{"id":5547,"title":"Money Secure 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/Money_Secure_Proposal_Form_ZK_V2_24_25_13122024_5ca493f1e7.pdf","sha256":"59e001c567acb4ba0d41daebe3d88577244e0449ae2dafccfefbe0f2cbdb1e15","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or corporate customers to apply for the Money Secure insurance policy. The proposer or owner fills it to provide personal, business, and risk details for underwriting.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","Provide full, accurate, and correct information; non-disclosure or misrepresentation may void the policy.","Attach additional sheets if space is insufficient, indicating the question number.","Use original documents for proofs and payments.","Electronic Insurance Account (EIA) email ID is mandatory.","Submission of proposal or payment does not oblige the company to issue a policy; acceptance is at company’s discretion.","Premium must be received in full and in time for policy liability to commence.","Policy terms and underwriting policy govern acceptance and issuance."],"title":"Money Secure Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer/Owner’s Details","fields":[{"help":"Enter full name in block letters","type":"text","label":"Proposer’s Name*","options":[],"required":true,"pdf_field":""},{"help":"Describe the trade or business","type":"text","label":"Proposer's Trade or Business*","options":[],"required":true,"pdf_field":""},{"help":"Enter contact phone number","type":"phone","label":"Contact No.","options":[],"required":false,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter GST Identification Number if applicable","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Enter address line 1","type":"text","label":"Address (Line 1)","options":[],"required":false,"pdf_field":""},{"help":"Enter address line 2","type":"text","label":"Address (Line 2)","options":[],"required":false,"pdf_field":""},{"help":"Enter nearest landmark","type":"text","label":"Nearest Landmark","options":[],"required":false,"pdf_field":""},{"help":"Enter city or district","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"Enter registered or permanent address","type":"text","label":"Registered Office Address / Permanent Address*","options":[],"required":true,"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":"Fill communication address details if different","type":"text","label":"If ‘No’, please provide below","options":[],"required":false,"pdf_field":""},{"help":"State of communication address","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Postal code of communication address","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""},{"help":"Country of communication address","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"Enter postal address","type":"text","label":"Communication (Postal) Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"section","label":"For Individual customers, please share below details:","options":[],"required":null,"pdf_field":""},{"help":"Enter PAN 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":"Enter CKYC 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":"Enter GSTIN if applicable","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Tick applicable proofs and specify if others","type":"checkbox","label":"Please share the following for authentication purpose: 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","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide existing policy number","type":"text","label":"If ‘Yes’, Policy No","options":[],"required":false,"pdf_field":""},{"help":"Select if you are a non-profit organization","type":"yes-no","label":"Are you a Non-profit Organization?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"section","label":"For Corporate customers / Firms, please share below details:","options":[],"required":null,"pdf_field":""},{"help":"Enter CKYC number for corporate","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":false,"pdf_field":""},{"help":"Enter PAN for corporate","type":"text","label":"PAN*:","options":[],"required":true,"pdf_field":""},{"help":"","type":"section","label":"Please share the below details for the Authorised Signatory:","options":[],"required":null,"pdf_field":""},{"help":"Name of authorised signatory","type":"text","label":"Name:","options":[],"required":false,"pdf_field":""},{"help":"Designation of authorised signatory","type":"text","label":"Designation:","options":[],"required":false,"pdf_field":""},{"help":"CKYC number of authorised signatory","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":false,"pdf_field":""},{"help":"Enter paid up capital amount","type":"amount","label":"Paid up Capital of the firm","options":[],"required":false,"pdf_field":""},{"help":"Enter start and end date (DD/MM/YYYY)","type":"date","label":"Period of Insurance","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details","fields":[{"help":"Describe the nature of business","type":"text","label":"Nature of Business","options":[],"required":false,"pdf_field":""},{"help":"Enter indemnity limit amount","type":"amount","label":"Limit of Indemnity Required","options":[],"required":false,"pdf_field":""},{"help":"","type":"section","label":"Money in Transit from Bank/ Insured’s premises/ place of collection to Insured’s Premises/ Bank/ place of disbursement as applicable","options":[],"required":null,"pdf_field":""},{"help":"","type":"section","label":"I. Money in transit","options":[],"required":null,"pdf_field":""},{"help":"Enter single carrying limit amount","type":"amount","label":"Single carrying limit (`)","options":[],"required":false,"pdf_field":""},{"help":"Enter total estimated annual transit amount","type":"amount","label":"Total estimated amount of money in transit per annum (`)","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured/limit for money in counter","type":"amount","label":"II. Money in counter","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured/limit for money in safe","type":"amount","label":"III. Money in safe","options":[],"required":false,"pdf_field":""},{"help":"Enter maximum 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","Own 2 Wheeler","By Public Transport","Own 4 Wheeler"],"required":false,"pdf_field":""},{"help":"Indicate presence of armed guard/security","type":"yes-no","label":"Please specify if there is an armed guard/Security","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if money is accompanied outside","type":"yes-no","label":"Accompanying the Money carried outside:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if security is present 24 hours at premises","type":"yes-no","label":"At Insured’s Premises for 24 hours:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if additional persons accompany money outside","type":"yes-no","label":"Please specify if additional person accompany the money outside:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if CCTV is operational throughout","type":"yes-no","label":"Is there a CCTV in the insured premises that is clearly operational all through:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide Year, Name of the Insurer, Premium Paid, Claim Amount, Type of claim","type":"table","label":"Please share Premium/Claim details for the past 36 months","options":[],"required":false,"pdf_field":""},{"help":"Indicate if insurance was refused previously","type":"yes-no","label":"Has any Insurance Company refused to give insurance in the past?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide reason for refusal","type":"text","label":"If ‘Yes’, please specify the reason","options":[],"required":false,"pdf_field":""},{"help":"For each cover, specify Yes/No and Sum Insured Limit if applicable","type":"table","label":"Please specify the additional covers required","options":["Assault Risk","Extension to cover Off roll/ Contractor’s employees","Strike, Riot and Civil Commotion","Theft","Damage to Safe","Use of Duplicate Key","Infidelity of Cash Carrying Employees","Cash kept overnight at Key Person’s house","Loss of personal effects of Employees","Terrorism Damage Cover","Floater Cover"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Acknowledgement and Payment Details","fields":[{"help":"Name of proposer","type":"text","label":"Received from Ms./Mrs./ Mr.","options":[],"required":false,"pdf_field":""},{"help":"Amount paid by cheque or demand draft","type":"amount","label":"Through Cheque/DD sum of `","options":[],"required":false,"pdf_field":""},{"help":"Signature of company official or intermediary","type":"signature","label":"Signature of Zurich Kotak General Insurance Company (India) Limited Official / Intermediary","options":[],"required":false,"pdf_field":""},{"help":"Date of receipt","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Time of receipt","type":"text","label":"Time","options":[],"required":false,"pdf_field":""},{"help":"Place of receipt","type":"text","label":"Place","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":"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":true,"pdf_field":""},{"help":"Note about address override","type":"note","label":"Your address details as mentioned in the EIA account shall override the address provided in this application for Insurance.","options":[],"required":null,"pdf_field":""},{"help":"","type":"section","label":"Details as per premium cheque to be used for electronic fund transfer;","options":[],"required":null,"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":"Bank account number for refund/claim","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":"","type":"section","label":"PAYMENT DETAILS","options":[],"required":null,"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","type":"text","label":"Bank and Branch Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"section","label":"For Credit / Debit Card","options":[],"required":null,"pdf_field":""},{"help":"Transaction reference number for card payment","type":"text","label":"Transaction Reference No","options":[],"required":false,"pdf_field":""},{"help":"Transaction date","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"IFSC or MICR code of bank branch","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Amount drawn","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"Date of transaction","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""},{"help":"","type":"section","label":"BANK DETAILS","options":[],"required":null,"pdf_field":""}],"filled_by":"intermediary and proposer"},{"title":"Nominee Details (Applicable for individual customers)","fields":[{"help":"Enter 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":"Enter date of birth of nominee","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile number of nominee","type":"phone","label":"Nominee Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter email ID of nominee","type":"email","label":"Nominee Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter present address of nominee","type":"text","label":"Nominee Present Address","options":[],"required":false,"pdf_field":""},{"help":"Enter permanent address of nominee","type":"text","label":"Nominee Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"Provide bank name and account details of nominee","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":false,"pdf_field":""},{"help":"Enter 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":"section","label":"Where Nominee is a minor, give details of Appointee","options":[],"required":false,"pdf_field":""},{"help":"Name of appointee","type":"text","label":"Name of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"DOB of appointee","type":"date","label":"Date of Birth DD/MM/YYYY","options":[],"required":false,"pdf_field":""},{"help":"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":"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":"Sign or provide thumb impression","type":"signature","label":"Signature/Thumb impression of Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Signature of intermediary or sales person","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":true,"pdf_field":""},{"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":""}],"filled_by":"proposer and intermediary"}],"deadlines":[],"applies_to":"Money Secure insurance policy proposal","attachments":["Additional sheets if more space is required to answer questions","Proof of Identity (POI) and Proof of Address (POA) documents as ticked","Cancelled cheque for electronic fund transfer if applicable","Insurance Repository Application form if EIA account creation requested"],"declarations":["The statements made in this Proposal Form are true to the best of the proposer’s knowledge and belief and form the basis of the contract.","Policy 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 official registries for KYC purposes.","Proposer declares if they qualify as a High Net Worth Individual (HNI) with net worth of ₹50 crore or more.","All premiums are paid from bonafide sources and not from proceeds of crime under the Prevention of Money Laundering Act.","The insurance company may cancel the contract if found guilty under money laundering laws.","The contents of the proposal form and policy terms have been explained in a language understood by the proposer.","Agent declarations confirm that policy features and terms have been explained to the proposer.","If proposer is a person with disability, an authorised representative may assist and provide declarations on their behalf."],"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/5547-money-secure-proposal-form"}