small Bore Hose Reels","Trailer Pumps","Dedicated Fire Brigade","Mutual Aid","Spot Protection for Critical Areas","Hydrant Only"],"required":false,"pdf_field":""},{"help":"Tick applicable security","type":"checkbox","label":"Security Available for Structure","options":["Security Guard","Electronic Device","Common Watchman","No"],"required":false,"pdf_field":""},{"help":"Select floor","type":"choice","label":"Insured Premises Floor","options":["Basement","Ground","Top","No."],"required":false,"pdf_field":""},{"help":"Enter sum insured amount","type":"amount","label":"Sum Insured","options":[],"required":true,"pdf_field":""},{"help":"Select basis of sum insured","type":"choice","label":"Basis of Sum Insured","options":["Structure","Contents","First Loss basis","Agreed Value","New for Old","Indemnity Value","Reinstatement Value"],"required":true,"pdf_field":""},{"help":"Enter percentage if applicable","type":"number","label":"If First Loss basis is selected, First loss %","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Do you want to opt for Escalation Provision (Applicable for Structure)?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter escalation percentage up to 25%","type":"number","label":"If Yes, Please mentioned the Escalation %:","options":[],"required":false,"pdf_field":""},{"help":"Tick covers you want","type":"checkbox","label":"Cover - All Risk Cover - Structure and Contents (Tick on cover you want to opt)","options":["Structure","Contents"],"required":false,"pdf_field":""},{"help":"Enter sum insured for each cover","type":"amount","label":"Sum Insured* (`)","options":[],"required":true,"pdf_field":""},{"help":"Enter policy period in years (max 5)","type":"number","label":"Policy Period","options":[],"required":false,"pdf_field":""},{"help":"Enter indemnity period in years (max 5)","type":"number","label":"Indemnity Period","options":[],"required":false,"pdf_field":""},{"help":"Tick if you want terrorism cover","type":"checkbox","label":"Cover - Terrorism Damage Cover (Tick on cover you want to opt)","options":["Terrorism Damage Cover"],"required":false,"pdf_field":""},{"help":"Enter sum insured for terrorism cover","type":"amount","label":"Sum Insured* (`)","options":[],"required":true,"pdf_field":""},{"help":"Enter policy period","type":"number","label":"Policy Period","options":[],"required":false,"pdf_field":""},{"help":"Enter indemnity period","type":"number","label":"Indemnity Period","options":[],"required":false,"pdf_field":""},{"help":"Enter number of months","type":"number","label":"Loss of Rent - Months (Maximum up to 36 Months)","options":[],"required":false,"pdf_field":""},{"help":"Enter number of months","type":"number","label":"Additional Rent for Alternate Accommodation - Months (Maximum up to 36 Months)","options":[],"required":false,"pdf_field":""},{"help":"Enter number of months","type":"number","label":"Trees and Plants / Garden Cover / Landscaping Damage - Months (Maximum up to 36 Months)","options":[],"required":false,"pdf_field":""},{"help":"Enter number of months","type":"number","label":"Additional Living Expenses - Months (Maximum up to 36 Months)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Claims Details","fields":[{"help":"Enter date of loss if any","type":"date","label":"Date of Loss","options":[],"required":false,"pdf_field":""},{"help":"Describe cause of loss","type":"text","label":"Cause of Loss","options":[],"required":false,"pdf_field":""},{"help":"Enter claimed amount","type":"amount","label":"Claimed Amount","options":[],"required":false,"pdf_field":""},{"help":"Enter settled amount or specify if outstanding","type":"amount","label":"Settled Amount /please specify if claim is outstanding","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"Has any other insurance company in respect of Insurance: Declined Your Proposal?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Covers","fields":[{"help":"Provide details of individual items valued more than ₹100,000","type":"table","label":"Details for Curios, Works of Art & Paintings Coverage (Description, Artist, Valuation Report Attached, Invoice copy attached, Sum Insured)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details","fields":[{"help":"Select yes or no","type":"yes-no","label":"Do you have an EIA Account","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter EIA number","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":false,"pdf_field":""},{"help":"Enter insurance repository name","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no","type":"yes-no","label":"If No, do you want Us to create an EIA account for you","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter email id","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Enter bank account number","type":"text","label":"Account Number","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"Enter account holder name","type":"text","label":"Account Holder name","options":[],"required":false,"pdf_field":""},{"help":"Enter cheque or demand draft number","type":"text","label":"Cheque / D.D#","options":[],"required":false,"pdf_field":""},{"help":"Enter bank branch name","type":"text","label":"Drawn To","options":[],"required":false,"pdf_field":""},{"help":"Enter bank and branch name","type":"text","label":"Bank and Branch Name","options":[],"required":false,"pdf_field":""},{"help":"Enter transaction reference number","type":"text","label":"For Credit / Debit Card - Transaction Reference No","options":[],"required":false,"pdf_field":""},{"help":"Enter transaction date","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Enter IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Enter amount drawn","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"Enter transaction date","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Enter nominee full name","type":"text","label":"Nominee Name*","options":[],"required":true,"pdf_field":""},{"help":"Enter relationship","type":"text","label":"Relationship of Nominee with Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee date of birth","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee mobile number","type":"phone","label":"Nominee Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee email","type":"email","label":"Nominee Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee present address","type":"text","label":"Nominee Present Address","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee permanent address","type":"text","label":"Nominee Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee bank details","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":false,"pdf_field":""},{"help":"Enter percentage share (total must not 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 (Name, Date of Birth, Relationship)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Sign here","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Intermediary signs here","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":true,"pdf_field":""},{"help":"Enter place","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Enter date","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and intermediary"}],"deadlines":[],"applies_to":"Home Secure insurance policy proposals","attachments":["Proof of Identity (POI) and Proof of Address (POA) documents as ticked","Valuation Report for Jewellery and Valuables if sum insured > ₹100,000","Invoice copy for Curios, Works of Art & Paintings if sum insured > ₹100,000","Cancelled cheque for electronic fund transfer"],"declarations":["The statements made in this proposal form are true to the best of the proposer’s knowledge and belief.","Any additions or alterations in the risk after submission must be immediately conveyed to the insurer.","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 government or regulatory portals for KYC purposes.","All premiums are paid from bonafide sources and not from proceeds of crime; insurer may call for documents to verify.","Insurance contract may be cancelled 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 of the form and policy terms were explained in a language understood by the proposer.","Declaration by agent that policy features and terms were explained to the proposer.","Declaration for persons with disability authorizing a representative to assist in completing the form."],"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/5530-home-secure-premium-proposal-form"}