{"id":5534,"title":"Home Secure - Prime Plus 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_Prime_Plus_Proposal_Form_ZK_v2_24_25_13122024_bdf1bed396.pdf","sha256":"fd03dd664b7884bfc9f57a2179d436d7b4e1bb493c6da2adf23594a7d8760cae","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals proposing to purchase the Home Secure - Prime Plus 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 and indicate question number.","Use original documents for proofs and valuation certificates as required.","Total claim share percentage for nominees must not exceed 100%.","Policy period for long term policies shall not exceed 10 years.","Maximum policy period for certain covers is up to 5 years.","Maximum indemnity periods for extensions like Loss of Rent and Additional Living Expenses are up to 36 months.","For valuable contents coverage, individual items valued over specified limits require detailed declaration and valuation.","Electronic Insurance Account details override address details provided in the proposal form."],"title":"Home Secure - Prime Plus Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer’s Information","fields":[{"help":"","type":"yes-no","label":"Are you an existing customer of Kotak Mahindra Bank Ltd. / Kotak Mahindra Prime Ltd.?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Zurich/Kotak Group Employees","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide employee ID if applicable","type":"text","label":"If yes, Employee ID","options":[],"required":false,"pdf_field":""},{"help":"Provide Customer Reference Number if applicable","type":"text","label":"If yes, CRN","options":[],"required":false,"pdf_field":""},{"help":"Provide existing policy number if applicable","type":"text","label":"If yes, Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Select your occupation","type":"choice","label":"Occupation*","options":["Profession","Salaried","Professionals","Student","Housewife","Retired","Others","Business","CA","Paramilitary Services","Govt. Teacher","Govt. Employee","Medical Doctor"],"required":true,"pdf_field":""},{"help":"Provide phone number","type":"phone","label":"Phone","options":[],"required":false,"pdf_field":""},{"help":"Enter first, middle, and last 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 marital status","type":"choice","label":"Marital Status","options":["Single","Married","Others"],"required":false,"pdf_field":""},{"help":"Provide full permanent address including city, state, pin code, country","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":"Provide correspondence address if different from permanent address","type":"text","label":"Correspondence Address*","options":[],"required":false,"pdf_field":""},{"help":"Provide mobile number","type":"phone","label":"Mobile*","options":[],"required":true,"pdf_field":""},{"help":"Provide 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":"Specify if 'Others' selected for title","type":"text","label":"Others","options":[],"required":false,"pdf_field":""},{"help":"Provide CKYC number if available","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"Provide GSTIN if applicable","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Select nationality","type":"choice","label":"Nationality*","options":["Indian","Non-Indian","NRI"],"required":true,"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","> 25 Lacs"],"required":false,"pdf_field":""},{"help":"Indicate if PAN or Form 60 is provided","type":"yes-no","label":"PAN* / Form 60 (only in case the customer does not have PAN No.)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Tick applicable identity and address proofs","type":"checkbox","label":"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":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured and Covers Opted","fields":[{"help":"Select basis for sum insured","type":"choice","label":"Basis of Sum Insured","options":["Structure","Contents"],"required":null,"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":"Select agreed value basis","type":"choice","label":"Agreed Value","options":["New for Old","Indemnity Value","Reinstatement Value","First Loss"],"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 per year (max 25%)","type":"number","label":"If Yes, Please mentioned the Escalation %","options":[],"required":false,"pdf_field":""},{"help":"Indicate if existing policy exists","type":"yes-no","label":"Is there any policy in place for the same property?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of existing policy","type":"text","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Tick the covers you want to opt for","type":"checkbox","label":"Cover/s required","options":["Home Building & Home Contents","Home Building Only","Home Contents Only","All Risk Cover - Structure and Contents","Burglary and Theft"],"required":null,"pdf_field":""},{"help":"Provide total area in square feet","type":"number","label":"Total Area Mentioned in the Registered Sale Deed Agreement (sq. ft)","options":[],"required":false,"pdf_field":""},{"help":"Tick the extension covers you want to opt for","type":"checkbox","label":"Do you wish to opt for any of the following extension cover (tick extension you want to opt for)","options":["Terrorism Damage Cover","Architects, Surveyors and Consulting Engineers Fees","Removal of Debris","Burglary or Theft of Content of Unoccupied Structure","Loss of Rent","Additional Rent for Alternate Accommodation","Trees and Plants / Garden Cover / Landscaping Damage","Additional Living Expenses","Temporary Resettlement Expenses","Contents Temporarily Removed","Enhanced cover during Wedding / Other Occasion","Search and Found"],"required":false,"pdf_field":""},{"help":"Start date of policy","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""},{"help":"Enter number of years (max 10 years)","type":"number","label":"No of Years in case of long term policy","options":[],"required":false,"pdf_field":""},{"help":"List all parties with insurable interest","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":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Location of Home Building","fields":[{"help":"Provide full postal address including pin code","type":"text","label":"Location of Home Building - Full postal address with Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Provide pin code","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Select type of building","type":"choice","label":"Is it in a multi-storey building or is it a standalone house?","options":["Multi-storey building","Standalone house"],"required":false,"pdf_field":""},{"help":"Provide floor number if applicable","type":"number","label":"In case of multi-storey building, please provide the floor number of Your house","options":[],"required":false,"pdf_field":""},{"help":"Indicate if basement exists","type":"yes-no","label":"Is there a basement to Your house?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Home Building","fields":[{"help":"Describe any additional structures on the site","type":"text","label":"Additional Structure","options":[],"required":false,"pdf_field":""},{"help":"Provide sum insured for residential structure","type":"amount","label":"SI for residential structure of Your Home including fittings and fixtures (in `)","options":[],"required":false,"pdf_field":""},{"help":"Provide sum insured for additional structures","type":"amount","label":"SI for additional structures (in `)","options":[],"required":false,"pdf_field":""},{"help":"Provide carpet area in square metres","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":false,"pdf_field":""},{"help":"Provide prevailing rate of construction cost","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date","options":[],"required":false,"pdf_field":""},{"help":"Select age category","type":"choice","label":"Age of Home Building","options":["Less than 5 years","5-10 years","10-20 years","Above 20 years"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Home Contents","fields":[{"help":"Provide sum insured for Furniture, Fixtures and Fittings, Electrical/Electronic, Others","type":"table","label":"Item wise Sum Insured for General Contents (in `)","options":[],"required":false,"pdf_field":""},{"help":"Provide sum insured for basement contents","type":"amount","label":"In case of Basement, If there are contents in it, please provide the Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Tick applicable in-built covers","type":"checkbox","label":"Cover for (Please Tick)","options":["Loss of Rent","Rent for Alternative Accommodation"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Covers","fields":[{"help":"Tick optional covers you want to opt for","type":"checkbox","label":"Do you wish to opt for any of the following optional cover (tick optional covers you want to opt for)","options":["Jewellery and Valuables","Curios, Works of Art & Paintings","Portable Equipments","Protection to Electronic Equipments","Breakdown of Domestic and Electronic Appliances","Loss of Contents during Transit","Loss of Cash during Transit","Keys & Locks Replacement Cover","Purchase Protection","Pedal Cycle","Plate Glass","Baggage","Tenant Liability","Public / Personal Liability","Liability to Domestic Staff","Golf Cover","Safety for Documents","Loss of Job","3 Home Loan EMI"],"required":false,"pdf_field":""},{"help":"Provide details of individual curios, works of art and paintings","type":"table","label":"Details for Curios, Works of Art & Paintings Coverage (Description, Artist Details, Valuation Report Attached Yes/No, Invoice Copy Attached Yes/No, Sum Insured)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Claims Details","fields":[{"help":"Provide date of loss, cause, claimed amount, settled amount or outstanding claim","type":"table","label":"Please specify details of any loss to the proposed Property in last 3 years","options":[],"required":false,"pdf_field":""},{"help":"Indicate if proposal was declined","type":"yes-no","label":"Has any other insurance company in respect of Insurance declined Your Proposal?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if cover on agreed value basis is required","type":"yes-no","label":"Do You require ‘Cover for Valuable Contents on Agreed Value Basis (under Home Contents cover)’?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach list of valuable items and sum insured","type":"attachment","label":"If Yes, please attach list of items and Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Indicate if valuation certificate is attached","type":"yes-no","label":"Valuation certificate attached? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if personal accident cover is required","type":"yes-no","label":"Do You require ‘Personal Accident Cover’ for Yourself and Your spouse?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide spouse name and age","type":"text","label":"If Yes, Name & age of Your spouse","options":[],"required":false,"pdf_field":""},{"help":"Provide your age","type":"number","label":"Your age","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Provide bank account number for electronic fund transfer","type":"text","label":"Account Number","options":[],"required":false,"pdf_field":""},{"help":"Provide bank name","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"Provide account holder name","type":"text","label":"Account Holder name","options":[],"required":false,"pdf_field":""},{"help":"Provide cheque or demand draft number","type":"text","label":"Cheque / D.D#","options":[],"required":false,"pdf_field":""},{"help":"Provide bank and branch name where cheque/DD is drawn","type":"text","label":"Drawn To","options":[],"required":false,"pdf_field":""},{"help":"Provide transaction reference number","type":"text","label":"For Credit / Debit Card - Transaction Reference No","options":[],"required":false,"pdf_field":""},{"help":"Provide transaction date","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Provide IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Provide amount drawn","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"Provide transaction date","type":"date","label":"Transaction Date","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":"Provide name of insurance repository","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":false,"pdf_field":""},{"help":"Indicate 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":"Provide email registered with insurance repository","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Provide full name of nominee","type":"text","label":"Nominee Name*","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship of Nominee with Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's date of birth","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's mobile number","type":"phone","label":"Nominee Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Provide nominee's email","type":"email","label":"Nominee Email ID","options":[],"required":false,"pdf_field":""},{"help":"Provide nominee's present address","type":"text","label":"Nominee Present Address","options":[],"required":false,"pdf_field":""},{"help":"Provide nominee's permanent address","type":"text","label":"Nominee Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"Provide nominee's bank details","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":false,"pdf_field":""},{"help":"Provide percentage share of claim (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","options":[],"required":false,"pdf_field":""},{"help":"Provide name of appointee","type":"text","label":"Name of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"Specify relationship of appointee with nominee","type":"text","label":"Relationship with the Nominee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"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":"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":"Intermediary or sales person to sign","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":true,"pdf_field":""},{"help":"Proposer to sign or affix thumb impression","type":"signature","label":"Signature/Thumb impression of Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and agent"}],"deadlines":[],"applies_to":"Home Secure - Prime Plus insurance policy proposal","attachments":["Additional sheets if more space is needed for answers","List of items and sum insured for Valuable Contents if opting for Agreed Value Basis","Valuation certificate for Valuable Contents if required","Proof of Identity and Proof of Address documents","Valuation Report for Jewellery and Valuables","Invoice copy for Curios, Works of Art & Paintings"],"declarations":["Statements made in the proposal form are true to the best of knowledge and belief and form the basis of the contract.","Any changes after submission must be immediately informed to the insurer.","Policy and service communications will be sent electronically unless physical copy is requested.","Consent is given to verify identity/address through specified government portals for KYC.","All premiums are paid from bonafide sources and not from proceeds of crime; insurer may request documents to verify source of funds.","Insurance contract may be cancelled if found guilty under money laundering laws.","Disclosure of association with Politically Exposed Persons is required.","Non-Profit Organizations must declare their status if applicable.","Proposer with disability may authorize a representative to assist in completing the form.","No person shall offer or accept rebates as inducement for insurance except as allowed by insurer's published prospectuses."],"dropped_labels":20},"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/5534-home-secure-prime-plus-proposal-form"}