{"id":5577,"title":"Home Secure Plus - Prime Plus 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/Annexure_4_Proposal_form_Prime_Plus_Home_Secure_Plus_b1aa05b7b7.pdf","sha256":"d11148749572d2760c3ddabb0e32d292af52e747f483b068daf7a0c6e2afee1f","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or entities proposing to purchase the Home Secure Plus insurance policy from Zurich Kotak General Insurance Company. The proposer fills it to provide personal, property, and coverage details for underwriting.","notes":["Fill the proposal form in BLOCK LETTERS.","All fields 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 to avoid policy voidance.","Use additional sheets if needed and indicate question numbers.","Total claim share percentage among nominees must not exceed 100%.","Submission of proposal or payment does not oblige the company to issue a policy.","If proposal is not accepted, payment will be refunded without interest.","Use original documents for proofs and attach valuation certificates where required."],"title":"Home Secure Plus - Prime Plus 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 full name","type":"text","label":"Name*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"First Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Middle Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Last Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender*","options":["Male","Female","Others"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Nationality*","options":["Indian","Non-Indian","NRI"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status","options":["Single","Married","Others"],"required":null,"pdf_field":""},{"help":"Full permanent address","type":"text","label":"Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is Correspondence Address same as Permanent Address?*","options":[],"required":true,"pdf_field":""},{"help":"If different from permanent address","type":"text","label":"Correspondence Address*","options":[],"required":true,"pdf_field":""},{"help":"DD/MM/YYYY format","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Title Mr. / Miss / Mrs. / M/s / Others","options":["Mr.","Miss","Mrs.","M/s","Others"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Occupation*","options":["Salaried","Business","Student","Housewife","Retired","Others"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Profession","options":[],"required":null,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile*","options":[],"required":true,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email*","options":[],"required":true,"pdf_field":""},{"help":"If applicable","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you an existing customer of Kotak Mahindra Bank Ltd. / Kotak Mahindra Prime Ltd.?","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Any existing policy from Us","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If yes, Employee ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Zurich/Kotak Group Employees","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"If yes, CRN","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If yes, Policy No.","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Annual 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":null,"pdf_field":""},{"help":"Enter PAN or attach Form 60","type":"text","label":"PAN* / Form 60 (only in case the customer does not have PAN No.)","options":[],"required":true,"pdf_field":""},{"help":"Tick applicable proofs","type":"checkbox","label":"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":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured and Covers Opted","fields":[{"help":"Select basis for sum insured","type":"choice","label":"Basis of Sum Insured","options":["Structure","Contents"],"required":true,"pdf_field":""},{"help":"Enter percentage if applicable","type":"number","label":"If First Loss basis is selected, First loss %","options":[],"required":false,"pdf_field":""},{"help":"Select valuation basis","type":"choice","label":"Agreed Value","options":["New for Old","Indemnity Value","Reinstatement Value"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you want to opt for Escalation Provision (Applicable for Structure)?","options":[],"required":null,"pdf_field":""},{"help":"Maximum up to 25% per year","type":"number","label":"If Yes, Please mentioned the Escalation %","options":[],"required":false,"pdf_field":""},{"help":"Maximum 30 years","type":"number","label":"Period of Insurance (No. of Years in case of long term policy)","options":[],"required":true,"pdf_field":""},{"help":"Policy start date","type":"date","label":"From","options":[],"required":true,"pdf_field":""},{"help":"Policy end date","type":"date","label":"To","options":[],"required":true,"pdf_field":""},{"help":"Tick extensions to opt for","type":"checkbox","label":"Do you wish to opt for any of the following extension cover (tick extension you want to opt for)","options":["Terrorism Damage Cover","Architects, Surveyors and Consulting Engineers Fees","Removal of Debris","Burglary or Theft of Content of Unoccupied Structure","Loss of Rent","Additional Rent for Alternate Accommodation","Trees and Plants / Garden Cover / Landscaping Damage","Additional Living Expenses","Temporary Resettlement Expenses","Contents Temporarily Removed","Enhanced cover during Wedding / Other Occasion","Search and Found"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Covers Opted","fields":[{"help":"","type":"yes-no","label":"Is there any policy in place for the same property?","options":[],"required":null,"pdf_field":""},{"help":"Provide existing policy details","type":"text","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Select if opting for this cover","type":"checkbox","label":"All Risk Cover - Structure and Contents","options":[],"required":false,"pdf_field":""},{"help":"Enter area in sq. ft","type":"number","label":"Structure (Please mention the Total Area Mentioned in the Registered Sale Deed Agreement :  __________ Sq. Ft)","options":[],"required":false,"pdf_field":""},{"help":"Select if opting for contents cover","type":"checkbox","label":"Contents","options":[],"required":false,"pdf_field":""},{"help":"Select if opting for burglary cover","type":"checkbox","label":"Burglary and Theft (Cover restricted within premises)","options":[],"required":false,"pdf_field":""},{"help":"Enter policy period in years","type":"number","label":"Policy Period (Maximum up to 5 years)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Location of Home Building","fields":[{"help":"Provide full address","type":"text","label":"Location of Home Building - Full postal address with Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter postal code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Is it in a multi-storey building or is it a standalone house?","options":["Multi-storey building","Standalone house"],"required":true,"pdf_field":""},{"help":"Enter floor number if applicable","type":"number","label":"In case of multi-storey building, please provide the floor number of Your house","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is there a basement to Your house?","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details for Griha Raksha Plus","fields":[{"help":"Amount to construct home building at policy commencement date","type":"amount","label":"Sum Insured (SI) for Home Building","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"SI for residential structure of Your Home including fittings and fixtures (in `)","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"SI for additional structures (in `)","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Age of Home Building","options":["Less than 5 years","5-10 years","10-20 years","Above 20 years"],"required":true,"pdf_field":""},{"help":"","type":"amount","label":"In case of Basement, If there are contents in it, please provide the Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are there any Fire Protection Devices?","options":[],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is your building certified by IGBC?","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Covers for Griha Raksha Plus","fields":[{"help":"Select if opting for each optional cover","type":"yes-no","label":"Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured for each optional cover","type":"amount","label":"Sum Insured (`)","options":[],"required":false,"pdf_field":""},{"help":"Provide details if opting for personal accident cover","type":"table","label":"Personal Accident Cover - Cover For, Name, Sum Insured (in `), DOB/Age for Self, Spouse, Child 1, Child 2, Mother/Mother-in Law, Father/Father-In Law","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"","type":"text","label":"Name of the Insured Policyholder","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name of the Nominee","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Relationship with the Insured Policyholder","options":[],"required":true,"pdf_field":""},{"help":"","type":"number","label":"Age of the Nominee","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Where Nominee is a minor, give details of Appointee","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Nominee Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Nominee Email ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Present Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":false,"pdf_field":""},{"help":"Total share must not exceed 100%","type":"number","label":"% of claim share*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Claims Details","fields":[{"help":"Include Date of Loss, Cause of Loss, Claimed Amount, Settled Amount or if claim is outstanding","type":"table","label":"Please specify details of any loss to the proposed Property in last 3 years","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any other insurance company in respect of Insurance: Declined Your Proposal?","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"For electronic fund transfer","type":"text","label":"Account Number","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Account Holder name","options":[],"required":true,"pdf_field":""},{"help":"If payment by cheque or demand draft","type":"text","label":"Cheque / D.D#","options":[],"required":false,"pdf_field":""},{"help":"Bank name on cheque/DD","type":"text","label":"Drawn To","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":"","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""},{"help":"Electronic Insurance Account","type":"yes-no","label":"Do you have an EIA Account","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"If No, do you want Us to create an EIA account for you","options":[],"required":false,"pdf_field":""},{"help":"Mandatory if EIA account exists or created","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Sign to declare correctness of information","type":"signature","label":"Signature of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"Answer truthfully","type":"yes-no","label":"Are You or any of the proposed applicants or close relatives is/are associated to Politically Exposed Person (PEP)?*","options":[],"required":true,"pdf_field":""},{"help":"Answer if applicable","type":"yes-no","label":"Are you a Non-Profit Organization?*(only in case of an entity)","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":false,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Authorised Representative*","options":[],"required":false,"pdf_field":""},{"help":"If applicable","type":"signature","label":"Declaration in case the proposer/policyholder is person with disability (PWD) - Signature/Thumb impression of Proposer","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Annexure - Contents Details","fields":[{"help":"List individual items with details and sum insured","type":"table","label":"Description of the Item, Age, Identification / Serial, Sum Insured* (`) for Jewellery and Valuable, Electronic Equipment, Domestic Appliances, Portable Equipment, Furniture & Fixtures, Any Other Item","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Home Secure Plus insurance policy proposals for residential property insurance including all risk cover, burglary & theft, and optional covers","attachments":["Valuation certificate (if opting for Valuable Contents on Agreed Value Basis)","Additional sheets if more space is needed for answers","Cancelled cheque for electronic fund transfer","Proof of Identity and Proof of Address documents"],"declarations":["The statements made in this proposal form are true to the best of the proposer’s knowledge and belief.","Any additions or alterations in the risk after submission must be conveyed immediately to the insurer.","All premiums have been or will be paid from bonafide sources and not from proceeds of crime.","The insurer has the right to verify identity and address through official registries.","The insurer may cancel the contract if found guilty under money laundering laws.","Consent is given to receive policy and service communications in soft copy via email.","The proposer confirms whether they or close relatives are politically exposed persons.","If proposer is a person with disability, they may authorize a representative to assist in form completion."],"dropped_labels":9},"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/5577-home-secure-plus-prime-plus-proposal-form"}