{"id":5537,"title":"Housing Society Package Policy 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/housing_society_package_policy_proposal_form_zk_v1_24_25_06062024_c8a9a6e573.pdf","sha256":"917c6a8ef32385adaf3ee8b9ca4605b5d88870b1e037283b204842c4d573dc57","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by proposers (policyholders) to apply for the Housing Society Package insurance policy, providing details about the property, coverage options, and other relevant information.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","The liability of the company starts only after acceptance of the proposal and receipt of premium.","Provide all information fully, accurately and correctly; non-disclosure may void the policy.","Attach additional sheets if more space is needed and indicate the question number.","Use original documents where required.","The policy is subject to the Board approved underwriting policy and terms and conditions of the Housing Society Package Policy.","The company may refund any payment without interest if the proposal is not accepted.","Use the prescribed formats for dates (DD/MM/YYYY) where applicable."],"title":"Housing Society Package Policy Proposal Form","submit":{"to":"Zurich Kotak General Insurance Company (India) Limited","how":"","address":"401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai - 400063, Maharashtra, India"},"purpose":"proposal","sections":[{"title":"Proposer’s Information","fields":[{"help":"Enter full name in block letters","type":"text","label":"Proposer’s Name*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"First Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Middle Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Last Name","options":[],"required":true,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Any existing policy from Us","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide existing policy number if applicable","type":"text","label":"If yes, Policy No.","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":""},{"help":"","type":"text","label":"Nomination","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the insured","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":"Provide GSTIN if applicable","type":"text","label":"GSTIN","options":[],"required":false,"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*","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":"Tick Yes or No","type":"choice","label":"Is the Postal Address same as the Registered Office Address?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","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":"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":"Provide PAN number","type":"text","label":"For Corporate customers, please share below details: PAN*:","options":[],"required":true,"pdf_field":""},{"help":"Provide GSTIN if applicable","type":"text","label":"GSTIN:","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Please share the below details for the Authorised Signatory: Name:","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":"Quote No.*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch Code","options":[],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Quote Date*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Sales Manager Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Service RM","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Branch code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Intermediary business vertical","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Client Ref. No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"SP Name/Code","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sections Opted For","fields":[{"help":"Section I is mandatory","type":"checkbox","label":"Section I - Zurich Kotak Bharat Griha Raksha","options":["Yes"],"required":true,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section II - Burglary and Housebreaking","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section III - Electronic Equipments/ Appliances","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section IV - Machinery Breakdown","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section V - Boiler and Pressure Vessels","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section VI - All Risk","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section VII - Money Insurance","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section VIII - Fidelity Cover","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section IX - Plate Glass","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section X - Signage","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section XI - Baggage","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section XII - Personal Accident","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section XIII - Employee Compensation","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section XIV - Public Liability","options":["Yes"],"required":false,"pdf_field":""},{"help":"Tick if opting","type":"checkbox","label":"Section XV - Directors and Officers Liability","options":["Yes"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Cover Opted (Section I)","fields":[{"help":"Tick Yes or No","type":"choice","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 one option","type":"choice","label":"Cover/s required","options":["Home Building & Home Contents","Home Building Only","Home Contents Only"],"required":true,"pdf_field":""},{"help":"Location pin code","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Provide full address","type":"text","label":"Location of Home Building - full postal address with Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Specify building type","type":"text","label":"Is it in a multi-storey building or is it a standalone house?","options":[],"required":false,"pdf_field":""},{"help":"Provide floor number","type":"number","label":"In case of multi-storey building, please provide the floor number of Your house","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Is there a basement to Your house?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"b. SI for additional structures (in `)","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Sum Insured (in`) Additional Structure","options":[],"required":false,"pdf_field":""},{"help":"Enter carpet area","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":false,"pdf_field":""},{"help":"Enter rate per square metre","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":"Home Contents and Additional Covers","fields":[{"help":"Enter amount in Rupees","type":"amount","label":"Furniture, Fixtures and Fittings (Home Furnishings) Sum Insured Item wise Sum Insured for General Contents (in `): Electrical / Electronic","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Others","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","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 if opting","type":"checkbox","label":"Cover for (Please Tick) Loss of Rent","options":["Loss of Rent"],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Loss of Rent: I. Sum Insured:","options":[],"required":false,"pdf_field":""},{"help":"Enter number of months","type":"number","label":"II. Number of Months:","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Rent for Alternative Accommodation: I. Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Enter number of months","type":"number","label":"II. Number of Months","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Do You require ‘Personal Accident Cover’ for Yourself and Your spouse?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide 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":""},{"help":"Tick Yes or No","type":"choice","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 items and sum insured","type":"attachment","label":"If Yes, please attach list of items and Sum Insured:","options":[],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Valuation certificate attached? (Yes / No)","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Burglary Cover Details","fields":[{"help":"List contents for burglary cover","type":"text","label":"Please specify the contents which you want to avail burglary cover against (in case of no entry in table here, total content SI will be considered)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Security Arrangements","fields":[{"help":"Describe security arrangements","type":"text","label":"Details of security arrangement at premises, including watch and ward facility (pls specify)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic / Mechanical / Boiler Equipment Cover","fields":[{"help":"Provide description with Sr. No. & make, year of manufacture, sum insured","type":"table","label":"Pl specify the electrical / mechanical / electronic equipment / Boiler against which you want to opt for cover under Section III, IV and V","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Maintenance Contract","fields":[{"help":"Tick Yes or No","type":"choice","label":"Valid maintenance contract Force?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach copy of maintenance contract","type":"attachment","label":"If yes, Copy to be enclosed","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Money Section","fields":[{"help":"Enter amount in Rupees","type":"amount","label":"Money in transit Single carrying limit (`)","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Total estimated amount of money in transit per annum (`)","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Money in counter Per Location Limit (`)","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Sum Insured / Limit (`)","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Money in safe Per Location Limit (`)","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Sum Insured / Limit (`)","options":[],"required":false,"pdf_field":""},{"help":"Enter distance in kilometers","type":"number","label":"What is the maximum distance in kms that the money will be carried?","options":[],"required":false,"pdf_field":""},{"help":"Select mode of transportation","type":"choice","label":"Mode of Transportation","options":["By Foot","By Public Transport","Own 2 Wheeler","Own 4 Wheeler"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Please specify if there is an armed guard / Security a. Accompanying the Money carried outside","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"b. At Insured’s Premises for 24 hours","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"c. Please specify if additional person accompany the money outside","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Is there a CCTV in the insured premises that is clearly operational all through","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Plate Glass Cover","fields":[{"help":"Provide size of plate glass","type":"text","label":"Size","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Sum Insured (`)","options":[],"required":false,"pdf_field":""},{"help":"Describe the fixed glass to be insured","type":"text","label":"Description","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Personal Accident","fields":[{"help":"","type":"text","label":"Name of the insured person","options":[],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Occupation","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Details of existing infirmity or disability","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship with You","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship of Nominee with Insured*","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Age","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Extensions","fields":[{"help":"Attach addendum for add-on covers","type":"attachment","label":"Please fill up the addendum enlisting the add on cover required for selected section as per question 1","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Fire Protection Arrangement","fields":[{"help":"Tick all that apply","type":"checkbox","label":"Details of Fire Protection Arrangement available (pl tick options available)","options":["Portable Fire Extinguishers","Sprinklers","Hydrants","Small bore hose reels","Trailer Pumps / Fire engines","Hydrant System","Sprinkler System","Fixed Water Spray System","Foam systems","Fire alarm systems","Gas flooding systems"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Past Claim Experience","fields":[{"help":"DD/MM/YYYY format","type":"date","label":"Date of Occurrence","options":[],"required":false,"pdf_field":""},{"help":"Describe loss details","type":"text","label":"Details of Loss","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Amount of Loss (`)","options":[],"required":false,"pdf_field":""},{"help":"Name insurer for each loss","type":"text","label":"Name of the Insurers","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History Questions","fields":[{"help":"Tick Yes or No","type":"choice","label":"Has any Company in respect of any section included by you for this insurance has a) Declined your Proposal?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"b) Cancelled or refused to renew your Policy?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"c) Accepted your Proposal on special terms and condition?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Period of Insurance","fields":[{"help":"Start date DD/MM/YYYY","type":"date","label":"From","options":[],"required":true,"pdf_field":""},{"help":"End date DD/MM/YYYY","type":"date","label":"To","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Directors and Officers Liability","fields":[{"help":"Select ownership type","type":"choice","label":"Nature of ownership","options":["Pvt Company","Public Company","Others (pl specify)"],"required":false,"pdf_field":""},{"help":"Provide details","type":"text","label":"Please provide details of serving directors and officers in the Proposer’s most recent annual report and accounts","options":[],"required":false,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"Has the chairman, managing director, chief executive officer or chief financial officer of the Proposer left such office within the last 3 years for any reason other than death or retirement? If yes then please provide details","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Limit of Liability required","options":[],"required":false,"pdf_field":""},{"help":"Provide any other relevant info","type":"text","label":"Any other information","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Signage Cover","fields":[{"help":"Describe signage","type":"text","label":"Description","options":[],"required":false,"pdf_field":""},{"help":"Specify location","type":"text","label":"Situation (outdoors/at height on ground) pl specify","options":[],"required":false,"pdf_field":""},{"help":"Specify type and age","type":"text","label":"Type/Age","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Sum Insured (`)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Baggage Cover","fields":[{"help":"Enter total amount in Rupees","type":"amount","label":"Sum Insured (`)","options":[],"required":false,"pdf_field":""},{"help":"Provide details of baggage and personal effects","type":"text","label":"Description","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Fidelity Guarantee","fields":[{"help":"Provide employee names if named","type":"text","label":"Name of Employee if Named basis","options":[],"required":false,"pdf_field":""},{"help":"Provide number of employees if unnamed","type":"number","label":"No of employee if (unnamed) basis","options":[],"required":false,"pdf_field":""},{"help":"Provide designation or nature of work","type":"text","label":"Designation/nature of work done by them","options":[],"required":false,"pdf_field":""},{"help":"Specify contractual or permanent","type":"text","label":"Contractual/ Permanent Employees","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Amount of indemnity per event or person","options":[],"required":false,"pdf_field":""},{"help":"Enter amount in Rupees","type":"amount","label":"Aggregate limit of indemnity","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Employee Compensation","fields":[{"help":"Provide designation or nature of work","type":"text","label":"Designation/nature of work done by them","options":[],"required":false,"pdf_field":""},{"help":"Specify salary or wages and frequency","type":"text","label":"Salary/wages monthly/ yearly (pls specify)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Public Liability","fields":[{"help":"Enter annual turnover","type":"amount","label":"Annual turn over","options":[],"required":false,"pdf_field":""},{"help":"Describe nature of work","type":"text","label":"Nature of work","options":[],"required":false,"pdf_field":""},{"help":"Specify limits","type":"text","label":"Limits required (AOA:AOY)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Provide bank account number","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","type":"text","label":"Drawn To","options":[],"required":false,"pdf_field":""},{"help":"Provide bank and branch name","type":"text","label":"Bank and Branch Name","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":"DD/MM/YYYY format","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":"Enter amount in Rupees","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details","fields":[{"help":"Tick Yes or No","type":"choice","label":"Do you have an EIA Account","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide EIA number","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":"Tick Yes or No","type":"choice","label":"If No, do you want Us to create an EIA account for you","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide registered email id","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Sign or stamp here","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Signature of intermediary","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":true,"pdf_field":""},{"help":"Enter place","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"Signature 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":""}],"filled_by":"proposer"},{"title":"Additional Declarations","fields":[{"help":"Tick Yes or No","type":"choice","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":"Tick Yes or No","type":"choice","label":"Are you a Non-Profit Organization?*(only in case of an entity)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select applicable type","type":"choice","label":"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":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Housing Society Package Policy","attachments":["Additional sheets if more space is needed for answers","Valuation certificate (if opting for Valuable Contents cover above `5 Lakh or individual item value exceeds `1 Lakh)","Copy of valid maintenance contract (if applicable)","List of items and Sum Insured for Valuable Contents (if applicable)","Addendum for add on cover required for selected sections","Cancelled cheque for electronic fund transfer","Insurance Repository Application form (if EIA account to be created)"],"declarations":["Statements made in this Proposal Form are true to the best of my/our knowledge and belief and form the basis of the contract.","Any additions or alterations in the risk after submission must be conveyed immediately to the insurer.","Policy and service related communication will be sent in soft copy to the email id mentioned unless physical copy is requested.","Consent is given to verify identity/address proof through specified government portals for KYC purposes.","All premiums have been/will be paid from bonafide sources and not from proceeds of crime as per Prevention of Money Laundering Act.","The insurer has the right to cancel the contract if found guilty under money laundering statutes.","The contents of the proposal form and policy terms have been explained in a language understood by the proposer.","The features and terms & conditions of the policy have been explained to the proposer by the agent/intermediary."],"dropped_labels":4},"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/5537-housing-society-package-policy-proposal-form"}