{"id":5590,"title":"Excess Follow Form","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_c1355e988c.pdf","sha256":"85dfae66360357090672d1703201e20e1030e2fed25ff5876adbc3e353b84172","pages":15,"collected":"2026-10-17","instructions":{"about":"This form is a proposal form to be filled by the proposer (individual or entity) seeking excess follow insurance coverage from Zurich Kotak General Insurance Company (India) Limited.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","Attach additional sheets if more space is needed and indicate question number.","Information given will be treated in strict confidence.","Use original documents for attachments where applicable.","Policy liability commences only after acceptance and receipt of premium.","The proposal form and any attachments become part of the insurance contract if accepted.","Ensure all questions are answered accurately and completely.","The software copyright infringement supplemental proposal is on a claims-made basis.","The limit of liability includes legal defense costs and applies to policy retention amounts.","The proposer should provide samples of service agreements, brochures, and contracts if requested."],"title":"Excess Follow Form","submit":{"to":"Zurich Kotak General Insurance Company (India) Limited","how":"","address":"Registered & Corporate Office: 401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai – 400063, Maharashtra, India"},"purpose":"proposal","sections":[{"title":"Proposer and Intermediary Details","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":"","type":"phone","label":"Intermediary/Agent Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Full legal name of the proposer","type":"text","label":"1. Name of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Complete street address","type":"text","label":"Street Address","options":[],"required":true,"pdf_field":""},{"help":"City of the proposer","type":"text","label":"City","options":[],"required":true,"pdf_field":""},{"help":"Official website URL if any","type":"text","label":"Website","options":[],"required":false,"pdf_field":""},{"help":"Country where the proposer is registered","type":"text","label":"2. Country of Registration","options":[],"required":true,"pdf_field":""},{"help":"Date when the proposer entity was incorporated or formed","type":"date","label":"3. Date of incorporation/formation","options":[],"required":true,"pdf_field":""},{"help":"Select nationality; if Non-Indian, specify country","type":"choice","label":"Nationality","options":["Indian","Non – Indian"],"required":true,"pdf_field":""},{"help":"Specify country if nationality is Non-Indian","type":"text","label":"If Non-Indian, please specify Country","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer and intermediary/agent"},{"title":"Proposer Type and Business Details","fields":[{"help":"Select the type of proposer","type":"choice","label":"Proposer is","options":["Corporation","Partnership","Individual"],"required":true,"pdf_field":""},{"help":"Select the organizational type","type":"choice","label":"Type of Organization","options":["Corporations","Governments","Non Governmental Organizations","Society","International Organization","Trust","Partnership","Cooperatives","Section 25 Company"],"required":true,"pdf_field":""},{"help":"Select source of funds; specify if Others","type":"choice","label":"Sources of funds","options":["Salary","Business","Others (please specify)"],"required":true,"pdf_field":""},{"help":"List all entities to be insured","type":"text","label":"4. Name of each entity to be included as an insured","options":[],"required":true,"pdf_field":""},{"help":"Describe relationship of entities to your business","type":"text","label":"How are these entities related to your business?","options":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"5. a. Is the proposer firm owned by, controlled by or associated with, or does the proposer firm own or control, any other partnership, corporation or firm?","options":[],"required":true,"pdf_field":""},{"help":"Provide details if above is Yes","type":"text","label":"If “yes” please provide the details","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"b. Are professional services provided to this entity?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Year when full time operations started","type":"number","label":"6. Year full time operation began","options":[],"required":true,"pdf_field":""},{"help":"Specify requested liability limits and jurisdictions","type":"text","label":"7. Limit(s) of Liability & Jurisdiction(s) being requested","options":[],"required":true,"pdf_field":""},{"help":"Specify applicable law for the policy","type":"text","label":"8. Applicable Law","options":[],"required":true,"pdf_field":""},{"help":"Specify policy start and end dates","type":"text","label":"9. Policy Period","options":[],"required":true,"pdf_field":""},{"help":"Specify territorial scope of coverage","type":"text","label":"10. Territorial Scope of Cover required","options":[],"required":true,"pdf_field":""},{"help":"Specify retention amount per wrongful act","type":"amount","label":"11. Retention (each Wrongful Act)","options":[],"required":true,"pdf_field":""},{"help":"Describe services and products offered","type":"text","label":"12. Describe in detail the nature of services and/or products provided","options":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"13. Does proposer engage in any other business or profession other than stated above?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain other business or profession if Yes","type":"text","label":"If yes, please explain","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Exposure and Risk Management","fields":[{"help":"Describe possible claim exposures","type":"text","label":"14. Indicate the exposure for which you require coverage. (What type of claims may be possible?)","options":[],"required":true,"pdf_field":""},{"help":"Describe loss prevention procedures","type":"text","label":"15. Describe the procedures the proposer uses to avoid such losses","options":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"16. Does any regulatory authority license the Applicant?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"List regulatory authorities if Yes","type":"text","label":"If yes, please list the regulatory authority(ies)","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"17. a. Has there been acquisition or merger activity in the past 5 years?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain acquisition or merger activity if Yes","type":"text","label":"If yes, please explain","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"If yes, does this company assume all liability past and present of the acquired company?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"b. Are there future acquisitions or mergers planned?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Explain future acquisitions or mergers if Yes","type":"text","label":"If yes, please explain","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"18. Is the Proposer presently involved in or considering any merger, acquisition or change in control?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if Yes","type":"text","label":"If yes, please provide full details","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"19. Has the Proposer changed its name in the past five (5) years?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if Yes","type":"text","label":"If yes, please provide full details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Financial and Client Information","fields":[{"help":"Estimated revenue for US and Canada","type":"amount","label":"20. a. Estimate revenue for the next 12 months. U.S. and Canada Rs.","options":[],"required":true,"pdf_field":""},{"help":"Estimated revenue for India","type":"amount","label":"India Rs.","options":[],"required":true,"pdf_field":""},{"help":"Estimated revenue for foreign countries","type":"amount","label":"Foreign Rs.","options":[],"required":true,"pdf_field":""},{"help":"List client, services provided, and revenue for five largest projects","type":"table","label":"21. List your five largest projects during the past three years","options":[],"required":true,"pdf_field":""},{"help":"Percentage value","type":"number","label":"22. What percentage of your business comes from repeat customers?","options":[],"required":true,"pdf_field":""},{"help":"Specify average contract duration","type":"text","label":"23. What is the average length of time of a contract?","options":[],"required":true,"pdf_field":""},{"help":"Fill percentage for each service category; total must be 100%","type":"table","label":"24. Indicate the percentage of receipts attributed to the following services","options":[],"required":true,"pdf_field":""},{"help":"Fill percentage receipts for listed software application types; total 100%","type":"table","label":"25. Identify major software applications and receipts attributable","options":[],"required":true,"pdf_field":""},{"help":"Fill percentage receipts for each market; total 100%","type":"table","label":"26. Indicate the market(s) for your products/services","options":[],"required":true,"pdf_field":""},{"help":"Percentage value","type":"number","label":"27. What percentage of the Proposer Firm’s business involves subcontracting of work to others?","options":[],"required":true,"pdf_field":""},{"help":"Describe purpose of subcontracting","type":"text","label":"If subcontracting exists, please note the purpose","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"If subcontracting exists do you have a subcontract agreement in writing?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select applicable option","type":"choice","label":"28. Does proposer have a written contract with clients?","options":["In all cases","Sometimes","Never"],"required":true,"pdf_field":""},{"help":"Check Yes or No for each item","type":"checkbox","label":"29. Do the proposer’s contracts contain:","options":["Hold harmless or indemnity agreements inuring to the proposer’s benefit","Hold harmless or indemnity agreements inuring to the proposer’s client’s benefits","A specific description of the services proposer will provide to the client","Guarantees or warranties","Limitation of liabilities","Exclusion of indirect or consequential losses"],"required":true,"pdf_field":""},{"help":"List memberships","type":"text","label":"30. In what professional organizations or trade associations does the proposer hold membership?","options":[],"required":false,"pdf_field":""},{"help":"Describe development methodology","type":"text","label":"31. Briefly explain your product/service development methodology","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"System Design and Quality Control","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"32. a. Is system design work documented and tested?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"b. Is documentation retained for the life of the system?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"c. Is a test plan followed for all program modifications?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"d. Are clients required to sign off on pilot tests run prior to regular production?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"33. Do clients have responsibility for determining the accuracy of results?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"If yes, is this in writing?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"34. Does the proposer have a contingency plan in writing in the event of computer failure?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Personnel and Training","fields":[{"help":"Fill number of employees, average years experience with proposer, and average overall years experience for each category: Management, Systems Designers, Systems Analysts, Programmers, Operators/Clerical, Other","type":"table","label":"35. Experience of personnel","options":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Are training programs provided for the above categories?","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insurance History and Claims","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"36. Is similar insurance currently in force?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Name of current insurer","type":"text","label":"If yes, indicate Carrier","options":[],"required":false,"pdf_field":""},{"help":"Policy expiration date","type":"date","label":"Expiration date","options":[],"required":false,"pdf_field":""},{"help":"Duration policy has been in force","type":"text","label":"How long in force","options":[],"required":false,"pdf_field":""},{"help":"Policy limit amount","type":"amount","label":"Limit","options":[],"required":false,"pdf_field":""},{"help":"Deductible amount","type":"amount","label":"Deductible","options":[],"required":false,"pdf_field":""},{"help":"Premium amount","type":"amount","label":"Premium","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"37. Have any claims been submitted to the current carrier?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"38. Has any similar insurance been declined or cancelled?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach explanation if insurance declined or cancelled","type":"attachment","label":"If yes, please attach details","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"39. Does any proposed insured have knowledge or information of any act, error or omission which might reasonably be expected to give rise to a claim?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Attach list of claims or check None","type":"attachment","label":"40. Attach a list and status of all errors and omissions claims made against any proposed insured during the past five years","options":[],"required":true,"pdf_field":""},{"help":"Check if no claims","type":"checkbox","label":"If none, please check here","options":["None"],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"41. Is commercial general liability insurance currently in force?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Name of insurer","type":"text","label":"If yes, Carrier","options":[],"required":false,"pdf_field":""},{"help":"Policy limit","type":"amount","label":"Limit","options":[],"required":false,"pdf_field":""},{"help":"Deductible amount","type":"amount","label":"Deductible","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Future Plans and Service Agreements","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"42. In the next eighteen (18) months, does the Applicant anticipate any changes in the nature of the professional services described?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe anticipated changes","type":"text","label":"If yes, please provide full details","options":[],"required":false,"pdf_field":""},{"help":"Check Yes or No for each item; attach samples where requested","type":"checkbox","label":"43. For each of the following, please check YES or NO","options":["a. Are contract fees negotiated and agreed to in advance?","b. Are written service agreements required for all clients? (If Yes, attach a sample)","c. Have the written service agreements been reviewed by a law firm experienced in the Applicant’s field?","d. Are all changes to service agreements confirmed in writing?","e. Does the Applicant provide warranties or guarantees?","f. Does the Applicant describe services in a brochure? (If Yes, attach a sample)","g. Is there a formal procedure for handling client complaints?","h. Is ADR or mediation to resolve complaints part of the service agreement?","i. Are audits or reviews of service performed by employees conducted?","j. How often? Annually, Semi-Annually, Quarterly, Other","k. Does the Applicant ever assume liability for others by contract? (If yes, please attach a sample contract)","l. Do employees hold professional licenses or certification? If Yes, please identify.","m. Does the Applicant pay for continuing education to maintain such professional licenses or certification?","n. Are there formal criteria for accepting new clients?","o. Is there a formal policy for conflict of interest?","p. Is there a formal policy for client confidentiality?","q. Does the Applicant engage in any other professional activities not listed in question 5 above?"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Attachments and Arbitration","fields":[{"help":"Attach requested documents if applicable","type":"attachment","label":"44. Where applicable, please attach the following documentation","options":["Latest audited annual report & accounts","Latest interim report & accounts","Brochures describing services or Products offered","Sample service agreements"],"required":false,"pdf_field":""},{"help":"Select if you want arbitration","type":"yes-no","label":"Do you wish to opt for Arbitration?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify venue if arbitration chosen","type":"text","label":"Venue for Arbitration (If Arbitration is opted)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Prior Knowledge and Warranty","fields":[{"help":"Provide details if Yes","type":"text","label":"If yes, provide details","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"ii. Does the Applicant, any partner, officer, director, or employee for whom coverage is being requested, know of any circumstances, acts, errors or omissions that could result in a professional liability claim?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if Yes","type":"text","label":"If yes, provide details","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"iii. Has any professional liability claim ever been made against the Applicant or any past or present partner, officer, director, or employee?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if Yes","type":"text","label":"If yes, provide details","options":[],"required":false,"pdf_field":""},{"help":"Provide details if Yes","type":"text","label":"If yes, provide details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Identification and Authorized Signatory","fields":[{"help":"Provide CKYC number","type":"text","label":"46. Company’s CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN (mandatory)","options":[],"required":true,"pdf_field":""},{"help":"Goods and Services Tax Identification Number","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Fill name, designation, PAN, and CKYC Identifier of authorized signatory","type":"group","label":"47. Please share the below details for the Authorised Signatory","fields":[{"help":"Authorized signatory's full name","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Authorized signatory's designation","type":"text","label":"Designation","options":[],"required":true,"pdf_field":""},{"help":"Authorized signatory's PAN","type":"text","label":"PAN","options":[],"required":true,"pdf_field":""},{"help":"Authorized signatory's CKYC number","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":false,"pdf_field":""}],"options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Bank and Payment Details","fields":[{"help":"Provide bank account details for payment and refunds","type":"text","label":"BANK ACCOUNT DETAILS","options":[],"required":true,"pdf_field":""},{"help":"Select payment mode","type":"choice","label":"PAYMENT DETAILS","options":["Cheque","Demand Draft","Credit/Debit Card","Online Payment"],"required":true,"pdf_field":""},{"help":"Bank account number","type":"text","label":"Account Number","options":[],"required":true,"pdf_field":""},{"help":"Bank IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":true,"pdf_field":""},{"help":"Name of bank","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Bank and Branch Name","options":[],"required":true,"pdf_field":""},{"help":"Name of account holder","type":"text","label":"Account Holder name","options":[],"required":true,"pdf_field":""},{"help":"Date of transaction","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details","fields":[{"help":"Answer Yes or No","type":"yes-no","label":"Do you have an EIA Account","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide EIA number if Yes","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":false,"pdf_field":""},{"help":"Name of insurance repository","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":false,"pdf_field":""},{"help":"Select if you want an EIA account created","type":"yes-no","label":"If No, do you want Us to create an EIA account for you","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Email registered with insurance repository","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Acknowledgement and Declaration","fields":[{"help":"Name of person from whom payment is received","type":"text","label":"Acknowledgement: Received from Ms./Mrs./Mr.","options":[],"required":true,"pdf_field":""},{"help":"Amount received","type":"amount","label":"Sum of Rs.","options":[],"required":true,"pdf_field":""},{"help":"Payment mode","type":"text","label":"Through Cheque/DD","options":[],"required":true,"pdf_field":""},{"help":"Signature of proposer and date","type":"signature","label":"DECLARATION","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":"Signature and stamp of proposer","type":"signature","label":"Signature and Stamp of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Signature and stamp of insurance advisor or intermediary","type":"signature","label":"DECLARATION FOR AGENT","options":[],"required":true,"pdf_field":""},{"help":"Signature of proposer and intermediary confirming explanation in local language","type":"signature","label":"VERNACULAR DECLARATION","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and intermediary"},{"title":"AML and Other Declarations","fields":[{"help":"Confirm premiums paid from bonafide sources and consent to document verification","type":"checkbox","label":"AML DECLARATION","options":[],"required":true,"pdf_field":""},{"help":"Select 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":"Answer Yes or No","type":"yes-no","label":"Are You or any of the proposed applicants or close relatives associated to Politically Exposed Person (PEP)?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"Are you a Non-Profit Organization? (only in case of an entity)","options":["Yes","No"],"required":false,"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":"Signature and stamp of proposer","type":"signature","label":"Signature and Stamp of Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Software Copyright Infringement Supplemental Proposal","fields":[{"help":"Name of insurer","type":"text","label":"Name of Insurance Company to which Proposal is made","options":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No; attach copy if Yes","type":"yes-no","label":"1. Do you have written policies and procedures concerning the use of copyrighted software?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Answer Yes or No; if Yes, specify frequency","type":"yes-no","label":"2. Do you conduct regular educational seminars, which all employees are required to attend, outlining appropriate software copyright procedures and the risks of infringement?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Specify frequency of seminars","type":"text","label":"If so, how often are these held?","options":[],"required":false,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"3. Do you have a person within your organization who is responsible for ensuring that copyright violations do not occur?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"4. Are licenses obtained for all software programs used?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Number of new software programs launched annually","type":"number","label":"5. On average, how many new software programs do you launch in a year?","options":[],"required":true,"pdf_field":""},{"help":"Number of custom software programs","type":"number","label":"Of these, how many are custom?","options":[],"required":true,"pdf_field":""},{"help":"Number of prepackaged software programs","type":"number","label":"Prepackaged?","options":[],"required":true,"pdf_field":""},{"help":"Percentage value","type":"number","label":"6. What percentage of your annual revenue is derived from software or software related products and services?","options":[],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"7. Do you take steps to ensure that new employees do not infringe on former employers software copyrights?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Answer Yes or No","type":"yes-no","label":"8. Do you take steps to ensure that former employees do not assert copyright claims against the proposer?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Answer Yes or No; attach details if Yes","type":"yes-no","label":"9. During the past 5 years, with respect to any possible or actual copyright claim, have you received any notice or warning, whether written or oral or been involved in any legal action or proceeding?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Answer Yes or No; provide details if Yes","type":"yes-no","label":"10. Are you aware of any circumstance that could give rise to a copyright claim?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Describe circumstances","type":"text","label":"If yes, provide a detailed description of those circumstances","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorized representative","type":"signature","label":"Signed","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Title of authorized representative","type":"text","label":"Title","options":[],"required":true,"pdf_field":""},{"help":"Name of producer","type":"text","label":"Producer","options":[],"required":false,"pdf_field":""},{"help":"Date for producer signature","type":"date","label":"Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Excess follow insurance policies","attachments":["Additional sheets if more space is needed","Details of declined or cancelled insurance if applicable","List and status of all errors and omissions claims made during past five years","Latest audited annual report & accounts","Latest interim report & accounts","Brochures describing services or products offered","Sample service agreements","Cancelled cheque or other bank document for electronic fund transfer","Sample contracts or service agreements if requested","Details of any legal notices or copyright claims if applicable"],"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.","The company may void the policy if any statement is untrue, incorrect, or incomplete.","The proposer consents to verification of identity and address through official registries for KYC purposes.","All premiums have been or will be paid from bonafide sources and not from proceeds of crime.","The proposer agrees to notify the insurer immediately of any changes in information before the policy effective date.","Signing this proposal does not bind the proposer or insurer to complete the insurance but forms the basis of coverage if granted.","The proposer agrees to receive policy and service communications in soft copy unless physical copy is requested.","The insurance company is not liable if NEFT transactions do not complete.","The proposer confirms understanding and acceptance of the policy terms and conditions.","The agent/intermediary declares that the policy features and terms have been fully explained to the proposer.","The vernacular declaration confirms the contents were explained in a language understood by the proposer.","No rebates are allowed as inducements to take or renew insurance as per Section 41 of Insurance Act 1938.","The undersigned authorized representative declares all statements are true and agrees to notify changes before policy effective date."],"dropped_labels":5},"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/5590-excess-follow-form"}