{"id":5535,"title":"Marine Cargo Insurance Proposal Form & Questionnaire","purpose":"proposal","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/Marine_Cargo_Insurance_Proposal_Form_ZK_26_27_v1_17032026_ed28703e1b.pdf","sha256":"eafd052889ab5c94603e7514ad9f0bd03da82b6ac1a2fe81d40f8436899fdf2e","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or corporate entities to apply for marine cargo insurance coverage by providing details about the proposer, the cargo, and the insurance requirements.","notes":["Fill the form in BLOCK LETTERS.","Fields marked with * are mandatory.","Attach additional sheets if space is insufficient and indicate question number.","Information provided will be treated in strict confidence.","Use original documents for proofs and payments.","Policy and service communications will be sent via email unless physical copy is requested."],"title":"Marine Cargo Insurance Proposal Form & Questionnaire","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":"Describe the trade or business of the proposer","type":"text","label":"Proposer's Trade or Business*","options":[],"required":true,"pdf_field":""},{"help":"Number of years in business","type":"number","label":"Years in Trade / Business","options":[],"required":false,"pdf_field":""},{"help":"City or district of registered office","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"State of registered office","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"First line of registered office address","type":"text","label":"Registered Office Address / Permanent Address* - Address (Line 1)","options":[],"required":true,"pdf_field":""},{"help":"Second line of registered office address","type":"text","label":"Registered Office Address / Permanent Address* - Address (Line 2)","options":[],"required":false,"pdf_field":""},{"help":"Nearest landmark to the registered office","type":"text","label":"Nearest Landmark","options":[],"required":false,"pdf_field":""},{"help":"Country of registered office","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"Postal code of registered office","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"First line of communication address","type":"text","label":"Communication (Postal) Address* - Address (Line 1)","options":[],"required":true,"pdf_field":""},{"help":"Nearest landmark to communication address","type":"text","label":"Nearest Landmark","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":"City or district of communication address if different","type":"text","label":"If ‘No’, please provide below - City / District","options":[],"required":false,"pdf_field":""},{"help":"Phone number for communication address","type":"phone","label":"Contact No.","options":[],"required":false,"pdf_field":""},{"help":"Email address for communication","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"State of communication address if different","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Country of communication address if different","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"Postal code of communication address if different","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Permanent Account Number or Form 60 if premium > 50,000","type":"text","label":"PAN* /Form 60 (mandatory if premium is above `50,000)","options":[],"required":true,"pdf_field":""},{"help":"Central KYC Registry number if available","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"Select nationality","type":"choice","label":"Nationality*","options":["Indian","Non-Indian","NRI"],"required":true,"pdf_field":""},{"help":"Select income range","type":"choice","label":"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":"Goods and Services Tax Identification Number","type":"text","label":"GSTIN","options":[],"required":false,"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":false,"pdf_field":""},{"help":"Indicate if you have an existing policy with the insurer","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide existing policy number if applicable","type":"text","label":"If ‘Yes’, Policy No","options":[],"required":false,"pdf_field":""},{"help":"Indicate 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":"CKYC number for corporate customers","type":"text","label":"For Corporate customers / Firms, please share below details: CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":false,"pdf_field":""},{"help":"PAN for corporate customers","type":"text","label":"PAN*:","options":[],"required":true,"pdf_field":""},{"help":"Name of authorized signatory","type":"text","label":"Please share the below details for the Authorised Signatory: Name:","options":[],"required":false,"pdf_field":""},{"help":"Designation of authorized signatory","type":"text","label":"Designation:","options":[],"required":false,"pdf_field":""},{"help":"CKYC number of authorized signatory","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details","fields":[{"help":"Describe the cargo or merchandise to be insured","type":"text","label":"Subject matter/Cargo/Merchandise to be insured","options":[],"required":true,"pdf_field":""},{"help":"Select condition of cargo","type":"choice","label":"New / Used / Secondhand / Reconditioned","options":["New","Used / Secondhand","Reconditioned"],"required":false,"pdf_field":""},{"help":"Provide full description of materials","type":"text","label":"Description (Please given full description of all materials to be covered)","options":[],"required":true,"pdf_field":""},{"help":"Select all applicable shipment methods","type":"checkbox","label":"Method of Shipment (Please tick whichever applicable)","options":["Sea","Air","Rail","Road","Post","Courier","Others (Please specify)"],"required":true,"pdf_field":""},{"help":"Describe packing details","type":"text","label":"Packing details (Please give details of primary packing and secondary packing, Also please state if the same is customary packing)","options":[],"required":true,"pdf_field":""},{"help":"Provide details if any insurer refused or imposed conditions","type":"text","label":"Has any other insurer refused to accept this insurance or imposed conditions to accept the same. If YES, give details.","options":[],"required":false,"pdf_field":""},{"help":"Additional information relevant to the insurance","type":"text","label":"Any other information for the proposed Insurance Policy","options":[],"required":false,"pdf_field":""},{"help":"Start date of insurance period","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""},{"help":"Provide details for last 3 years in table format","type":"table","label":"Previous Insurance Particulars & Claims Experience (To give details of loss for 3 years even if there was no insurance) - Year, Premium Paid, Claims Received, Outstanding, Total, Cause of Loss, No of Claims, Insuring Conditions, Insurer","options":[],"required":false,"pdf_field":""},{"help":"Provide details for open policy shipments","type":"text","label":"In case of Open Policy, please give the following details - Total Value, Mode (Specify Domestic/Overseas or Both), Full details of incoming materials, Full details of outgoing materials, Full details of inter-depo movements","options":[],"required":false,"pdf_field":""},{"help":"Specify voyage details","type":"text","label":"Voyage: Export From / To, Import From / To, Inland From / To, Specific From / To","options":[],"required":false,"pdf_field":""},{"help":"Enter value of cargo","type":"amount","label":"Value of the Cargo / Merchandise","options":[],"required":true,"pdf_field":""},{"help":"Value declared for insurance","type":"amount","label":"Value for the purpose of Insurance (for specific policy)","options":[],"required":false,"pdf_field":""},{"help":"Limit per sending for open policies","type":"amount","label":"Limit per sending (other than specific policy)","options":[],"required":false,"pdf_field":""},{"help":"Limit per location for open policies","type":"amount","label":"Limit per location (other than specific policy)","options":[],"required":false,"pdf_field":""},{"help":"Indicate if duty coverage is desired","type":"yes-no","label":"Are you willing to cover Duty (for Import Consignment)?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify amount of duty to be covered","type":"amount","label":"If yes, please specify the amount.","options":[],"required":false,"pdf_field":""},{"help":"Specify sale terms","type":"text","label":"Sale Terms (FOB / CIF / Others (Please specify))","options":[],"required":false,"pdf_field":""},{"help":"Indicate if special letter of credit terms apply","type":"yes-no","label":"Any Special L/C terms?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify special L/C terms","type":"text","label":"If yes, please specify","options":[],"required":false,"pdf_field":""},{"help":"Select insuring terms required","type":"choice","label":"Insuring Terms required","options":["All Risks","Named Perils / Basic Cover","War & SRCC","SRCC"],"required":true,"pdf_field":""},{"help":"Specify any extensions required","type":"text","label":"Extension if any. Please give details.","options":[],"required":false,"pdf_field":""},{"help":"Select declaration periodicity","type":"choice","label":"Periodicity of declaration Specific / Weekly / Fortnightly / Monthly / Others (other than specific policy)","options":["Specific","Weekly","Fortnightly","Monthly","Others"],"required":false,"pdf_field":""},{"help":"Specify voluntary excess amount if any","type":"amount","label":"Would you like to opt for a Voluntary excess? If yes please specify the amount","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Vernacular Declaration","fields":[{"help":"Signature of intermediary or sales person","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":true,"pdf_field":""},{"help":"Signature or thumb impression of proposer","type":"signature","label":"Signature / Thumb impression of Proposer","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":""}],"filled_by":"intermediary and proposer"},{"title":"Bank Details and Payment Details","fields":[{"help":"Bank account number for electronic fund transfer","type":"text","label":"Account Number","options":[],"required":false,"pdf_field":""},{"help":"Name of bank","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":"Bank IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Tick if cancelled cheque from other bank is submitted","type":"checkbox","label":"Cancelled cheque submitted of other bank","options":[],"required":false,"pdf_field":""},{"help":"Cheque or demand draft number","type":"text","label":"Cheque / D.D #","options":[],"required":false,"pdf_field":""},{"help":"Name of bank branch cheque/DD is drawn on","type":"text","label":"Drawn To","options":[],"required":false,"pdf_field":""},{"help":"Bank and branch name for cheque/DD","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":"Amount drawn on cheque/DD/card","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"Date of transaction","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Policy Details","fields":[{"help":"Provide export details for sales turnover policy","type":"text","label":"In case of Sales Turnover Policy, please give the following details - Exports for the full year (Please specify the period reckoned)","options":[],"required":false,"pdf_field":""},{"help":"Provide details of vessel or vehicle and transporter","type":"text","label":"Details of the carrying vessel / vehicle such as name/no. and name of the transporter","options":[],"required":false,"pdf_field":""},{"help":"Expected domestic sales turnover","type":"amount","label":"Total Sales turnover expected: Domestic","options":[],"required":false,"pdf_field":""},{"help":"Expected sailing or dispatch date","type":"date","label":"In case of Specific Policy, please give the following details - Expected Date of Sailing / Dispatch","options":[],"required":false,"pdf_field":""},{"help":"Provide relevant transport document number and date","type":"text","label":"LR / RR / GR / BL / AWB No. and date if any.","options":[],"required":false,"pdf_field":""},{"help":"Provide Electronic Insurance Account number if available","type":"text","label":"If Yes, please quote EIA Number","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":"Email registered with Insurance Repository","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":false,"pdf_field":""},{"help":"Indicate if you have an EIA account","type":"yes-no","label":"Do you have an EIA Account","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and AML Declaration","fields":[{"help":"Place of signing declaration","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Date of signing declaration","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"Signature or thumb impression of proposer","type":"signature","label":"Signature/Thumb impression of Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Indicate if associated with a 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":"Indicate 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":""},{"help":"Select type of organization","type":"choice","label":"In case of entity, Type of Organisation making the payment","options":["Limited Company","International Organisation","Trust","Partnership","Non-Government Organisation (NGO)","Section 25 Company","Society","Others","Government Organisation","Co-operatives"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration for Agent","fields":[{"help":"Signature and stamp of insurance advisor or agent","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":"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":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Marine Cargo Insurance policies including Specific Policy, Open Cover, Open Policy, and Sales Turnover Policy (STOP)","attachments":["Additional sheets if more space is required to answer questions","Proof of Identity and Proof of Address documents","Cancelled cheque for bank details","Insurance Repository Application form (if EIA account creation requested)"],"declarations":["The statements made in this proposal form are true, complete and form the basis of the insurance policy.","The insurer's liability starts only after acceptance of the proposal and receipt of premium.","The policy is voidable if any material information is untrue, incorrect, or withheld.","The insurer may verify identity and address proofs through official registries.","Premiums must be paid from legitimate sources and the insurer may cancel the policy if money laundering is detected.","No rebates or inducements are allowed under Section 41 of the Insurance Act 1938.","The intermediary declares that the policy features and terms have been explained to the proposer."],"dropped_labels":3},"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/5535-marine-cargo-insurance-proposal-form-and-questionnaire"}