{"id":5567,"title":"Group Smart Travel 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/Group_Smart_Travel_Proposal_Form_ZK_v1_25_26_11082025_c834237881.pdf","sha256":"260a322fa12984010e4e21f249ea7c2763f0b3d466a4cab51085517c33bb8cc8","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by groups or organizations to apply for the Group Smart Travel insurance policy from Zurich Kotak General Insurance Company. It is filled by the proposer or group administrator.","notes":["Fill the form in BLOCK LETTERS.","Fields marked with * are mandatory.","Use additional sheets if space is insufficient and indicate question number.","Original bills and documents may be required for claims (not specified here).","The form includes office use only fields which are not to be filled by the proposer.","The proposer should provide complete residential address if opting for Home Burglary or Fire and Allied Perils benefits.","Details of sports organizer, sport name, and equipment must be provided if opting for sports injury benefits."],"title":"Group Smart Travel Proposal Form","submit":{"to":"Zurich Kotak General Insurance Company (India) Limited","how":"","address":"Registered & Corporate Office: 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 the full name of the proposer or group administrator","type":"text","label":"Name of the Proposer/ Group Administrator (Organisation/ Institute/ Association)*","options":[],"required":true,"pdf_field":""},{"help":"Describe the trade, business or activity of the proposer","type":"text","label":"Proposer's Trade/ Business/ Activity *","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is the Mailing Address same as the Registered Office Address?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If mailing address differs, provide full mailing address","type":"text","label":"Proposer's Mailing Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter contact phone number","type":"phone","label":"Contact No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email ID*","options":[],"required":true,"pdf_field":""},{"help":"Enter GST Identification Number if applicable","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Enter Permanent Account Number","type":"text","label":"PAN*","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Any existing policy from Us Yes No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide existing policy number if applicable","type":"text","label":"If 'Yes', Policy No","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Details","fields":[{"help":"Enter start date of policy period","type":"date","label":"Policy Period: From","options":[],"required":true,"pdf_field":""},{"help":"Select the group type","type":"choice","label":"Group Type","options":["Employer Employee","Non Employer Employee"],"required":true,"pdf_field":""},{"help":"Select type of travel","type":"choice","label":"Type of Travel","options":["International Travel","Domestic Travel","Student Travel"],"required":true,"pdf_field":""},{"help":"Select trip type if international travel","type":"choice","label":"Trip Type (In Case of International Travel)","options":["Single Trip","Annual Multi Trip"],"required":false,"pdf_field":""},{"help":"Enter maximum trip duration in days","type":"number","label":"If opted for Annual Multi trip, Maximum Trip duration (days)","options":[],"required":false,"pdf_field":""},{"help":"Enter total number of persons to be insured","type":"number","label":"Number of Persons to be insured","options":[],"required":true,"pdf_field":""},{"help":"Select sum insured basis","type":"choice","label":"Sum Insured Basis","options":["Individual","Family Floater"],"required":true,"pdf_field":""},{"help":"Select purpose of travel","type":"choice","label":"Purpose Of Travel","options":["Business","Leisure","Study","Employment","Adventure","Others Please specify"],"required":false,"pdf_field":""},{"help":"Select geographical scope","type":"choice","label":"Geographical Scope","options":["Within India","Worldwide","Worldwide Excluding USA & Canada","Asia","Europe","Schengen"],"required":false,"pdf_field":""},{"help":"Applicable only to credit linked policies","type":"text","label":"Type of Credit (#)","options":[],"required":false,"pdf_field":""},{"help":"Enter country or city of origin","type":"text","label":"Country/City Of Origin","options":[],"required":false,"pdf_field":""},{"help":"List destination countries or cities","type":"text","label":"Destinations Countries/Cities","options":[],"required":false,"pdf_field":""},{"help":"Enter travel vehicle number","type":"text","label":"Flight/Train/Bus/Cab Number","options":[],"required":false,"pdf_field":""},{"help":"Enter PNR number if applicable","type":"text","label":"PNR Number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Enter name of insured person","type":"text","label":"Insured Name*","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's full name","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 nominee's date of birth","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's mobile number","type":"phone","label":"Nominee Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's email address","type":"email","label":"Nominee Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter current 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 details for claim payments","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":false,"pdf_field":""},{"help":"Enter percentage share of claim for nominee","type":"number","label":"% of claim share*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured Person Details","fields":[{"help":"Enter date of birth","type":"date","label":"Date of Birth DD/MM/YYYY","options":[],"required":true,"pdf_field":""},{"help":"Enter nationality","type":"text","label":"Nationality","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female","Other"],"required":true,"pdf_field":""},{"help":"Specify pre-existing disease if any","type":"text","label":"Pre-existing Disease","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Information (For Student Travel Only)","fields":[{"help":"Enter name of educational institute","type":"text","label":"Name of Educational Institute","options":[],"required":false,"pdf_field":""},{"help":"Provide course details","type":"text","label":"Course Details","options":[],"required":false,"pdf_field":""},{"help":"Provide address of educational institute","type":"text","label":"Educational Institute Address","options":[],"required":false,"pdf_field":""},{"help":"Country of educational institute","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"Enter sponsor's name","type":"text","label":"Sponsor name","options":[],"required":false,"pdf_field":""},{"help":"Specify relationship with insured","type":"text","label":"Relationship With Insured","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Previous Policy Details","fields":[{"help":"Enter previous policy period","type":"text","label":"Policy Period From – To","options":[],"required":false,"pdf_field":""},{"help":"Enter insurer name","type":"text","label":"Name of the Insurer","options":[],"required":false,"pdf_field":""},{"help":"Enter previous policy number","type":"text","label":"Policy number","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Enter cheque or demand draft number","type":"text","label":"Cheque / D.D #","options":[],"required":false,"pdf_field":""},{"help":"Enter amount paid","type":"amount","label":"Amount","options":[],"required":false,"pdf_field":""},{"help":"Enter date of payment","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Enter bank branch","type":"text","label":"Branch","options":[],"required":false,"pdf_field":""},{"help":"Enter IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Enter transaction reference number","type":"text","label":"For Credit/Debit Card: Transaction Reference No.","options":[],"required":false,"pdf_field":""},{"help":"Enter transaction date","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Appointee Details (if nominee is minor)","fields":[{"help":"Enter name of appointee","type":"text","label":"Name of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"Enter appointee's date of birth","type":"date","label":"Date of Birth DD/MM/YYYY","options":[],"required":false,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship with the Nominee","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's name","type":"text","label":"Name of the Nominee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consent","fields":[{"help":"Sign and stamp the form","type":"signature","label":"Signature and Stamp 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":""}],"filled_by":"proposer"},{"title":"Bank Account Details for Payments","fields":[{"help":"Enter bank account number for claim payments","type":"text","label":"Account Number","options":[],"required":false,"pdf_field":""},{"help":"Enter IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"Enter name of account holder","type":"text","label":"Account Holder Name","options":[],"required":false,"pdf_field":""},{"help":"Tick if bank details are same as premium cheque","type":"checkbox","label":"Bank details as per premium cheque to be used for electronic fund transfer","options":[],"required":false,"pdf_field":""},{"help":"Tick if no existing bank account","type":"checkbox","label":"No existing Bank Account","options":[],"required":false,"pdf_field":""},{"help":"Tick to agree","type":"checkbox","label":"I agree to open a bank account and provide my bank account details to the Company for electronic fund transfer","options":[],"required":false,"pdf_field":""},{"help":"Tick if cancelled cheque submitted","type":"checkbox","label":"Cancelled Cheque submitted of Other Bank","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Group Smart Travel insurance policies","attachments":["Additional sheets if space is insufficient to answer questions","Cancelled cheque if submitting bank details","Details of sports if opting for sports injury benefits","Complete residential address if opting for Home Burglary or Fire and Allied Perils benefits"],"declarations":["The proposer declares that all information provided is true, complete and accurate to the best of their knowledge.","The policy will be issued only after full payment of premium and acceptance by the company.","The proposer will notify any change in occupation or health before acceptance of risk.","The proposer consents to the company seeking medical and other information for underwriting and claims.","The proposer authorizes sharing of proposal and medical information with regulatory authorities.","The proposer consents to receive policy and service communications by email.","The proposer consents to KYC verification through various government portals.","The proposer authorizes premium blocking and debiting under BIMA ASBA facility upon acceptance.","The proposer confirms premiums are paid from bona fide sources and understands the company’s rights under AML regulations.","The proposer declares if associated with Politically Exposed Persons or Non-Profit Organization status.","The proposer confirms understanding of the proposal form and policy terms as explained by the agent.","The proposer consents to electronic fund transfer for payments related to the policy."],"dropped_labels":19},"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/5567-group-smart-travel-proposal-form"}