{"id":5572,"title":"Maxima Professional Liability Insurance – Technology 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/Maxima_Professional_Liability_Insurance_Technology_Proposal_Form_7302046adc.pdf","sha256":"7dd49e4864172ec6c499edcb7de6276bc5bfacc1db57cf46497bd600dd6f1a0c","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for professional liability insurance specifically for technology-related businesses. It is filled by the prospective insured (individual or corporate) seeking insurance coverage.","notes":["Answer all questions legibly and completely.","If insufficient space, provide additional information on separate sheet.","Mark Not Applicable (N/A) where sections do not apply.","Signing the proposal does not bind the proposer to complete the insurance.","Insurance liability starts only after proposal acceptance and premium receipt.","Use original documents for attachments where applicable.","Total nominee claim share cannot exceed 10%.","Email ID is mandatory for Electronic Insurance Account registration.","Proposer must sign or affix thumb impression after understanding the form.","If proposer is a person with disability, authorized representative may assist and sign."],"title":"Maxima Professional Liability Insurance – Technology 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":"Applicant Details","fields":[{"help":"","type":"text","label":"Name of Insured*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Insured Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"If Correspondence Address different from Permanent Address, please provide*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Web Site Address:","options":[],"required":false,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Establishment Date:","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Contact No*","options":[],"required":true,"pdf_field":""},{"help":"","type":"email","label":"Email Id","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Nationality*","options":["Indian","Non-Indian","NRI"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Annual Income:","options":["Up to 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":"","type":"text","label":"GSTIN:","options":[],"required":false,"pdf_field":""},{"help":"Permanent Account Number or Form 60 if no PAN","type":"text","label":"PAN*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"/Form 60 (only in case the customer does not have PAN No.)","options":[],"required":false,"pdf_field":""},{"help":"Tick applicable proofs and specify if Others","type":"checkbox","label":"Proof of Identity (POI) and Proof of Address (POA) [(     ) Tick whichever is applicable]","options":["PAN","Passport","Driving Licence","Voter ID","Ration Card","Others (Please specify)"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"For Corporate customers / Firms, please share below details: CKYC Identifier / Number Generated by CERSAI","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"PAN*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"GSTIN:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Business Activities","fields":[{"help":"","type":"number","label":"Number of Partners/Directors/Principals","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Number of Professional Employees (Technical Staff)","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Number of Other Technical Staff","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Number of Trainee Staff","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Number of Non-Technical Staff (i.e. administration, clerical, typists etc.)","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Total Number of employees","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are there any employees outside India?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if employees outside India","type":"text","label":"If Yes, Kindly share details","options":[],"required":false,"pdf_field":""},{"help":"Provide brief resume if less than 3 years in industry","type":"table","label":"Please give the following details of all Partners/Directors/Principals: Name, Qualifications, Years in Industry, Years as Partner/Director/Principal","options":[],"required":false,"pdf_field":""},{"help":"Describe products and services offered","type":"text","label":"Please provide a full description of the activities of Insured (Product and Services)","options":[],"required":false,"pdf_field":""},{"help":"Provide percentage revenue for each industry","type":"table","label":"Is the end use of the product or service provided by you involved in any of the following? Please share % of revenue","options":["Non - Profit Associations excluding NGO","Healthcare","Food & Beverage","Hotels / Hospitality","Logistics / Transport","Manufacturing","Retail","Information Technology","Utilities","Agricultural","Property / Construction","Pharmaceuticals","Automotive","Electronics","Energy","Mining","Power Generation","Telecommunications","Biotechnology","Mining Exploration","Airlines","Banks","Fund Industry","Insurance","Stock Brokers","Financial Institutions – Infrastructure","Other Financial Services organisation","Industries not specifically defined"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Please provide details of any major new operations undertaken during the last 12 months or planned for the next 12 months","options":[],"required":false,"pdf_field":""},{"help":"List work descriptions and corresponding percentage","type":"table","label":"Approximate the business activities by percentage of fee income derived (Brief Description of Work and Percentage %)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Names of any professional organisations or associations of which you or your Partners/ Directors/ Principals are members","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are subcontractors required to carry their own Professional Liability insurance?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"If yes, what is the average Limit of Liability required? (INR)","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Do you always require satisfactory references or only when engaging senior employees?","options":["Always","Senior Appointments Only"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are client funds kept in a properly designated client account separate from Insured's bank account? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if yes","type":"yes-no","label":"Is any partner/director/principal or the Insured aware of any act, error or omission, unresolved contract dispute or other circumstances which may reasonably be expected to result in a claim? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if yes","type":"yes-no","label":"Is any partner/director/principal or the Insured aware of any circumstances or occurrences which may give rise to a claim? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"List and provide details on any suits, potential suits, complaint letters, disputes or other circumstances alleging non-performance of contract or products/services","options":[],"required":false,"pdf_field":""},{"help":"If none, check the box","type":"table","label":"Details of previous Professional Liability Insurance – Technology carried during past 3 years: Period, Insurer, Limit, Retention, Premium","options":[],"required":false,"pdf_field":""},{"help":"If yes, advise reasons","type":"yes-no","label":"Has any proposal for Professional Liability Insurance – Technology ever been declined, cancelled, renewal refused or special terms imposed? (Yes/No)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Limit of Liability desired","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Retention desired","options":[],"required":false,"pdf_field":""},{"help":"Specify policy duration","type":"text","label":"Policy Period","options":[],"required":false,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Retroactive date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank Account and Payment Details","fields":[{"help":"","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"Name of payee","type":"text","label":"Drawn To","options":[],"required":false,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank and Branch Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"For Credit/Debit Card: Transaction Reference No","options":[],"required":false,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured Information and Nominee Details (for individual customers)","fields":[{"help":"","type":"text","label":"Name in Full*","options":[],"required":true,"pdf_field":""},{"help":"Format: DD/MM/YYYY","type":"date","label":"Date of Birth (DD/MM/YYYY)*","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Gender*","options":["Male","Female","Other"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Occupation*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"ABHA ID","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details and AML Declaration","fields":[{"help":"","type":"yes-no","label":"Do you have an EIA Account?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":false,"pdf_field":""},{"help":"If Yes, please fill up Insurance Repository Application form","type":"yes-no","label":"If No, do you want Us to create an EIA account for you?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Email id is mandatory","type":"email","label":"Email id (to be registered with Insurance Repository)","options":[],"required":true,"pdf_field":""},{"help":"PEPs are individuals entrusted with prominent public functions","type":"yes-no","label":"Are You or any of the proposed applicants or close relatives associated to Politically Exposed Person (PEP)?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Professional Liability Insurance – Technology","attachments":["Most Recent Audited Financials","Copy of your standard and largest contract","Copy of your business plan if company is less than 3 years old","Copy of your contract with your subcontractors","PAN Card number","GSTIN Number","Cancelled cheque for electronic fund transfer"],"declarations":["All information given is true and non-misleading; false or withheld information may void the policy.","Consent to receive policy and service communication in soft copy is valid for all regulatory/policy servicing requirements.","Consent to verify identity/address proof through official government portals for KYC purposes.","Proposer may declare High Net Worth Individual status if net worth is ₹50 crore or more.","Agent declares that policy features and terms were explained to the proposer.","Prohibition of rebates under Section 41 of Insurance Act 1938 applies."],"dropped_labels":41},"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/5572-maxima-professional-liability-insurance-technology-proposal-form"}