{"id":5531,"title":"Home Secure - Prime Application Form (Mortgage Loan Customers)","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_Prime_KMBL_Mortgage_Loan_Customers_Application_Form_ZK_26_27_v1_13052026_d254a12d15.pdf","sha256":"db4ca10156e38da551fad9c446b24ea4da33c296525e61ea8c97f398931b9923","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by individual mortgage loan customers of Kotak Mahindra Bank Limited to apply for the Home Secure - Prime insurance policy.","notes":["Total percentage share of nominees cannot exceed 100%.","For long-term policies, the period shall not exceed 10 years.","Use the link https://healthid.ndhm.gov.in/ to create ABHA Number if not available.","Provide an additional sheet if there is more than one nominee.","Signatures/thumb impressions are mandatory where marked with *.","The form includes statutory warning about prohibition of rebates under Section 41 of Insurance Act 1938.","Policy and service communication will be sent in soft copy to the email provided unless physical copy is requested."],"title":"Home Secure - Prime Application Form (Mortgage Loan Customers)","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Insured Details (Applicant)","fields":[{"help":"","type":"text","label":"IMD Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Branch Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Loan Account No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"CRN/ APAC*","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Group Manager Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Group Manager Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Members Covered","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Proposal for*","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Type of House*","options":["Owner","New Property","Flat / Apartment","Old Property","Independent Building"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Type of Ownership","options":[],"required":null,"pdf_field":""},{"help":"For long-term policy, period shall not exceed 10 years","type":"number","label":"Period of Insurance (No of Years in case of long-term policy: __________)","options":[],"required":null,"pdf_field":""},{"help":"Start date of insurance","type":"date","label":"From:","options":[],"required":null,"pdf_field":""},{"help":"End date of insurance","type":"date","label":"To:","options":[],"required":null,"pdf_field":""},{"help":"Select cover required","type":"choice","label":"Cover","options":["Home building & home contents","Bharat Griha Raksha"],"required":null,"pdf_field":""},{"help":"Full name of the person to be insured","type":"text","label":"Name*","options":[],"required":true,"pdf_field":""},{"help":"Date of birth of the person to be insured","type":"date","label":"Date of Birth *","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Gender*","options":["Male","Female","Others"],"required":true,"pdf_field":""},{"help":"Full permanent address","type":"text","label":"Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"Nearest landmark to permanent address","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"City or district of permanent address","type":"text","label":"City / District","options":[],"required":null,"pdf_field":""},{"help":"State of permanent address","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Postal code of permanent address","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Country of permanent address","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"Email address of the insured","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Mobile number of the insured","type":"phone","label":"Mobile No.*","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is Correspondence Address same as Permanent Address?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Correspondence address if different from permanent address","type":"text","label":"If ‘No’, please provide below Correspondence Address*","options":[],"required":false,"pdf_field":""},{"help":"Address of the insured property","type":"text","label":"Insured Property Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Occupation*","options":["Business","Salaried","Professionals","Student","Housewife","Retired","Others"],"required":true,"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":"Marital Status","options":["Single","Married","Others"],"required":null,"pdf_field":""},{"help":"Last 4 digits of Aadhaar number","type":"number","label":"Aadhaar Number (last 4 digit)","options":[],"required":null,"pdf_field":""},{"help":"PAN number or Form 60 if no PAN","type":"text","label":"PAN Number / Form 60 (only in case the customer does not have PAN No.)","options":[],"required":null,"pdf_field":""},{"help":"If not created, visit https://healthid.ndhm.gov.in/ to create","type":"text","label":"ABHA Number","options":[],"required":null,"pdf_field":""},{"help":"Date of hypothecation","type":"date","label":"Hypothecation","options":[],"required":null,"pdf_field":""}],"filled_by":"applicant"},{"title":"Nominee Details","fields":[{"help":"Full name of nominee","type":"text","label":"Name of the Nominee","options":[],"required":true,"pdf_field":""},{"help":"Relationship to proposer","type":"text","label":"Relationship of Nominee with Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Date of birth of nominee","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"pdf_field":""},{"help":"Mobile number of nominee","type":"phone","label":"Nominee Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Email address of nominee","type":"email","label":"Nominee Email ID","options":[],"required":false,"pdf_field":""},{"help":"Current address of nominee","type":"text","label":"Nominee Present Address","options":[],"required":false,"pdf_field":""},{"help":"Permanent address of nominee","type":"text","label":"Nominee Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"Bank details for claim payment","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":false,"pdf_field":""},{"help":"Percentage share of claim (total must not exceed 100%)","type":"number","label":"% of claim share*","options":[],"required":true,"pdf_field":""},{"help":"Name, DOB, and relationship of appointee if nominee is minor","type":"text","label":"Where Nominee is a minor, give details of Appointee","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"Payment Details","fields":[{"help":"Mode of premium payment","type":"choice","label":"Payment Mode","options":[],"required":null,"pdf_field":""},{"help":"Cheque/DD/Instrument number if applicable","type":"text","label":"Instrument No.","options":[],"required":null,"pdf_field":""},{"help":"Date of payment instrument","type":"date","label":"Instrument Date","options":[],"required":null,"pdf_field":""},{"help":"Name of bank or financial institution","type":"text","label":"Bank / Financial Institution Name","options":[],"required":null,"pdf_field":""},{"help":"Consent for direct debit payment","type":"checkbox","label":"Consent to pay","options":["I hereby agree to pay premium through direct debit from my account maintained with Kotak Mahindra Bank Limited."],"required":null,"pdf_field":""}],"filled_by":"applicant"},{"title":"Sum Insured and Coverage Details","fields":[{"help":"Monthly EMI amount for loss of job cover","type":"amount","label":"I. EMI Amount:______________ Per Month (Sum Insured is Max 3 home loan EMI)","options":[],"required":null,"pdf_field":""},{"help":"Start date for loss of job cover","type":"date","label":"II. Policy period: From:","options":[],"required":null,"pdf_field":""},{"help":"End date for loss of job cover","type":"date","label":"To:","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for loss of job cover","type":"amount","label":"I. Sum Insured: 10% of Home Building SI","options":[],"required":null,"pdf_field":""},{"help":"Duration for loss of job cover","type":"number","label":"II. Number of Months: 12 months","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for home building","type":"amount","label":"SI for residential structure of Your Home including fittings and fixtures (in `):","options":[],"required":null,"pdf_field":""},{"help":"Carpet area of home","type":"number","label":"Carpet area of structure of Home in square metres:","options":[],"required":null,"pdf_field":""},{"help":"Rate of construction cost per square metre","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date:","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for additional structures","type":"amount","label":"SI for additional structures (in `):","options":[],"required":null,"pdf_field":""},{"help":"Provide item wise sum insured for furniture, electrical, others","type":"table","label":"Item wise Sum Insured for General Contents (in `):","options":[],"required":null,"pdf_field":""},{"help":"Select if burglary and theft cover required","type":"choice","label":"Burglary and Theft (Cover restricted within premises) (Maximum Policy Period up to 5 years)","options":["Same as Home Contents SI"],"required":null,"pdf_field":""},{"help":"Start date for burglary and theft cover","type":"date","label":"Policy period: From:","options":[],"required":null,"pdf_field":""},{"help":"End date for burglary and theft cover","type":"date","label":"To:","options":[],"required":null,"pdf_field":""},{"help":"Sum insured for additional structures","type":"amount","label":"Additional Structure Sum Insured (in `)","options":[],"required":null,"pdf_field":""}],"filled_by":"applicant"},{"title":"Declarations and Signatures","fields":[{"help":"Applicant's signature or thumb impression","type":"signature","label":"Signature / Thumb Impression of Applicant*","options":[],"required":true,"pdf_field":""},{"help":"Signature of intermediary or sales person","type":"signature","label":"Signature of Intermediary / Sales person*","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"","type":"checkbox","label":"Declaration in case the proposer/policyholder is person with disability (PWD)","options":["I hereby declare that I am a person with a disability and authorize a representative to act on my behalf."],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Other Declaration","options":["I agree to share my medical records with the Insurer/TPA through ABHA number.","I authorize the company to share information for underwriting and claims settlement.","I consent to receive policy and service communication in soft copy via email.","I consent to KYC verification through various government portals.","I confirm premiums are paid from bonafide sources and comply with AML regulations."],"required":false,"pdf_field":""},{"help":"Answer if any applicant or close relative is a PEP","type":"yes-no","label":"Are You or any of the proposed applicants or close relatives associated to Politically Exposed Person (PEP)?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer if the entity is a non-profit organization","type":"yes-no","label":"Are you a Non-Profit Organization?* (only in case of an entity)","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"applicant and intermediary"}],"deadlines":[],"applies_to":"Individual Mortgage Loan Customers of KMBL","attachments":["KYC documents (Identity and address proofs) if CKYC Identifier is not available","Additional sheet if more than 1 nominee"],"declarations":["The applicant declares that all information provided is true and complete to the best of their knowledge.","The policy will come into force only after full payment of the premium.","The applicant will notify any change in occupation or health after submission but before risk acceptance.","The applicant consents to the insurer seeking medical and insurance information for underwriting and claims.","The applicant agrees to share medical records via ABHA number if available.","The applicant consents to electronic communication for policy and service related matters.","The applicant consents to KYC verification through government portals.","The applicant confirms premiums are paid from bonafide sources and comply with AML laws.","The applicant declares if they or close relatives are Politically Exposed Persons (PEP).","The applicant declares if they are a Non-Profit Organization (if applicable)."],"dropped_labels":8},"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/5531-home-secure-prime-application-form-mortgage-loan-customers"}