{"id":5586,"title":"Maxima Cyber Secure Liability Insurance Proposal Form","purpose":"proposal","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/Maxima_Cyber_Secure_Liability_Retail_Proposal_form_ZK_v2_24_25_06012025_bb4053a0a8.pdf","sha256":"d274c1d5f64705885f23a5c478043df78c16deb1d86ee360fd68f103d6f6ba61","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer/applicant to apply for Maxima Cyber Secure Liability insurance coverage from Zurich Kotak General Insurance Company. The proposer fills it with detailed information about their business, cyber security practices, and risk management.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","Attach additional sheets if more space is needed, indicating question number.","Information given will be treated in strict confidence.","Total % share of nominees cannot exceed 100%.","Original documents or copies as specified must be attached.","Submission of proposal or payment does not oblige the company to issue a policy.","Policy issuance is subject to underwriting policy and premium receipt.","Use cancelled cheque for electronic fund transfer details.","E-mail ID is mandatory for Electronic Insurance Account (EIA)."],"title":"Maxima Cyber Secure Liability Insurance Proposal Form","submit":{"to":"Zurich Kotak General Insurance Company (India) Limited","how":"","address":"401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai - 400063. Maharashtra, India; Email: care@zurichkotak.com"},"purpose":"proposal","sections":[{"title":"Proposer / Applicant’s Details","fields":[{"help":"","type":"text","label":"Name of Insured","options":[],"required":true,"pdf_field":""},{"help":"Provide full permanent address","type":"text","label":"Insured Permanent Address*","options":[],"required":true,"pdf_field":""},{"help":"Provide correspondence address if different","type":"text","label":"If Correspondence Address different from Permanent Address, please provide*","options":[],"required":true,"pdf_field":""},{"help":"Company website URL","type":"text","label":"Website","options":[],"required":false,"pdf_field":""},{"help":"Describe main business activity","type":"text","label":"Business Activity","options":[],"required":false,"pdf_field":""},{"help":"Number of years business has been operating","type":"number","label":"Years of Business","options":[],"required":false,"pdf_field":""},{"help":"List subsidiaries with name and business activity","type":"table","label":"List of Subsidiary/Subsidiaries (Kindly provide separate sheet if it is more)","options":[],"required":false,"pdf_field":""},{"help":"Total number of employees","type":"number","label":"Number of Employee","options":[],"required":false,"pdf_field":""},{"help":"Number of online customers","type":"number","label":"Number of online Customers","options":[],"required":false,"pdf_field":""},{"help":"Total IP addresses assigned","type":"number","label":"Total Number of IP Addresses Assigned","options":[],"required":false,"pdf_field":""},{"help":"Gross revenue for prior year","type":"amount","label":"Gross Revenue Prior Year","options":[],"required":false,"pdf_field":""},{"help":"Number of active IP addresses","type":"number","label":"Total Number of Active IP Addresses","options":[],"required":false,"pdf_field":""},{"help":"Provide asset values by region and total","type":"amount","label":"Total Assets a) Domestic b) USA/Canada c) OECD d) Non-OECD Total","options":[],"required":false,"pdf_field":""},{"help":"Revenue from online sales or services","type":"amount","label":"Gross Revenue from Online Sales or Services","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Cyber Security and Risk Management Questions","fields":[{"help":"","type":"yes-no","label":"Do you have an information security team (IST)?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Does your organisation offer Privacy Awareness Training or other cyber-related trainings?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"List outsourced providers and services","type":"text","label":"Do you outsource any portion of your information security and/or data processing? If Yes, provide name(s) of provider(s) and services provided.","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you require providers to indemnify you in case of any data breach?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you require providers to have their own data protection liability insurance coverage?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are critical and high risk vulnerabilities remediated within one month?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Is your company subject to Payment Card Industry (PCI) Security Standards? If Yes, specify level.","options":["Yes","No","Level 1","Level 2","Level 3","Level 4"],"required":false,"pdf_field":""},{"help":"Total IT budget amount","type":"amount","label":"Annual aggregate IT Budget","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the IT Budget Dedicated?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you prohibit local admin rights on workstations for users?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have a formal, documented information security policy approved by the Board or equivalent?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you regularly identify and assess new threats and adjust security policy accordingly?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have a formal, written incident response plan addressing unauthorized access, denial of service, extortion, data corruption or damage?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you use honeypots or similar techniques to detect unauthorized use?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"If yes, have you set up a Bring Your Own Device (BYOD) policy?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have an operational system for logging and monitoring user activity?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Incident includes unauthorized access, denial of service, extortion, data corruption, etc.","type":"yes-no","label":"Do you have an Incident Management Programme including cyber-related incidents? If yes, is it formally documented, tested annually, and performed by trained personnel?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you process or store any type of records on behalf of third parties?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have a remote wipe function installed and enabled on all portable devices where available?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have a vulnerability assessment program monitoring IT network and data security breaches?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have an internet and email usage policy written into employment contracts and clearly communicated?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have a privacy policy on your website?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have a procedure for responding to allegations of libel, intellectual property infringement, or privacy violations?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Includes advertising agents","type":"yes-no","label":"Do you obtain written warranties and indemnities from third parties for content they have created for you?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of current insurance","type":"text","label":"Do you currently have cyber security or similar insurance? If yes, provide insurer name, limit of liability, period, premium, retention, aggregate limit, retroactive date.","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"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":"Bank details for claim payment","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":"Provide appointee details if nominee is minor","type":"text","label":"Where Nominee is a minor, give details of Appointee: Name, Date of Birth, Relationship with Nominee","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank and Payment Details","fields":[{"help":"Account number for electronic fund transfer","type":"text","label":"Account Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Account Holder name","options":[],"required":false,"pdf_field":""},{"help":"Cheque or demand draft number","type":"text","label":"Cheque / D.D #","options":[],"required":false,"pdf_field":""},{"help":"Name on cheque or draft","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":"Date of transaction","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Bank IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":false,"pdf_field":""},{"help":"Amount drawn on cheque or draft","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"Date of payment transaction","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Sign or thumb impression","type":"signature","label":"Signature / Thumb Impression of Proposer*","options":[],"required":true,"pdf_field":""},{"help":"Signature of intermediary or sales person","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":""},{"help":"Non-profit organization as defined under Income-tax Act","type":"yes-no","label":"Are you a Non-Profit Organization?* (only in case of an entity)","options":["Yes","No"],"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","Society","Others","Government Organisation","Co-operatives"],"required":false,"pdf_field":""}],"filled_by":"proposer and intermediary"}],"deadlines":[],"applies_to":"Maxima Cyber Secure Liability Insurance Policy","attachments":["Copy of Risk assessment performed by an organization other than You","IT Policy","BCP Plan","List of Service Providers","Description of any cyber incidents in past two years if applicable","Details of any refused or cancelled cyber insurance if applicable"],"declarations":["Statements made in the proposal form are true and form basis of contract.","Company liability starts only after acceptance and premium receipt.","Company may void policy for untrue, incorrect, or incomplete statements or non-disclosure.","Consent to electronic communication and KYC verification.","Declaration of High Net Worth Individual status if applicable.","AML declaration confirming premiums paid from bonafide sources.","Agent declaration confirming explanation of policy features and terms.","Declaration in case proposer is person with disability authorizing representative."],"dropped_labels":48},"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/5586-maxima-cyber-secure-liability-insurance-proposal-form"}