{"id":5585,"title":"Excess Follow Form for Casualty","purpose":"proposal","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/Excess_Follow_Form_for_Casualty_Proposal_Form_020eee52fe.pdf","sha256":"c337798897bed59e4e3ea14b786e8f08cd5ba2b03c1e632ae5e2781f577ab79c","pages":11,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for insurance under the Excess Follow Form for Casualty policy, to be filled by the proposer (insured entity) seeking coverage.","notes":["Proposers desiring only Public Liability coverage are not required to fill Section IV.","Proposers desiring only Product Liability coverage are not required to fill Section III.","Proposers not desiring extensions under Section V and VI are not required to fill those Sections.","Mark Not Applicable (N/A) where sections do not apply.","Attach separate sheets if space is insufficient.","Fees of working directors not to be included in employee details.","Use original documents for attachments.","Policy liability commences only after proposal acceptance and premium receipt as per Insurance Act, 1938."],"title":"Excess Follow Form for Casualty","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Section I: General Information","fields":[{"help":"","type":"text","label":"Policy issuing office","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy servicing office","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary/Agent Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary License no /Agent code.","options":[],"required":null,"pdf_field":""},{"help":"Provide contact number of intermediary or agent","type":"phone","label":"Intermediary/Agent Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Include all subsidiaries or affiliated companies to be insured","type":"text","label":"Name & Registered Address of the Insured (including names of all subsidiaries or affiliated companies to be insured)","options":[],"required":true,"pdf_field":""},{"help":"Provide official website address","type":"text","label":"Website Address","options":[],"required":false,"pdf_field":""},{"help":"Describe the nature of your business","type":"text","label":"Please describe your business operations and activities","options":[],"required":true,"pdf_field":""},{"help":"Indicate if communication address differs from head office","type":"yes-no","label":"Is the Communication address same as the Head Office address ?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide communication address if different from head office","type":"text","label":"Communication Address","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section II: Insurance Requirement","fields":[{"help":"Specify duration of business operation","type":"text","label":"Length of time in business","options":[],"required":true,"pdf_field":""},{"help":"List subsidiaries or affiliates in USA with addresses","type":"text","label":"Does Insured have a subsidiary, affiliate or representative in the USA? If yes, please provide Name and Addresses of such affiliation","options":[],"required":true,"pdf_field":""},{"help":"Provide details of existing or sought Zurich Kotak policies","type":"text","label":"Is Insured currently covered or seeking coverage under any Zurich Kotak General Insurance policies? If so, pls provide details","options":[],"required":true,"pdf_field":""},{"help":"Provide details if additional insured parties exist","type":"text","label":"Name and Registered Address of Additional Insured, if any","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section III: General Liability","fields":[{"help":"Select the applicable form type","type":"choice","label":"Form Type","options":["Claims Made","Occurrence Based"],"required":true,"pdf_field":""},{"help":"Provide limits for each category in Indian Rupees","type":"amount","label":"Limits of Insurance (Amount in Indian Rupees): Limit of Liability Any One Event In the Aggregate General Aggregate Limit Premises and Operations Transportation Liability Extension Products/Completed Operations Limit Employers Liability Automobiles Liability (Non Owned/Hired) Extension","options":[],"required":true,"pdf_field":""},{"help":"Specify start and end dates of policy period","type":"date","label":"Policy Period","options":[],"required":true,"pdf_field":""},{"help":"Provide retroactive date if Claims Made form selected","type":"date","label":"Retroactive date (only for Claims Made Form)","options":[],"required":false,"pdf_field":""},{"help":"Select the territory of coverage","type":"choice","label":"Territory","options":["India","Worldwide excluding USA and Canada","Worldwide including USA and Canada"],"required":true,"pdf_field":""},{"help":"Select the jurisdiction applicable","type":"choice","label":"Jurisdiction","options":["India","Worldwide excluding USA and Canada","Worldwide including USA and Canada"],"required":true,"pdf_field":""},{"help":"Provide details of all premises with number of locations and nature of risk","type":"table","label":"List all premises to be insured in India and overseas: Location, Manufacturing Units, Warehouses/Godowns/Shops/Depots/Tank Farms/Offices, No. of locations, Nature of Risk (for India and Overseas)","options":[],"required":true,"pdf_field":""},{"help":"Provide annual sales turnover for premises operations and transportation for last three years","type":"table","label":"Please quantify annual sales turnover of last three years (Amount in Indian Rupees): Year, Premises Operations, Transportation* (Projected, Current, Last Year)","options":[],"required":true,"pdf_field":""},{"help":"Describe surrounding areas in each direction for each manufacturing unit","type":"table","label":"Please describe in brief surrounding areas and third party property within an approximate radius of 2 kms from each manufacturing unit: Manufacturing Unit, Industrial Area, Agricultural Area, Residential Area, Others (North, East, South, West)","options":[],"required":true,"pdf_field":""},{"help":"Attach layout plans and risk inspection reports","type":"attachment","label":"Please attach Lay-Out Plans and Risk Inspection Report of the manufacturing units proposed for Insurance","options":[],"required":true,"pdf_field":""},{"help":"Provide details on hazardous materials handled","type":"text","label":"Do you handle or use gases, pressure-storage, explosive, hazardous substances, asbestos, toxic, radioactive materials and hydrocarbons? If so, please give details of their quantity, storage, handling and precautions taken","options":[],"required":true,"pdf_field":""},{"help":"Describe fire and explosion prevention measures","type":"text","label":"Is there a programme for the prevention of fire, explosion incidents? If so, pls indicate: (a). Type of detection and alarm system (b). Availability of service organisation in case of such incidents (fire brigade, specialists in environmental protection and toxicology) (c). Provisions made for supply of energy, water etc. in an emergency","options":[],"required":true,"pdf_field":""},{"help":"Indicate exposure to harmful substances","type":"yes-no","label":"Will you, or your employees, handle or come into contact with any industrial dust of known harmful nature (e.g. asbestos, silica, cotton), radioactive materials, or any other substance harmful to health?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section IV: Product Liability","fields":[{"help":"Select extensions required","type":"checkbox","label":"Extensions required: (a). Act of God Perils Extension (viz., Earthquake, Storm, Typhoon, Flood and Inundation etc.) (b). 72 Hrs Sudden and Accidental Pollution Extension (c). Effluent Discharge Extension","options":["Act of God Perils Extension","72 Hrs Sudden and Accidental Pollution Extension","Effluent Discharge Extension"],"required":false,"pdf_field":""},{"help":"Provide pipeline length if Effluent Discharge Extension selected","type":"text","label":"If yes, what is the length of pipeline from the compound wall of your premises to the disposal point?","options":[],"required":false,"pdf_field":""},{"help":"Provide total travel days per year","type":"number","label":"Number of travel days per year","options":[],"required":false,"pdf_field":""},{"help":"Describe purpose of overseas trips","type":"text","label":"Purpose of trips","options":[],"required":false,"pdf_field":""},{"help":"List overseas travel destinations","type":"text","label":"Overseas Travel Destinations","options":[],"required":false,"pdf_field":""},{"help":"Explain use of comparative advertising and consultation","type":"text","label":"Do you use comparative advertising in your advertisements? If \"Yes\", was an independent organization consulted on how such comparisons were made?","options":[],"required":false,"pdf_field":""},{"help":"Confirm music rights in advertisements","type":"text","label":"Is music used in your advertisements? If \"Yes\", were all the rights secured prior to use?","options":[],"required":false,"pdf_field":""},{"help":"Indicate use of famous people's likeness","type":"yes-no","label":"Is the likeness of famous people used in your advertisements?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate any copyright or trademark litigation","type":"yes-no","label":"Have you ever been sued, or have you sued another, for copyright or trademark infringement?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if other publications are produced","type":"yes-no","label":"Besides the information related to your goods, products or services, do you produce any other publications for external use?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Attach product brochures or related literature","type":"attachment","label":"Please attach a product brochure or literature or labels or warnings etc. with this form","options":[],"required":true,"pdf_field":""},{"help":"Provide detailed product information","type":"table","label":"Please furnish details of products to be considered for insurance: Products, Principal Components, Annual Units Produced, End Usage/ Intended Customer Use, Expected Life of the Product","options":[],"required":true,"pdf_field":""},{"help":"Provide sales turnover by region for last three years","type":"table","label":"Please quantify annual sales turnover of last three years (Amount in Indian Rupees): Year, USA/Canada/Australia, UK/Europe, Rest of the World, India (Projected, Current, Last Year)","options":[],"required":true,"pdf_field":""},{"help":"Describe additional services and turnover","type":"text","label":"Do you provide any services or treatment other than sale of products? If yes, pls describe the nature of services and estimated annual turnover","options":[],"required":false,"pdf_field":""},{"help":"List new products planned for marketing","type":"text","label":"Please furnish particulars of new products to be marketed during the next 12 months","options":[],"required":false,"pdf_field":""},{"help":"Provide duration of export to each region","type":"text","label":"How long have you been exporting to these countries? (a). USA and Canada (b). UK/Europe (c). Rest of the World","options":[],"required":false,"pdf_field":""},{"help":"Specify if product is fully manufactured or parts are purchased","type":"text","label":"Do you manufacture the complete product? If not, what components/parts are purchased by you?","options":[],"required":false,"pdf_field":""},{"help":"Indicate presence of R&D or technical collaboration","type":"yes-no","label":"Do you have Research & Development department or Technical Know-how/Collaboration?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if rights of recovery are retained","type":"yes-no","label":"Do you retain rights of recovery against manufacturers?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details and precautions for hazardous products","type":"text","label":"Please specify any products, which are inflammable/explosive, dangerous, radioactive, and harmful to health, poisonous by themselves or any combination with others. If so, please give full details and state what precautions are taken","options":[],"required":false,"pdf_field":""},{"help":"List discontinued, recalled or withdrawn products","type":"text","label":"Please furnish details and list of products discontinued or recalled or withdrawn during the last five years","options":[],"required":false,"pdf_field":""},{"help":"Provide details of government enquiries or investigations","type":"text","label":"Have your products ever been subject to any enquiry or investigation by any Government agency, concerning the efficiency/adequacy or labelling, hazardous contents or safety? If so, please give full details","options":[],"required":false,"pdf_field":""},{"help":"Provide details if products are sold under other labels","type":"text","label":"Are any products manufactured and sold under someone else’s label or trademark? If yes, please give full details","options":[],"required":false,"pdf_field":""},{"help":"Indicate if contract holds distributors harmless","type":"yes-no","label":"Does the Insured’s contract of sale agree to hold distributors harmless?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide vendor details if named insured inclusion required","type":"text","label":"Does the Insured require the name of vendor to be included as a Named Insured? If yes, pls provide the name, address and list of products to be supplied to the vendor","options":[],"required":false,"pdf_field":""},{"help":"Indicate if vendor does final product preparation","type":"yes-no","label":"Does the vendor undertake final preparation of product?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate compliance with product standards","type":"yes-no","label":"Do your products comply with standards like ISI or any other Standards?","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section V: Employee details","fields":[{"help":"Provide employee numbers and wage roll by category and region","type":"table","label":"Please provide projected details for the next 12 months: Description of Employees*, USA/Canada/Australia, UK/Europe, Rest of the World, India (No., Wage roll) for Clerical Staff, Supervisory/Manual, Hazardous Activity**, All other employees","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section VI: Non-Owned and Hired Automobile Liability","fields":[{"help":"Provide details of hired automobiles by country and type","type":"table","label":"Please provide projected details for the next 12 months: Country, Estimated No. of Automobiles Hired, Type Of Vehicle, Frequency of Hire, Duration of a Single Hire for USA/Canada/Australia, UK/Europe, Rest of the World","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section VII: Loss Information","fields":[{"help":"List all claims or incidents in last five years","type":"table","label":"Please enter all claims or losses (regardless of fault and whether or not insured) or any occurrences or incidents, conditions, defects, circumstances or suspected defects, which may give rise to a claim; over the last five years under Public Liability and/or Products Liability (Amount in Indian Rupees): Date of Occurrence, Description of Claim, Date of Claim, Amount Paid, Amount Reserved, Claim Status","options":[],"required":true,"pdf_field":""},{"help":"Indicate awareness of any potential claims","type":"yes-no","label":"Are you aware of any incident/circumstance that could lead to loss or claim under the proposed policy (Yes/No)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details of potential claims or incidents","type":"text","label":"If yes please provide full details of that incident/circumstance","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section VIII: Prior Insurance","fields":[{"help":"Provide details of expiring insurance policies","type":"table","label":"Please provide details of expiring policy: Type, Insurer, Limit of Liability, Premium* (excluding taxes and ERF contribution), Deductible for Public Liability Act, Public Liability, Product Liability, Commercial General Liability","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Section IX: Other Information (Compulsory)","fields":[{"help":"Select source(s) of funds and specify if Other","type":"choice","label":"Sources of funds : Salary, Business, Investments, Other (Please Specify)","options":["Salary","Business","Investments","Other"],"required":true,"pdf_field":""},{"help":"Provide CKYC identifier if available","type":"text","label":"Company’s CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"Provide PAN number","type":"text","label":"PAN (mandatory)","options":[],"required":true,"pdf_field":""},{"help":"Provide GSTIN if applicable","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Provide authorised signatory details","type":"text","label":"Please share the below details for the Authorised Signatory: Name, Designation, PAN, CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":true,"pdf_field":""},{"help":"Provide EIA account details or request creation","type":"text","label":"Electronic Insurance Account details of Proposer (e-mail id is mandatory): Do you have an EIA Account (Yes/No), If Yes, please quote EIA Number, Please mention name of Insurance Repository, If No, do you want Us to create an EIA account for you (Yes/No), Email id (Registered with Insurance Repository)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate association with Politically Exposed Persons","type":"yes-no","label":"Are You or any of the proposed applicants or close relatives is/are associated to Politically Exposed Person (PEP)?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Indicate if entity is a Non-Profit Organization","type":"yes-no","label":"Are you a Non-Profit Organization? (only in case of an entity)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select the type of organization","type":"choice","label":"In case of entity, Type of Organization making the payment","options":["Limited Company","Government Organization","Non-Government Organization (NGO)","Society","Trust","Partnership","International Organization","Co-operatives","Section 25 Company","Others"],"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":"Sign and stamp the form","type":"signature","label":"Signature and Stamp of Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration for Agents","fields":[{"help":"Proposer's signature confirming explanation by agent","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Agent's signature and stamp","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":"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":""}],"filled_by":"agent"},{"title":"Vernacular Declaration","fields":[{"help":"Proposer's signature/thumb impression after explanation in vernacular","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Agent's signature confirming explanation in vernacular","type":"signature","label":"Signature of Intermediary/ Sales Person","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":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"Casualty insurance proposals including Public Liability, Product Liability, and related extensions as per sections III to VI.","attachments":["Lay-Out Plans and Risk Inspection Report of the manufacturing units proposed for Insurance","Product brochure or literature or labels or warnings etc."],"declarations":["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.","Policy and service related communication will be sent in soft copy to the email id mentioned unless physical copy is requested.","Consent is given to verify identity/address proof through specified government portals for KYC purposes.","All premiums have been/will be paid from bonafide sources and not from proceeds of crime as per Prevention of Money Laundering Act, 2002.","The insurance company has the right to cancel the contract if found guilty under money laundering statutes.","Agent declares that policy features and terms have been fully explained to the proposer.","Vernacular declaration confirms the proposer has understood the proposal form and policy terms in their language.","Submission of proposal or payment does not oblige the company to issue a policy; acceptance is at company's discretion.","No person shall offer or accept any rebate of commission or premium except as allowed by insurer's published prospectus or tables."],"dropped_labels":7},"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/5585-excess-follow-form-for-casualty"}