{"id":5536,"title":"Machinery Loss of Profits 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/Machinery_Loss_of_Profits_Insurance_Proposal_Form_ZK_V2_24_25_12122024_eaeb3a779c.pdf","sha256":"1c19a9330fe96dd958f8ce880c82b7cfd5ee1d897d637fd33ea6f328b3e0ae8a","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer or owner to apply for Machinery Loss of Profits Insurance, supplementing the material damage cover for machinery breakdown or boiler and pressure plant explosion.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","Provide additional sheets if space is insufficient and indicate question number.","The liability of the company starts only after acceptance and premium receipt.","Use original and accurate information as this proposal forms the basis of the policy.","The proposer must exercise reasonable precautions for machinery safety.","Electronic Insurance Account (EIA) email ID is mandatory for registration.","The company is not liable if NEFT transactions fail.","Nominee details are applicable for individual customers only.","Total nominee claim share percentage cannot exceed 100%.","Statutory warning on prohibition of rebates under Insurance Act applies."],"title":"Machinery Loss of Profits Insurance Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer/ Owner’s Details","fields":[{"help":"","type":"text","label":"Proposer’s Name*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Proposer's Trade or Business*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 1)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 2)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nearest Landmark","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Registered Office Address / Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the Communication Address same as the Registered Office Address/ Permanent Address?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Fill only if communication address differs","type":"text","label":"If ‘No’, please provide below Address (Line 1)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 2)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nearest Landmark","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Communication (Postal) Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Business Premises","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nature of Trade or Business*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Contact No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"PAN 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Corporate customers / Firms, please share below details: CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"PAN*:","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details","fields":[{"help":"If yes, complete schedule ‘A’","type":"yes-no","label":"Do you wish to cover the risk of Loss of Proﬁts arising from - a) Breakdown of Machinery in your premises","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, complete schedule ‘B’","type":"yes-no","label":"Do you wish to cover the risk of Loss of Proﬁts arising from - b) Explosion of Boiler and Pressure Plant in your premises","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If insured, provide insurer name","type":"text","label":"Name of the Insurer","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Title of the Policy","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy Nos.","options":[],"required":false,"pdf_field":""},{"help":"Provide start and end dates","type":"date","label":"Period(s) of Insurance From ______________ to _____________","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Are the lists of the Machinery in Schedule A and B representing the whole or only a part of the Machinery in the premises?","options":["Whole","Part"],"required":true,"pdf_field":""},{"help":"If yes, provide details of inspection and maintenance schedule","type":"yes-no","label":"Are all your Machineries subject to periodical inspection?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach process flow diagram and utility line diagrams","type":"text","label":"Give description of the manufacturing process and utility supplies such as power, steam, air, water etc. required for production.","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"In the event of stoppage of any of the machines proposed for insurance - a) Can machines, which remain in operation, carry the load originally borne by the machine, which has failed?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, specify extent","type":"yes-no","label":"b) Are there any alternative means of maintaining production by - i) the work being done at other premises?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"ii) hiring temporarily suitable replacement machine","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"iii) by any other means","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, give details","type":"yes-no","label":"Are any of the machines described in the schedule A & B de-rated?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"State repair facilities available in regard to machinery specified in Schedule A & B a) In your own premises","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"b) Any other nearest place","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Which machines proposed under this insurance are the machines for which the spare parts would need to be imported?","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"State the estimated period of interruption affecting resumption of normal production, on account of spoilage of materials in process following a breakdown or failure of utility supplies.","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"What are your normal working hours? a) _______hrs. per day","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"b) _______days per week","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"c) ________days per year.","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Can extra shifts be worked to make up production loss?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, give details of cause, duration and loss in last 3 years","type":"yes-no","label":"Have you ever suffered Loss of Proﬁt following Machinery Breakdown and/or Boiler Explosion?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"If the business is ‘Seasonal’ indicate the period of high and low output or turnover and indicate the degree of ﬂuctuation. State if there is a tendency of ﬂuctuations due to demands.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Designation","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Hypothecation Details: Bank Name","options":[],"required":false,"pdf_field":""},{"help":"If yes, provide Policy No","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy No","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Paid up Capital of the ﬁrm","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured Standing Charges","fields":[{"help":"Delete or supplement as appropriate","type":"amount","label":"Interest on Debentures","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Motor Upkeep and Licenses","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Lighting, Heating Power","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Water Charges","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Directors' Fees and Ofﬁce Expenses","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Remuneration","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Rents and Rates","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Salaries including State Insurance Contribution","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Taxes other than those chargeable on Proﬁts","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Insurance Premiums","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Contributions to Pension Fund","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Telephone Rentals","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Miscellaneous Charges (not travelling expenses) exceeding 5% of the total amount of the aforesaid Standing Charges","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Traveling Expenses","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Advertising Cost","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Auditors’ and Legal Fees","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Trade and Charitable Subscriptions","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Repairs and renewals chargeable to revenue account","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Depreciations of Buildings/ Machinery Plant and Motor Vehicles","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured Details","fields":[{"help":"Maximum time to resume normal production","type":"number","label":"Indemnity period -_________ months","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"OR ii) Wages to the extent of _____ % of the total wages for roll. OR Rs.","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"On Auditors/Accountants Fees - (cost incurred in the preparation of claims.) Rs.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Financial and Insurance History","fields":[{"help":"","type":"yes-no","label":"Are your books regularly audited?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"If so, give name and address of your Auditors.","options":[],"required":false,"pdf_field":""},{"help":"Provide start and end dates","type":"date","label":"Date of commencement of Insurance? From __ __/__ __/ __ __ __ __ (dd/mm/yyyy) To __ __/__ __/ __ __ __ __ (dd/mm/yyyy)","options":[],"required":false,"pdf_field":""},{"help":"If yes, provide company name and renewal status","type":"yes-no","label":"Are you insured or have you made a proposal in respect of loss of Proﬁt following Machinery Breakdown and/or Boiler Explosion?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If yes, provide insurer name, sum insured and policy no.","type":"yes-no","label":"Are you insured against Loss of proﬁt following Fire?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insurer","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Policy No.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account and Payment Details","fields":[{"help":"","type":"yes-no","label":"Do you have an EIA Account","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":false,"pdf_field":""},{"help":"Mandatory","type":"email","label":"Email id (to be registered with Insurance Repository)","options":[],"required":true,"pdf_field":""},{"help":"If yes, fill Insurance Repository Application form","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":"","type":"checkbox","label":"Details as per premium cheque to be used for electronic fund transfer; Cancelled cheque submitted of other bank","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Account Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank 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Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"BANK DETAILS (Cheque / Demand Draft / Credit / Debit Card / Online Payment)","options":["Cheque","Demand Draft","Credit / Debit Card","Online Payment"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details (Applicable for individual customers)","fields":[{"help":"","type":"text","label":"Nominee Name*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Relationship of Nominee with Proposer*","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Nominee Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Nominee Email ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Present Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":false,"pdf_field":""},{"help":"Total % share cannot exceed more than 100%","type":"number","label":"% of claim share*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Where Nominee is a minor, give details of Appointee Name of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Date of Birth DD/MM/YYYY","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the Nominee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"","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":"","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature/Thumb impression of Proposer*","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Authorised Representative*","options":[],"required":false,"pdf_field":""},{"help":"Proposer to authorize representative if assistance required","type":"text","label":"Declaration in case the proposer/policyholder is person with disability (PWD)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer and agent"}],"deadlines":[],"applies_to":"Machinery Loss of Profits Insurance supplementary to Machinery Breakdown/ Boiler and Pressure Plant material damage cover","attachments":["Additional sheets if more space is needed for answers","Process flow diagram showing connected machinery and bottlenecks or buffer stocks","Separate line diagram for utility supplies such as power, steam, air and water"],"declarations":["The proposer declares all information is true, complete and no material information is withheld.","The policy shall be voidable if any untrue or incomplete statement or non-disclosure is found.","The proposer agrees to accept the policy subject to terms, exceptions and conditions.","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.","The proposer confirms premiums are paid from bonafide sources and not from proceeds of crime.","The proposer declares if they qualify as a High Net Worth Individual (HNI) with net worth of ₹50 crore or more.","The proposer declares if they or close relatives are associated with Politically Exposed Persons (PEP).","The proposer declares if they are a Non-Profit Organization, specifying type if applicable.","Agent declares that policy features and terms were explained to the proposer who signed/thumbed after understanding."],"dropped_labels":7},"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/5536-machinery-loss-of-profits-insurance-proposal-form"}