{"id":5581,"title":"Home Secure Plus - Premium 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_Premium_Home_Secure_Plus_0956c5852d.pdf","sha256":"9bce8675d01ad828e729cde124f3432c6864528ceba012f1a6750d1f3cc3e8bf","pages":6,"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 company’s liability starts only after acceptance of the proposal and receipt of premium.","Provide all information fully, accurately, and correctly; non-disclosure may void the policy.","Attach additional sheets if more space is needed, indicating the question number.","Sum Insured for Contents must not be less than INR 5 Lakhs if insured alone; if insured with Structure, minimum 10% of Structure sum insured.","For contents valued less than INR 5 Lakhs collectively, individual item values must be declared in the annexure.","Use original documents for proofs and valuation reports.","Total nominee share cannot exceed 100%.","Electronic Insurance Account email ID is mandatory if opting for EIA.","Statutory warning about prohibition of rebates under Section 41 of Insurance Act 1938 is included."],"title":"Home Secure Plus - Premium Proposal Form","submit":{"to":"","how":"","address":""},"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","Others"],"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":null,"pdf_field":""},{"help":"DD/MM/YYYY","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":false,"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":""},{"help":"List all parties with insurable interest","type":"text","label":"Policy to be issued in favour of (list out all the parties who have insurable interest) including the financial institutions","options":[],"required":null,"pdf_field":""},{"help":"Address of parties with insurable interest","type":"text","label":"Address (Line 1)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 2)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City / District","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Phone","options":[],"required":false,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured Information","fields":[{"help":"","type":"choice","label":"Is Insured Premises Address same as Permanent Address / Correspondence Address?*","options":["Yes, Permanent Address","Yes, Correspondence Address","No"],"required":true,"pdf_field":""},{"help":"Full insured premises address","type":"text","label":"If ‘No’, please provide below Insured Premises address*","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 1)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address (Line 2)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City / District","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Type of Construction","options":["Reinforced Concrete","Burned Brick"],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Walls made of","options":["Bricks"],"required":null,"pdf_field":""},{"help":"Years and months","type":"text","label":"Age of Structure For Structure Insurance*","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Roof made of","options":["Cement","Concrete","RCC","Stone","Asbestos","Mud","Corrugated","Tiles","Clay","Wood","Thatched","Any other item"],"required":null,"pdf_field":""},{"help":"If loan is taken","type":"text","label":"Bank / Institution Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Hypothecation Details (if any)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Loan Account Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Loan Amount","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Loan Tenure","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"EMI Amount","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Other Information","options":[],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Fire Extinguishing Appliance Installed","options":["Hydrant & Sprinkler","Small Bore Hose Reels","Hydrant Only","Trailer Pumps","Sprinkler Only","Dedicated Fire Brigade","Portable Extinguishing","Mutual Aid","Spot Protection for Critical Areas"],"required":false,"pdf_field":""},{"help":"In KM","type":"number","label":"Distance from the nearest Fire Brigade","options":[],"required":false,"pdf_field":""},{"help":"","type":"checkbox","label":"Security Available for Structure","options":["Security Guard","Electronic Device","Common Watchman","No"],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Insured Premises Floor","options":["Basement","Ground","Top","Floor"],"required":false,"pdf_field":""},{"help":"Enter sum insured amount","type":"amount","label":"SUM INSURED","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Basis of Sum Insured","options":["Structure","Contents","First Loss basis","Agreed Value","New for Old","Indemnity Value","Reinstatement Value"],"required":true,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"If First Loss basis is selected, First loss %","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you want to opt for Escalation Provision (Applicable for Structure)?","options":[],"required":false,"pdf_field":""},{"help":"Maximum up to 25% per year","type":"number","label":"If Yes, Please mentioned the Escalation %:","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"All Risk Cover - Structure and Contents","fields":[{"help":"Columns: Sr. No., Cover, Indemnity Period, Tick Extension You want to opt, Sum Insured (`), Policy Period","type":"table","label":"Cover","options":[],"required":true,"pdf_field":""},{"help":"Columns: Sr. No., Extension, Indemnity Period, Tick Extension You want to opt, Sum Insured (`), Policy Period","type":"table","label":"Extension Cover","options":[],"required":false,"pdf_field":""},{"help":"Columns: Sr. No., Optional Cover, Indemnity Period, Tick Optional Covers You want to opt, Sum Insured (`), Policy Period","type":"table","label":"Optional Cover","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Claims Details","fields":[{"help":"Columns: Date of Loss, Cause of Loss, Claimed Amount, Settled Amount / specify 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":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any other insurance company in respect of Insurance: Cancelled or refused to renew Your policy?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Has any other insurance company in respect of Insurance: Accepted Your Proposal on special terms and condition?","options":[],"required":false,"pdf_field":""}],"filled_by":"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":"","type":"text","label":"Relationship of Nominee with Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Date of birth of nominee","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"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 cannot exceed 100%","type":"number","label":"% of claim share*","options":[],"required":true,"pdf_field":""},{"help":"Name and relationship of appointee","type":"text","label":"Where Nominee is a minor, give details of Appointee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Amount paid","type":"amount","label":"Received from Ms./Mrs./ Mr a sum of `","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Through Cheque/DD","options":["Cheque","Demand Draft"],"required":false,"pdf_field":""},{"help":"Cheque or demand draft number","type":"text","label":"Cheque / D.D#","options":[],"required":false,"pdf_field":""},{"help":"Bank name","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":"Select payment mode","type":"choice","label":"I. BANK DETAILS","options":["Cheque","Demand Draft","Credit/Debit Card","Online Payment"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details of Proposer","fields":[{"help":"","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 for EIA","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Your address details as mentioned in the EIA account shall override the address provided in this application for Insurance.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations","fields":[{"help":"Sign to declare all information is true","type":"signature","label":"Signature of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place*","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date*","options":[],"required":true,"pdf_field":""},{"help":"Answer if applicable","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":"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":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Agent Declaration","fields":[{"help":"Agent signs to confirm explanation of policy","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":"Proposer confirms understanding","type":"signature","label":"Signature / Stamp 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":""}],"filled_by":"agent"},{"title":"Vernacular Declaration","fields":[{"help":"Proposer confirms explanation in local language","type":"signature","label":"Signature / Stamp of the Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Agent confirms explanation","type":"signature","label":"Signature of Intermediary / Sales Person*","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":""}],"filled_by":"agent and proposer"},{"title":"Declaration for Person with Disability (PWD)","fields":[{"help":"Signature or thumb impression","type":"signature","label":"Signature/Thumb impression of 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":"Fill name of authorized representative","type":"text","label":"I authorize [Name of Representative], to act as my authorized representative and provide necessary declaration on my behalf for this Insurance Policy.","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and authorized representative"},{"title":"Annexure - Contents Declaration","fields":[{"help":"Columns: Sr. No., Description, Age, Identification / Serial, Sum Insured (`)","type":"table","label":"Description of the Item","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Home Secure Plus insurance policy proposals","attachments":["Proof of Identity (POI) and Proof of Address (POA)","Valuation Report for Jewellery and Valuable items","Invoice copy for Curios, Works of Art & Paintings","Additional sheets if more space is required"],"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.","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 specified government portals for KYC.","All premiums are paid from bonafide sources and not from proceeds of crime; insurer may cancel contract if found otherwise.","Agent declares that policy features and terms have been explained to the proposer.","Proposer confirms understanding of the proposal and policy terms by signing.","If proposer is a person with disability, they may authorize a representative to assist and declare on their behalf."],"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/5581-home-secure-plus-premium-proposal-form"}