{"id":5532,"title":"Industrial All Risks Insurance 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/Industrial_All_Risk_Insurance_Proposal_Form_ZK_26_27_v1_17032026_c263e3ce59.pdf","sha256":"9349a236317a72b530d514e32338f3051bc2dc304862d6c4f6c4032dda104aac","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer or owner to apply for Industrial All Risks Insurance coverage by providing details about themselves, the risk, and coverage required.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","Attach additional sheets if more space is needed and indicate question number.","Information given will be treated in strict confidence.","Electronic Insurance Account email ID is mandatory.","Use original documents and cancelled cheque for bank details.","Submission of proposal or payment does not oblige the company to issue a policy.","Policy issuance is subject to underwriting policy and full premium payment."],"title":"Industrial All Risks Insurance Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer / Owner’s Details","fields":[{"help":"Enter full name of the proposer","type":"text","label":"Proposer’s Name*","options":[],"required":true,"pdf_field":""},{"help":"Specify the trade or business of the proposer","type":"text","label":"Proposer's Trade or Business*","options":[],"required":true,"pdf_field":""},{"help":"Enter contact phone number","type":"phone","label":"Contact No.","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter GST Identification Number","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Enter address line 1","type":"text","label":"Address (Line 1)","options":[],"required":false,"pdf_field":""},{"help":"Enter address line 2","type":"text","label":"Address (Line 2)","options":[],"required":false,"pdf_field":""},{"help":"Enter nearest landmark","type":"text","label":"Nearest Landmark","options":[],"required":false,"pdf_field":""},{"help":"Enter city or district","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"Enter state","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Enter registered or permanent address","type":"text","label":"Registered Office Address / Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter country","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"Enter postal pin code","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","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 line 1 if different","type":"text","label":"If ‘No’, please provide below Address (Line 1)","options":[],"required":false,"pdf_field":""},{"help":"Provide communication address line 2 if different","type":"text","label":"Address (Line 2)","options":[],"required":false,"pdf_field":""},{"help":"Provide nearest landmark for communication address","type":"text","label":"Nearest Landmark","options":[],"required":false,"pdf_field":""},{"help":"Provide city or district for communication address","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"Provide state for communication address","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Enter communication postal address","type":"text","label":"Communication (Postal) Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter country for communication address","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"Enter pin code for communication address","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name if applicable","type":"text","label":"Hypothecation Details: Bank Name","options":[],"required":false,"pdf_field":""},{"help":"Select if you have an existing policy","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide existing policy number","type":"text","label":"If ‘Yes’, Policy No","options":[],"required":false,"pdf_field":""},{"help":"Select if you are a non-profit organization","type":"yes-no","label":"Are you a Non-profit Organization?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"For Corporate customers, please share below details: PAN*:","options":[],"required":true,"pdf_field":""},{"help":"Enter GSTIN","type":"text","label":"GSTIN:","options":[],"required":false,"pdf_field":""},{"help":"Enter name of authorised signatory","type":"text","label":"Please share the below details for the Authorised Signatory: Name:","options":[],"required":false,"pdf_field":""},{"help":"Enter designation of authorised signatory","type":"text","label":"Designation:","options":[],"required":false,"pdf_field":""},{"help":"Enter CKYC identifier","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":false,"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 intermediary service RM","type":"text","label":"Intermediary Service RM","options":[],"required":false,"pdf_field":""},{"help":"Enter intermediary branch code","type":"text","label":"Intermediary Branch code","options":[],"required":false,"pdf_field":""},{"help":"Enter intermediary business vertical","type":"text","label":"Intermediary business vertical","options":[],"required":false,"pdf_field":""},{"help":"Enter intermediary 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":"Risk Details","fields":[{"help":"Select the type of construction","type":"choice","label":"Type of construction","options":["Class “A”","Class “AA”","Class “B”","Class “C”","Class “D”","Mixed","Construction (E)"],"required":false,"pdf_field":""},{"help":"Enter number of basement levels","type":"number","label":"No of Basement Levels","options":[],"required":false,"pdf_field":""},{"help":"Enter age of the plant in years","type":"number","label":"Age of the Plant","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Covers","fields":[{"help":"Select if opting for this cover","type":"checkbox","label":"Architects', Surveyors' and Consulting Engineers' Fees Clause","options":[],"required":false,"pdf_field":""},{"help":"Select if opting for this cover","type":"checkbox","label":"Escalation Clause","options":[],"required":false,"pdf_field":""},{"help":"Select if opting for this cover","type":"checkbox","label":"Omission to Insure Additions, Alterations or Extensions Clause","options":[],"required":false,"pdf_field":""},{"help":"Select if opting for this cover","type":"checkbox","label":"Temporary Removal of Stocks Clause","options":[],"required":false,"pdf_field":""},{"help":"Select if opting for this cover","type":"checkbox","label":"Terrorism Damage Cover Endorsement","options":[],"required":false,"pdf_field":""},{"help":"Specify any other additional cover","type":"text","label":"Any other Additional cover you wish to opt for","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Fire Extinguishing Appliances","fields":[{"help":"Indicate presence of fire alarm or smoke detection","type":"yes-no","label":"Fire Alarm and/ or Smoke Detection system","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate presence of fire diversion or CO2 flooding","type":"yes-no","label":"Fire Diversion and/ or Spot Protection /CO2 flooding","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate presence of hand appliances etc. with hydrant system","type":"yes-no","label":"Hand Appliances and / or hose reels and / or Trailer Pumps/ Fire Engines  + Hydrant System","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate presence of sprinkler or fixed water spray system","type":"yes-no","label":"Independent Sprinkler and/ or Fixed Water Spray System","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate presence of combined systems","type":"yes-no","label":"Hand Appliances and/ or hose reels and/ or Trailer Pumps/ Fire Engines  + Hydrant System & independent Sprinkler/ Fixed Water Spray System","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate presence of mutual aid systems","type":"yes-no","label":"Hand Appliances and/ or hose reels and/ or Trailer Pumps /Fire Engines/Mutual Aid","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section II – Business Interruption","fields":[{"help":"Enter total sum insured for gross profit","type":"amount","label":"Gross Profit (Net Profit + Standing Charges) Total Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Enter indemnity period in months","type":"number","label":"Please specify the Indemnity Period in Months","options":[],"required":false,"pdf_field":""},{"help":"Enter standing charges amount","type":"amount","label":"Standing Charges","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Machinery Loss of Profit (MLOP)","fields":[{"help":"Select if opting for MLOP cover","type":"yes-no","label":"Do you wish to opt for Machinery Loss of Profit cover?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Voluntary Deductible","fields":[{"help":"Select if opting for voluntary deductible","type":"yes-no","label":"Do you wish to opt for Voluntary Deductible","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Acknowledgement and Payment Details","fields":[{"help":"Name of proposer","type":"text","label":"Received from Ms./Mrs./ Mr.","options":[],"required":false,"pdf_field":""},{"help":"Payment mode","type":"text","label":"Through Cheque/DD","options":[],"required":false,"pdf_field":""},{"help":"Amount paid","type":"amount","label":"Sum of `","options":[],"required":false,"pdf_field":""},{"help":"Date of payment","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Time of payment","type":"text","label":"Time","options":[],"required":false,"pdf_field":""},{"help":"Place of payment","type":"text","label":"Place","options":[],"required":false,"pdf_field":""},{"help":"Signature of official or intermediary","type":"signature","label":"Signature of Zurich Kotak General Insurance Company (India) Limited Official / Intermediary","options":[],"required":false,"pdf_field":""},{"help":"Indicate if you have an Electronic Insurance Account","type":"yes-no","label":"Do you have an EIA Account","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide EIA number if applicable","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":false,"pdf_field":""},{"help":"Name of insurance repository","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":false,"pdf_field":""},{"help":"Select if you want an EIA account created","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":"Email ID is mandatory","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""},{"help":"Bank account number for electronic fund transfer","type":"text","label":"Account Number","options":[],"required":false,"pdf_field":""},{"help":"Bank name","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"Name of account holder","type":"text","label":"Account Holder name","options":[],"required":false,"pdf_field":""},{"help":"Cheque or demand draft number","type":"text","label":"Cheque / D.D #","options":[],"required":false,"pdf_field":""},{"help":"Drawn to which bank","type":"text","label":"Drawn To","options":[],"required":false,"pdf_field":""},{"help":"Bank and branch name","type":"text","label":"Bank and Branch Name","options":[],"required":false,"pdf_field":""},{"help":"Transaction reference number for card payment","type":"text","label":"For Credit/Debit Card: Transaction Reference No","options":[],"required":false,"pdf_field":""},{"help":"Date of transaction","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Bank IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Amount drawn","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"Date of refund or claim transaction","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""},{"help":"IFSC or MICR code for refund/claim","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer and intermediary"},{"title":"Declarations","fields":[{"help":"Sign the declaration","type":"signature","label":"Signature of the 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":""}],"filled_by":"proposer"},{"title":"Additional Declarations","fields":[{"help":"Select type of organisation","type":"choice","label":"In case of entity, Type of Organisation making the payment","options":["Limited Company","International Organisation","Trust","Partnership","Section 25 Company","Non-Government Organisation (NGO)","Society","Others","Government Organisation","Co-operatives"],"required":false,"pdf_field":""},{"help":"Select if associated with PEP","type":"yes-no","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 if you are 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":"proposer"}],"deadlines":[],"applies_to":"Industrial All Risks Insurance policies","attachments":["Additional sheets if more space is required to answer any question","Cancelled cheque for electronic fund transfer","Insurance Repository Application form (if opting for EIA account creation)"],"declarations":["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 liability starts only after acceptance of the proposal and receipt of premium by the company.","The company may void the policy if any information is untrue, incorrect, incomplete, or withheld.","Consent is given to verify identity/address through official registries for KYC purposes.","All premiums are paid from bonafide sources and not from proceeds of crime; company may cancel contract if found otherwise.","Proposer confirms understanding of the proposal form and policy terms as explained in their language.","Agent/intermediary confirms explaining policy features and terms to the proposer."],"dropped_labels":6},"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/5532-industrial-all-risks-insurance-proposal-form"}