{"id":5550,"title":"Mega Risks 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/Mega_Risks_Insurance_Proposal_Form_ZK_26_27_v1_17032026_0eccf5483f.pdf","sha256":"f8e182dd1df1fa840648c71b8143eef7087e93aa2e9484c7484c385db59fbe15","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or corporate entities to apply for Mega Risks Insurance coverage by providing detailed information about the proposer, risk details, and sum insured. The proposer or owner fills this form.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","If additional space is needed, attach extra sheets and indicate the question number.","Information given will be treated in strict confidence.","Submission of the proposal or payment does not oblige the company to issue a policy.","The company’s decision to accept the proposal is at its sole discretion.","Premium must be received in full and in time for the policy to be effective.","If the proposal is not accepted, payment will be refunded without interest.","No person shall offer or accept any rebate of commission or premium except as allowed by published prospectuses.","Non-compliance with rebate provisions is punishable with a fine up to ten lakh rupees."],"title":"Mega Risks Insurance Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer / Owner’s Details","fields":[{"help":"Enter the quote number","type":"text","label":"Quote No.*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch Code","options":[],"required":null,"pdf_field":""},{"help":"Enter the date of the quote","type":"date","label":"Quote Date*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Sales Manager Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Service RM","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Branch code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary business vertical","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Client Ref. No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"SP Name/Code","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of the proposer","type":"text","label":"Proposer’s Name*","options":[],"required":true,"pdf_field":""},{"help":"Specify the trade or business of the proposer","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":null,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Enter GST Identification Number","type":"text","label":"GSTIN","options":[],"required":null,"pdf_field":""},{"help":"Enter address line 1","type":"text","label":"Address (Line 1)","options":[],"required":null,"pdf_field":""},{"help":"Enter address line 2","type":"text","label":"Address (Line 2)","options":[],"required":null,"pdf_field":""},{"help":"Enter nearest landmark","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"Enter city or district","type":"text","label":"City / District","options":[],"required":null,"pdf_field":""},{"help":"Enter state","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter registered or permanent address","type":"text","label":"Registered Office Address / Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter country","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"Enter postal pin code","type":"number","label":"Pin Code","options":[],"required":null,"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":"Enter communication address line 1 if different","type":"text","label":"If ‘No’, please provide below Address (Line 1)","options":[],"required":null,"pdf_field":""},{"help":"Enter communication address line 2 if different","type":"text","label":"Address (Line 2)","options":[],"required":null,"pdf_field":""},{"help":"Enter nearest landmark for communication address","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"Enter city or district for communication address","type":"text","label":"City / District","options":[],"required":null,"pdf_field":""},{"help":"Enter state for communication address","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter communication postal address","type":"text","label":"Communication (Postal) Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter country for communication address","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"Enter pin code for communication address","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"For Corporate customers, please share below details: PAN*:","options":[],"required":true,"pdf_field":""},{"help":"Enter GSTIN for corporate customers","type":"text","label":"GSTIN:","options":[],"required":null,"pdf_field":""},{"help":"Enter name of authorised signatory","type":"text","label":"Please share the below details for the Authorised Signatory: Name:","options":[],"required":null,"pdf_field":""},{"help":"Enter designation of authorised signatory","type":"text","label":"Designation:","options":[],"required":null,"pdf_field":""},{"help":"Enter CKYC identifier","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI):","options":[],"required":null,"pdf_field":""},{"help":"Enter paid up capital amount","type":"amount","label":"Paid up Capital of the firm","options":[],"required":null,"pdf_field":""},{"help":"Enter insurance start date","type":"date","label":"Period of Insurance: From:","options":[],"required":null,"pdf_field":""},{"help":"Enter insurance end date","type":"date","label":"To","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name for hypothecation","type":"text","label":"Hypothecation Details: Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Select if you have an existing policy","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter existing policy number if applicable","type":"text","label":"If ‘Yes’, Policy No","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are you a Non-profit Organization?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details","fields":[{"help":"Provide description and sum insured for Building, Plant & Machinery, Stocks & Stocks in process, Others; include total sum insured and risk location addresses","type":"table","label":"Details of Sum Insured Section I – Material Damage","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Sum Insured / Limits for Additional Covers","fields":[{"help":"Provide particulars and sum insured/limits for add-on covers including Gross Profit and Total Sum Insured","type":"table","label":"Section III – Business Interruption","options":[],"required":null,"pdf_field":""},{"help":"Provide policy period, sum insured and premium paid, incurred claim amount, nature of claim/section for last 5 policy periods","type":"table","label":"Details of Claims Experience - Please give premium and claim details for last 5 policy periods","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you wish to opt for Machinery Loss of Profit cover?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter indemnity period in months and standing charges amount","type":"text","label":"Please specify the Indemnity Period in Months and Standing Charges","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Details and Payment Details","fields":[{"help":"Provide account number, bank name, account holder name, cancelled cheque if applicable","type":"text","label":"Details as per premium cheque to be used for electronic fund transfer","options":[],"required":null,"pdf_field":""},{"help":"Enter cheque or demand draft number","type":"text","label":"Cheque / D.D #","options":[],"required":null,"pdf_field":""},{"help":"Enter name of bank branch drawn to","type":"text","label":"Drawn To","options":[],"required":null,"pdf_field":""},{"help":"Enter bank and branch name","type":"text","label":"Bank and Branch Name","options":[],"required":null,"pdf_field":""},{"help":"Enter transaction reference number","type":"text","label":"For Credit/Debit Card: Transaction Reference No","options":[],"required":null,"pdf_field":""},{"help":"Enter transaction date","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":null,"pdf_field":""},{"help":"Enter amount drawn","type":"amount","label":"Drawn Amount","options":[],"required":null,"pdf_field":""},{"help":"Enter transaction date for refund/claims","type":"date","label":"Transaction Date","options":[],"required":null,"pdf_field":""},{"help":"Provide EIA account details and email id registered with Insurance Repository","type":"text","label":"ELECTRONIC INSURANCE ACCOUNT DETAILS OF PROPOSER (E-MAIL ID IS MANDATORY)","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do you have an EIA Account","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter EIA number if applicable","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":null,"pdf_field":""},{"help":"Enter name of insurance repository","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"If No, do you want Us to create an EIA account for you","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter email id registered with insurance repository","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Sign the form","type":"signature","label":"Signature of Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"Signature and stamp of 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":"Signature of company official or intermediary","type":"signature","label":"Signature of Zurich Kotak General Insurance Company (India) Limited Official / Intermediary","options":[],"required":null,"pdf_field":""},{"help":"Signature of intermediary or sales person","type":"signature","label":"Signature of Intermediary/ Sales Person*","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","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":"Select Yes or No","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 the type of organisation","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":null,"pdf_field":""}],"filled_by":"proposer and intermediary"}],"deadlines":[],"applies_to":"Mega Risks Insurance policies","attachments":["Additional sheets if more space is required to answer any question","Cancelled cheque for electronic fund transfer if applicable","Insurance Repository Application form if EIA account creation is 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 liability commences only after acceptance and premium receipt.","The company may void the policy for any untrue, incorrect, or incomplete statements or non-disclosure.","Consent is given to verify identity/address through specified government portals for KYC.","All premiums are paid from bonafide sources and not from proceeds of crime; the company may cancel the contract if found otherwise.","The proposer has understood the policy features and terms as explained by the agent.","The proposer has understood the proposal form contents and policy terms as explained in their vernacular language."],"dropped_labels":0},"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/5550-mega-risks-insurance-proposal-form"}