{"id":5611,"title":"Cyber Secure+ PROPOSAL FORM - GROUP POLICIES","purpose":"proposal","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/Cyber_Secure_Proposal_Form_Group_72e1b01f28.pdf","sha256":"4bffe700c8cc6ab00e1f714eba583e371a7d4822899e1f0c8bb330ffac18a8f5","pages":7,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for group cyber insurance coverage to be filled by the proposer or applicant representing the group seeking insurance.","notes":["Fill the proposal form in BLOCK LETTERS.","All details marked with * are mandatory.","The liability of the company commences only after acceptance of the proposal and receipt of premium.","Attach additional sheets if more space is needed and indicate question number.","Use original or valid documents for proof of identity and address.","Electronic Insurance Account (EIA) details override address details provided in the form.","The company is not obliged to issue a policy upon submission of the proposal or payment.","If the proposal is not accepted, payment will be refunded without interest."],"title":"Cyber Secure+ PROPOSAL FORM - GROUP POLICIES","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer / Applicant’s Details","fields":[{"help":"Enter the quote number provided","type":"text","label":"Quote No.*","options":[],"required":true,"pdf_field":""},{"help":"Enter the date of the quote","type":"date","label":"Quote Date*","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Sales Manager Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Service RM","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Branch code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary business vertical","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary Client Ref No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"SP Name / Code","options":[],"required":null,"pdf_field":""},{"help":"Select appropriate title","type":"choice","label":"Title Mr. / Miss / Mrs. / M/s / Others","options":["Mr.","Miss","Mrs.","M/s","Others"],"required":null,"pdf_field":""},{"help":"Enter full name (First, Middle, Last)","type":"text","label":"Name*","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender*","options":["Male","Female","Others"],"required":true,"pdf_field":""},{"help":"Enter date of birth in dd/mm/yyyy format","type":"date","label":"Date of Birth*","options":[],"required":true,"pdf_field":""},{"help":"Select nationality","type":"choice","label":"Nationality ##","options":["Indian","Non-Indian","NRI"],"required":null,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"Marital Status","options":["Single","Married","Others"],"required":null,"pdf_field":""},{"help":"Enter contact phone number","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email id:","options":[],"required":null,"pdf_field":""},{"help":"Enter full permanent address including city, state, pin code, country","type":"text","label":"Permanent Address *","options":[],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is the Postal Address same as the Permanent Address?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter PAN number or tick Form 60 if no PAN","type":"text","label":"PAN* / Form 60 (only in case the customer does not have PAN No.)","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Enter GSTIN if applicable","type":"text","label":"GSTIN:","options":[],"required":null,"pdf_field":""},{"help":"Enter CKYC number if available","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer/applicant"},{"title":"Authentication Details","fields":[{"help":"Tick applicable proof documents","type":"checkbox","label":"Proof of Identity (POI) and Proof of Address (POA) [Tick whichever is applicable]","options":["PAN","Aadhaar","Passport","Driving License","Voter ID","Others (specify)"],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are you an existing customer of Kotak Mahindra Bank Ltd. / Kotak Mahindra Prime Ltd.?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter Customer Relationship Number","type":"text","label":"If ‘Yes’, CRN","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Zurich/ Kotak Group Employees","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter employee ID","type":"text","label":"If ‘Yes’, Employee ID","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Any existing policy from Us","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter existing policy number","type":"text","label":"If ‘Yes’, Policy No","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer/applicant"},{"title":"Cover Selection","fields":[{"help":"Select cover type; Family Cover limited to spouse and max two children under 18","type":"choice","label":"Please tick the type of Cover You want to opt for?","options":["Individual Cover","Family Cover"],"required":null,"pdf_field":""},{"help":"Enter policy start date","type":"date","label":"Policy Period: From","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer/applicant"},{"title":"Preventive Services Selection","fields":[{"help":"Select if preventive services are required","type":"yes-no","label":"Preventive Services","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select all applicable benefits","type":"checkbox","label":"Benefits required under Preventive Services","options":["Identity Monitoring","Digital Health and Assessment","Wi-fi Scan","QR Code Scanner","Device Protection","Cyber Education and Awareness - Tips and Tricks","Emergency Guidance and Enhanced FAQs","Cyber Helpline / Incident Response","Crisis Response - Helpline Emergency assistance to block cards, SIM Cards and replace identity cards (PAN Card and Driving License)","Emergency Travel Assistance on call","Password Vault","Asset Surface Management"],"required":null,"pdf_field":""},{"help":"Select one package if required","type":"choice","label":"Package required under Preventive Services","options":["Cyber safe Essential (Identity Monitoring + Cyber Education and Awareness - Tips and Tricks)","Cyber safe Core (Identity Monitoring + Cyber Education and Awareness - Tips and Tricks + Digital Health and Assessment)","Cyber safe Plus (Identity Monitoring + Cyber Education and Awareness - Tips and Tricks + Digital Health and Assessment + Cyber Helpline/ Incident Response)"],"required":null,"pdf_field":""}],"filled_by":"proposer/applicant"},{"title":"Insured Details","fields":[{"help":"Enter employee ID of insured person","type":"text","label":"Employee ID","options":[],"required":true,"pdf_field":""},{"help":"Enter full name","type":"text","label":"Name of the Insured Person","options":[],"required":true,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of Birth DD/MM/YYYY","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender","options":["Male","Female","Others"],"required":true,"pdf_field":""},{"help":"Select marital status","type":"choice","label":"Marital Status","options":["Single","Married","Others"],"required":true,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship with the Insured Person","options":[],"required":true,"pdf_field":""},{"help":"Enter contact number","type":"phone","label":"Contact No.","options":[],"required":true,"pdf_field":""},{"help":"Enter email address","type":"email","label":"Email ID","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee name","type":"text","label":"Nominee Details - Name","options":[],"required":true,"pdf_field":""},{"help":"Enter appointee details if nominee is minor","type":"text","label":"Appointee Details in case Nominee is a Minor","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer/applicant"},{"title":"Group Cyber Security Details","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Do you ensure that the members of the group have access to anti-virus, anti-spyware or equivalent malware protection solutions?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of malware protection solutions","type":"text","label":"If Yes, please provide details","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do the members of the Group have ever Tie-up with Expert for Cyber Attack Protection Experts to Mitigate?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of cyber attack protection experts","type":"text","label":"If Yes, please provide details","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do members of the Group have dedicated Cyber Security team available?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of cyber security team","type":"text","label":"If Yes, please provide details","options":[],"required":null,"pdf_field":""},{"help":"Enter average or majority age group of members","type":"text","label":"What is the average or majority age group?","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Do any member of the Group have ever been a victim of online fraud or cyber bullying/defamation or have any of your Computer Systems been hacked or compromised?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of incidents","type":"text","label":"If Yes, please provide details","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer/applicant"},{"title":"Payment Details","fields":[{"help":"Enter cheque or demand draft number","type":"text","label":"Cheque / D.D #","options":[],"required":null,"pdf_field":""},{"help":"Enter amount drawn","type":"amount","label":"Drawn Amount","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number for refund/claims","type":"text","label":"Account Number","options":[],"required":null,"pdf_field":""},{"help":"Enter name of bank branch or payee","type":"text","label":"Drawn To","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC or MICR code","type":"text","label":"IFSC/MICR Code","options":[],"required":null,"pdf_field":""},{"help":"Enter date of payment","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Enter bank branch name","type":"text","label":"Bank and Branch Name","options":[],"required":null,"pdf_field":""},{"help":"Enter account holder's name","type":"text","label":"Account Holder name","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer/applicant"},{"title":"Electronic Insurance Account Details","fields":[{"help":"Select Yes or No","type":"yes-no","label":"Do you have an EIA Account?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter EIA account number","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":null,"pdf_field":""},{"help":"Enter name of insurance repository","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"If No, do you want Us to create an EIA account for you","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter registered email id","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer/applicant"},{"title":"Declarations and Signatures","fields":[{"help":"Enter date of signing","type":"date","label":"*Date","options":[],"required":true,"pdf_field":""},{"help":"Sign or provide thumb impression","type":"signature","label":"*Signature/ Thumb Impression of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of Proposer","options":[],"required":null,"pdf_field":""},{"help":"Signature and stamp of insurance advisor or sales person","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 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":"Signature of intermediary or sales person","type":"signature","label":"Signature of Intermediary/ Sales Person*","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer/applicant and intermediary"},{"title":"Additional Declarations","fields":[{"help":"Tick if physical copy is desired","type":"checkbox","label":"I / We would still want to receive a physical copy of the policy","options":[],"required":null,"pdf_field":""},{"help":"Tick to give consent for KYC verification","type":"checkbox","label":"I / We hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through Central KYC Registry or Goods and Service Tax Portal or Ministry Of Corporate Affairs Portal or National Securities Depository Limited portal for the purpose of undertaking KYC.","options":[],"required":null,"pdf_field":""},{"help":"Select 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)?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Are you a Non-Profit Organization? (only in case of an entity)","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer/applicant"}],"deadlines":[],"applies_to":"Group policies under Cyber Secure+","attachments":["Proof of Identity (POI) and Proof of Address (POA) documents as applicable","Additional sheets if more space is required to answer questions","Insurance Repository Application form if EIA account creation is requested"],"declarations":["The statements made in this Proposal Form are true to the best of the proposer’s knowledge and belief.","This declaration forms the basis of the contract between the proposer and Zurich Kotak General Insurance Company (India) Limited.","The company’s liability is subject to terms and conditions of the policy and receipt of premium in full and in time.","The company may cancel the insurance contract if premiums are paid from proceeds of crime or if found guilty under money laundering laws.","The proposer consents to electronic communication for policy and service related communication unless physical copy is requested.","The proposer consents to KYC verification through specified government portals.","No person shall offer or accept rebates on commission or premium except as allowed by insurer’s published prospectuses.","Politically Exposed Persons (PEPs) must be disclosed as per the form."],"dropped_labels":9},"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/5611-cyber-secure-proposal-form-group-policies"}