{"id":5582,"title":"Home Secure Plus - Excel 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_Excel_Home_Secure_Plus_ab2c8330d4.pdf","sha256":"184ec51e517b4381ea79ea58deefb93aa64fb621a35cdc90169750b3fbdf95d8","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 this form to provide personal, property, and coverage details for underwriting the insurance policy.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","Liability of the company starts only after acceptance of the proposal and receipt of premium.","The proposal form is the basis of the insurance contract; provide full, accurate, and correct information.","The policy is voidable if any material information is untrue, incorrect, or withheld.","Attach additional sheets if more space is needed and indicate the question number.","Use original documents for proofs and attach valuation certificate if opting for valuable contents cover.","Electronic Insurance Account email id is mandatory if opting for EIA details.","The statutory warning about prohibition of rebates under Section 41 of Insurance Act 1938 applies."],"title":"Home Secure Plus - Excel Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer's Information","fields":[{"help":"Select the type of proposal","type":"choice","label":"Proposal for*","options":["New Property","Old Property","Endorsement","Renewal"],"required":true,"pdf_field":""},{"help":"Select the type of house","type":"choice","label":"Type of House*","options":["Flat / Apartment","Independent Building"],"required":true,"pdf_field":""},{"help":"Select ownership type","type":"choice","label":"Type of Ownership*","options":["Owner","Tenant"],"required":true,"pdf_field":""},{"help":"Enter full name: First, Middle, Last","type":"text","label":"Name*","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender*","options":["Male","Female","Others"],"required":true,"pdf_field":""},{"help":"Select nationality","type":"choice","label":"Nationality*","options":["Indian","Non-Indian","NRI"],"required":true,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"Marital Status","options":["Single","Married","Others"],"required":false,"pdf_field":""},{"help":"Enter full permanent address","type":"text","label":"Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is Correspondence Address same as Permanent Address?*","options":[],"required":true,"pdf_field":""},{"help":"If different from permanent address, enter correspondence address","type":"text","label":"Correspondence Address*","options":[],"required":true,"pdf_field":""},{"help":"Enter date of birth in DD/MM/YYYY format","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"Select title","type":"choice","label":"Title","options":["Mr.","Miss","Mrs.","M/s","Others"],"required":false,"pdf_field":""},{"help":"Select occupation","type":"choice","label":"Occupation*","options":["Salaried","Business","Student","Housewife","Retired","Others"],"required":true,"pdf_field":""},{"help":"Select profession if applicable","type":"choice","label":"Profession","options":["Govt. Teacher","Govt. Employee","Medical Doctor","Paramilitary Services","CA","Others"],"required":false,"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":"Enter GSTIN if applicable","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Enter CKYC number if available","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are you an existing customer of Kotak Mahindra Bank Ltd. / Kotak Mahindra Prime Ltd.?","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Any existing policy from Us","options":[],"required":false,"pdf_field":""},{"help":"Enter employee ID if applicable","type":"text","label":"If yes, Employee ID","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Zurich/Kotak Group Employees","options":[],"required":false,"pdf_field":""},{"help":"Enter CRN if applicable","type":"text","label":"If yes, CRN","options":[],"required":false,"pdf_field":""},{"help":"Enter policy number if applicable","type":"text","label":"If yes, Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Select annual income range","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 Form 60 number","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":true,"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":false,"pdf_field":""},{"help":"Enter address line 1","type":"text","label":"Address (Line 1)","options":[],"required":false,"pdf_field":""},{"help":"Enter address line 2","type":"text","label":"Address (Line 2)","options":[],"required":false,"pdf_field":""},{"help":"Enter nearest landmark","type":"text","label":"Nearest Landmark","options":[],"required":false,"pdf_field":""},{"help":"Enter city or district","type":"text","label":"City / District","options":[],"required":false,"pdf_field":""},{"help":"Enter state","type":"text","label":"State","options":[],"required":false,"pdf_field":""},{"help":"Enter country","type":"text","label":"Country","options":[],"required":false,"pdf_field":""},{"help":"Enter phone number","type":"phone","label":"Phone","options":[],"required":false,"pdf_field":""},{"help":"Enter pin code","type":"number","label":"Pin Code","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Covers Opted","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Is there any policy in place for the same property?","options":[],"required":false,"pdf_field":""},{"help":"Provide details of existing policy if any","type":"table","label":"If Yes, please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Select cover type","type":"choice","label":"Cover","options":["Home Building & Home Contents","Home Building Only","Home Contents Only"],"required":true,"pdf_field":""},{"help":"Select if opting for this cover","type":"checkbox","label":"Burglary and Theft (Cover restricted within premises) (Maximum Policy Period up to 5 years)","options":[],"required":false,"pdf_field":""},{"help":"Enter full postal address","type":"text","label":"Location of Home Building - Full postal address with Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Enter pin code","type":"number","label":"Pin Code","options":[],"required":true,"pdf_field":""},{"help":"Select building type","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":"Select Yes or No","type":"yes-no","label":"Is there a basement to Your house?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details for Griha Raksha Plus","fields":[{"help":"Enter sum insured amount for home building","type":"amount","label":"Sum Insured (SI) for Home Building","options":[],"required":true,"pdf_field":""},{"help":"Enter carpet area in square meters","type":"number","label":"Carpet area of structure of Home in square metres","options":[],"required":true,"pdf_field":""},{"help":"Enter cost rate per square meter","type":"amount","label":"Rate of Cost of Construction per square metre at the policy Commencement Date","options":[],"required":true,"pdf_field":""},{"help":"Select age of home building","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":""}],"filled_by":"proposer"},{"title":"Home Contents Cover","fields":[{"help":"Enter sum insured for basement contents","type":"amount","label":"In case of Basement, If there are contents in it, please provide the Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are there any Fire Protection Devices?","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is your building certified by IGBC?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Optional Covers for Griha Raksha Plus","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Loss of Rent or Rent for Alternate Accommodation Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Cover for Valuable Contents on Agreed Value Basis - Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount","type":"amount","label":"Cover for Valuable Contents on Agreed Value Basis - Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Accidental Damage - Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Involuntary Betterment/Technological Advancement - Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Enter sum insured amount","type":"amount","label":"Involuntary Betterment/Technological Advancement - Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Loss Minimization Expenses - Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Additional Living Expenses - Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Incidental Expenses - Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Broad Water Damage - Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Tenants Liability - Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Smoke Damage - Cover Opted","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Landscaping Expenses - Cover Opted","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Enter insured policyholder name","type":"text","label":"Name of the Insured Policyholder","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee name","type":"text","label":"Name of the Nominee","options":[],"required":true,"pdf_field":""},{"help":"Enter relationship","type":"text","label":"Relationship with the Insured Policyholder","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee age","type":"number","label":"Age of the Nominee","options":[],"required":true,"pdf_field":""},{"help":"Provide appointee details if nominee is minor","type":"text","label":"Where Nominee is a minor, give details of Appointee","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee DOB","type":"date","label":"Nominee Date of Birth DD/MM/YYYY*","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee mobile number","type":"phone","label":"Nominee Mobile Number","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee email","type":"email","label":"Nominee Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee present address","type":"text","label":"Nominee Present Address","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee permanent address","type":"text","label":"Nominee Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee bank details","type":"text","label":"Nominee Bank Name and Account Details","options":[],"required":false,"pdf_field":""},{"help":"Enter percentage share of claim","type":"number","label":"% of claim share*","options":[],"required":true,"pdf_field":""},{"help":"Enter appointee name if applicable","type":"text","label":"Name of the Appointee","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 bank name cheque/DD is drawn to","type":"text","label":"Drawn To","options":[],"required":false,"pdf_field":""},{"help":"Enter bank and branch name","type":"text","label":"Bank and Branch Name","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":"Date","options":[],"required":false,"pdf_field":""},{"help":"Enter IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Enter amount drawn","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"Enter transaction date","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details of Proposer","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Do you have an EIA Account","options":[],"required":false,"pdf_field":""},{"help":"Enter EIA number if available","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":false,"pdf_field":""},{"help":"Enter insurance repository name","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":false,"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":[],"required":false,"pdf_field":""},{"help":"Enter registered email id","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 the 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":"Intermediary signs here","type":"signature","label":"Signature of Intermediary / Sales Person*","options":[],"required":true,"pdf_field":""},{"help":"Authorized representative signature if applicable","type":"signature","label":"Signature of Authorised Representative*","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer and intermediary"}],"deadlines":[],"applies_to":"Home Secure Plus insurance policy proposal","attachments":["Valuation certificate (if opting for Cover for Valuable Contents on Agreed Value Basis)","Additional sheets if more space is required for any question","Cancelled cheque for electronic fund transfer"],"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.","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 purposes.","All premiums are paid from bonafide sources and not from proceeds of crime; insurer may cancel contract if otherwise.","The proposer confirms whether they or close relatives are politically exposed persons (PEP).","The proposer confirms if they are a Non-Profit Organization if applicable.","The intermediary declares that the policy features and terms have been explained to the proposer who has understood them."],"dropped_labels":24},"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/5582-home-secure-plus-excel-proposal-form"}