{"id":5608,"title":"INVOLUNTARY LOSS OF EMPLOYMENT 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/Involuntary_Loss_of_Employment_Proposal_Form_ZK_26_27_v1_17072026_7a1ae417f7.pdf","sha256":"b2b97ecb4814ba65ad9f2f50e43c1031c4990e8029d392c0bfeead6df69cd1b7","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for insurance coverage against involuntary loss of employment. It is filled by the proposer (the person seeking insurance).","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","The liability of the company starts only after acceptance of the proposal and receipt of premium.","Provide all information fully, accurately and correctly.","Attach additional sheets if more space is needed and indicate question number.","Use original documents where required.","Cancelled cheque should be of the same bank account for refund/claim payments.","Intimate any change in bank account details in writing to the insurer.","If ECS is selected, submit standing instruction form available at branches."],"title":"INVOLUNTARY LOSS OF EMPLOYMENT PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"A. PROPOSER'S INFORMATION","fields":[{"help":"Select your title","type":"choice","label":"Title Mr. / Miss / Mrs. / M/s / Others","options":["Mr.","Miss","Mrs.","M/s","Others"],"required":true,"pdf_field":""},{"help":"Enter your full name in BLOCK LETTERS","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Select your gender","type":"choice","label":"Gender Male Female Others","options":["Male","Female","Others"],"required":true,"pdf_field":""},{"help":"Enter your date of birth","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Enter your nationality","type":"text","label":"Nationality","options":[],"required":true,"pdf_field":""},{"help":"Select your marital status","type":"choice","label":"Marital Status Single Married Others","options":["Single","Married","Others"],"required":true,"pdf_field":""},{"help":"Enter your permanent address line 1","type":"text","label":"Permanent Address Address (Line 1)","options":[],"required":true,"pdf_field":""},{"help":"Tick yes if correspondence address is same as permanent address","type":"yes-no","label":"Is Correspondence Address same as Permanent Address? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter correspondence address line 1 if different","type":"text","label":"Correspondence Address Address (Line 1)","options":[],"required":false,"pdf_field":""},{"help":"Enter GSTIN if applicable","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Enter landline phone number","type":"phone","label":"Phone - Landline","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile phone number","type":"phone","label":"Mobile","options":[],"required":true,"pdf_field":""},{"help":"Enter emergency contact number","type":"phone","label":"Emergency contact No","options":[],"required":false,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email id","options":[],"required":true,"pdf_field":""},{"help":"Enter PAN or Form 60 details","type":"text","label":"PAN/Form 60","options":[],"required":false,"pdf_field":""},{"help":"Tick yes if you are a Kotak Group employee","type":"yes-no","label":"Kotak Group Employees Yes No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter employee ID if applicable","type":"text","label":"If 'Yes', Employee ID","options":[],"required":false,"pdf_field":""},{"help":"Tick yes if existing customer","type":"yes-no","label":"Are you an existing customer of Kotak Mahindra Bank Ltd. / Kotak Mahindra Prime Ltd.? Yes No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter customer reference number if applicable","type":"text","label":"If 'Yes', CRN","options":[],"required":false,"pdf_field":""},{"help":"Tick yes if you have an existing policy","type":"yes-no","label":"Any existing policy from Us Yes No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Enter policy number if applicable","type":"text","label":"If ‘Yes’, Policy No","options":[],"required":false,"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":""}],"filled_by":"proposer"},{"title":"B. RISK DETAILS","fields":[{"help":"Enter name of your current employer","type":"text","label":"Name of Current Employer","options":[],"required":true,"pdf_field":""},{"help":"Enter industry or sector of employment","type":"text","label":"Nature of Industry/ Sector","options":[],"required":true,"pdf_field":""},{"help":"Enter total years of service","type":"number","label":"Total number of years in service","options":[],"required":true,"pdf_field":""},{"help":"Enter years of service with current employer","type":"number","label":"Total number of years in service with current employer","options":[],"required":true,"pdf_field":""},{"help":"Enter your current job designation","type":"text","label":"Current Designation","options":[],"required":true,"pdf_field":""},{"help":"Describe nature of your work","type":"text","label":"Nature of Work","options":[],"required":true,"pdf_field":""},{"help":"Mention any existing illness","type":"text","label":"Any existing illness","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Have you ever been absent from work for more than a week in last 2 years due to any illness/ injury? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if yes","type":"text","label":"Please specify the details","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Have you ever been suspended from your current or previous employment? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if yes","type":"text","label":"Please specify the details","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Have you ever been terminated/ permanently dismissed from your job? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if yes","type":"text","label":"Please specify the details","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"C. COVERAGE DETAILS","fields":[{"help":"Enter loan tenure","type":"text","label":"Loan Tenure","options":[],"required":true,"pdf_field":""},{"help":"Enter insurance start date","type":"date","label":"Period of insurance: From","options":[],"required":true,"pdf_field":""},{"help":"Select your occupation type","type":"choice","label":"Please provide details of occupation","options":["Central/ State Govt. Employees","Employee in Un-listed Private Companies","Employee in Public Sector Companies","Other","Employee in Listed Private Companies"],"required":true,"pdf_field":""},{"help":"Select type of loan","type":"choice","label":"Type of Loan: Personal Loan Home Loan Auto Others","options":["Personal Loan","Home Loan","Auto","Others"],"required":true,"pdf_field":""},{"help":"Enter name of financial institution","type":"text","label":"Name of the Financial Institution","options":[],"required":true,"pdf_field":""},{"help":"Enter branch name","type":"text","label":"Branch of the Financial Institution","options":[],"required":true,"pdf_field":""},{"help":"Enter loan account number","type":"text","label":"Loan Account Number","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"D. NOMINEE DETAILS","fields":[{"help":"Enter insured person's name","type":"text","label":"Insured Name","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's name","type":"text","label":"Name of the Nominee","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's share percentage","type":"number","label":"% Share of Claim Amount","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's date of birth","type":"date","label":"Date of Birth","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's age","type":"number","label":"Age","options":[],"required":true,"pdf_field":""},{"help":"Select nominee's gender","type":"choice","label":"Gender (M/F/O)","options":["M","F","O"],"required":true,"pdf_field":""},{"help":"Enter relationship with proposer","type":"text","label":"Relationship with Policyholder","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's mobile number","type":"phone","label":"Mobile No. of the Nominee","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's address","type":"text","label":"Address Nominee","options":[],"required":false,"pdf_field":""},{"help":"Enter nominee's email","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Provide appointee details if nominee is minor","type":"text","label":"If Nominee is a minor, give the details of Appointee","options":[],"required":false,"pdf_field":""},{"help":"Enter appointee's name","type":"text","label":"Name of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"Enter appointee's date of birth","type":"date","label":"Date of Birth","options":[],"required":false,"pdf_field":""},{"help":"Select appointee's gender","type":"choice","label":"Gender (M/F/O)","options":["M","F","O"],"required":false,"pdf_field":""},{"help":"Enter relationship with nominee","type":"text","label":"Relationship with Nominee","options":[],"required":false,"pdf_field":""},{"help":"Enter appointee's mobile number","type":"phone","label":"Mobile No. of the Appointee","options":[],"required":false,"pdf_field":""},{"help":"Enter appointee's address","type":"text","label":"Address of Appointee","options":[],"required":false,"pdf_field":""},{"help":"Enter appointee's email","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter bank account number for payment","type":"text","label":"Account Number","options":[],"required":false,"pdf_field":""},{"help":"Enter IFSC code of bank branch","type":"text","label":"IFSC Code","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"Enter bank branch name","type":"text","label":"Branch Name","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"E. AML DECLARATION","fields":[{"help":"Select type of organization if applicable","type":"choice","label":"In case of entity, Type of Organization making the payment","options":["Limited Company","Government Organization","Non-Government Organization","Society","Trust","Partnership","International Organization","Co-operatives","Section 25 Company","Others"],"required":false,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Are You or any of the proposed applicants or close relatives is/are associated to Politically Exposed Person (PEP)? Yes No","options":["Yes","No"],"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 here","type":"signature","label":"Signature and Stamp of Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"DECLARATION","fields":[{"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 here","type":"signature","label":"Signature and Stamp of Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"VERNACULAR DECLARATION","fields":[{"help":"Proposer signs here","type":"signature","label":"Signature / Stamp of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Intermediary signs here","type":"signature","label":"Signature of Intermediary / Sales Person","options":[],"required":true,"pdf_field":""},{"help":"Enter place","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter date","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"intermediary and proposer"},{"title":"DECLARATION FOR AGENT","fields":[{"help":"Proposer signs here","type":"signature","label":"Signature / Stamp of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Agent signs here","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":"Enter place","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter date","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"agent and proposer"},{"title":"F. SCOPE OF COVER","fields":[{"help":"Select proposal type","type":"choice","label":"Proposal Type Credit Linked Non-Credit Linked","options":["Credit Linked","Non-Credit Linked"],"required":true,"pdf_field":""},{"help":"Select number of EMIs","type":"choice","label":"Number of EMIs 3 6 9 12","options":["3","6","9","12"],"required":true,"pdf_field":""},{"help":"Enter sum insured or EMI amount","type":"amount","label":"Sum Insured/ Per month EMI Amount","options":[],"required":true,"pdf_field":""},{"help":"Select claim frequency","type":"choice","label":"Claim Frequency Once in a Policy Period Annual","options":["Once in a Policy Period","Annual"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"G. PREMIUM PAYMENT AND BANK ACCOUNT DETAILS","fields":[{"help":"Enter premium amount","type":"amount","label":"Premium Amount","options":[],"required":true,"pdf_field":""},{"help":"Enter cheque or journal number","type":"text","label":"Cheque/ Journal No.","options":[],"required":false,"pdf_field":""},{"help":"Enter date of payment","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Select payment option","type":"choice","label":"Premium Payment Options Cheque EFT DD Debit/ Credit card Other","options":["Cheque","EFT","DD","Debit/ Credit card","Other"],"required":true,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Enter cheque or DD number","type":"text","label":"Cheque/ DD No.","options":[],"required":false,"pdf_field":""},{"help":"Enter branch name","type":"text","label":"Branch Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"H. INSURED BANK DETAILS","fields":[{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Enter branch name","type":"text","label":"Branch Name","options":[],"required":true,"pdf_field":""},{"help":"Enter account holder name","type":"text","label":"Name as in Bank Account","options":[],"required":true,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Bank Account Number","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Enter MICR code","type":"text","label":"MICR Code","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Involuntary Loss of Employment insurance policy","attachments":["Cancelled Cheque (copy) for bank account","Separate sheet if nominee list is more than one","Additional sheets for any extra information as needed"],"declarations":["All premiums have been/will be paid from bonafide sources and not from proceeds of crime.","The statements made in this proposal form are true to the best of my knowledge and belief.","Any additions or alterations in the risk after submission must be conveyed immediately.","Policy and service communication will be sent in soft copy to the email provided unless physical copy is requested.","Consent is given to verify identity/address through official registries for KYC purposes.","The contents of the proposal form and policy terms have been explained in a language understood by the proposer.","No rebates are allowed as inducements under Section 41 of Insurance Act 1938.","If the proposer is a person with disability, an authorized representative may assist in completing the form.","The agent has explained the policy features and terms to the proposer who has understood them."],"dropped_labels":16},"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/5608-involuntary-loss-of-employment-proposal-form"}