{"id":5616,"title":"Jewellers Block Insurance Policy 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/jewellers_block_insurance_policy_proposal_form_c08a72a7a9.pdf","sha256":"66a0dfe9bbe20bc407acd43d5896f0e4f9cfeea7577785693e53ee9daab714ad","pages":16,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (potential policyholder) to apply for Jewellers Block Insurance Policy coverage from Zurich Kotak General Insurance Company. The proposer fills it with details about their business, premises, stock, security, and insurance requirements.","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.","Provide all information fully, accurately and correctly; non-disclosure may void the policy.","Attach additional sheets if more space is needed, indicating question number.","Submission of this form or payment does not bind the company to issue a policy.","Use original documents where required.","Policy and service communication will be sent to the email provided unless physical copy is requested.","Prohibition of rebates under Section 41 of Insurance Act 1938 applies."],"title":"Jewellers Block Insurance Policy Proposal Form","submit":{"to":"Zurich Kotak General Insurance Company (India) Limited","how":"post / in person / as per company instructions","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 Business Information","fields":[{"help":"","type":"text","label":"Policy issuing office","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy servicing office","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary/Agent Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Intermediary License no /Agent code.","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Intermediary/Agent Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Fill in BLOCK LETTERS","type":"text","label":"Proposer's Name","options":[],"required":true,"pdf_field":""},{"help":"Fill in BLOCK LETTERS","type":"text","label":"Proposer's Present Address","options":[],"required":true,"pdf_field":""},{"help":"Fill in BLOCK LETTERS","type":"text","label":"Permanent Address","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Telephone","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Fax","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN","options":[],"required":true,"pdf_field":""},{"help":"12-digit Aadhaar number","type":"text","label":"Aadhar No.","options":[],"required":true,"pdf_field":""},{"help":"Central KYC number if available","type":"text","label":"CKYC (if available)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Name of the Trade/Business of the Insured","options":[],"required":true,"pdf_field":""},{"help":"","type":"phone","label":"Telephone","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Fax","options":[],"required":false,"pdf_field":""},{"help":"","type":"phone","label":"Mobile","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN","options":[],"required":true,"pdf_field":""},{"help":"12-digit Aadhaar number","type":"text","label":"Aadhar No.","options":[],"required":true,"pdf_field":""},{"help":"List all parties with insurable interest","type":"text","label":"Policy to be Issued in favor of (list out all the parties who have insurable interest) including the financial institutions","options":[],"required":true,"pdf_field":""},{"help":"Start date of insurance","type":"date","label":"Period of Insurance From","options":[],"required":true,"pdf_field":""},{"help":"","type":"checkbox","label":"Source of Business - Broker","options":["Broker"],"required":null,"pdf_field":""},{"help":"Provide full postal addresses with pin codes and floor number","type":"table","label":"Insured Premises - Location of risk/business to be covered - full postal address with Pin Code (up to 4 addresses with floor)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Other Premises - where property will be deposited","options":[],"required":false,"pdf_field":""},{"help":"Number of years","type":"number","label":"How long have you carried on business - In insured premises?","options":[],"required":true,"pdf_field":""},{"help":"Percentage","type":"number","label":"Nature of your Business - Wholesale (%)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Employees","fields":[{"help":"","type":"number","label":"How Many employees do you have?","options":[],"required":true,"pdf_field":""},{"help":"If no, specify practice","type":"yes-no","label":"Is there a system to obtain references from previous employers?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide details if yes","type":"yes-no","label":"Has there been any occasion to question honesty or conduct of any person proposed for guarantee? If yes, provide details","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"How often are the employees required to account for money?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are books of accounts balancing every day?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"What independent system including Audits is there to check all sums received by employees and frequency of audits?","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Valuation and Stock Information","fields":[{"help":"Claims for own stock settled on cost price unless otherwise agreed","type":"text","label":"On what basis do you require claims to be settled?","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premises and Security","fields":[{"help":"If yes, specify date (dd/mm/yy)","type":"yes-no","label":"Has a Security Survey been conducted concerning the Premises?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Are the premises occupied at night by the proposer?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If yes, select time period during which building is secured","type":"yes-no","label":"Are the premises occupied at night by an employee or caretaker?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If yes, specify type and duration","type":"yes-no","label":"Will there be a watchman on the insured premise(s)?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Type of watchman","options":["Common Watchman","Dedicated Watchman","Armed Watchman","Unarmed Watchman"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Duration of the watchman","options":["All 24 Hours","Only During Business Hours","Only Outside Business Hours"],"required":true,"pdf_field":""},{"help":"If yes, state what protection","type":"yes-no","label":"Is an inside grill fitted to your Gold and Gems Showroom, window or other protection installed against loss by window smashing?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Are your display windows protected by rolling shutter outside business hours?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If yes, state name and forward copy of maker's specifications","type":"yes-no","label":"Is there any burglar alarm?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Are hold-up/panic buttons incorporated in the system?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the system maintained under contract?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If yes, give full details","type":"yes-no","label":"Is there a strong room?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"Provide number and locations of cameras","type":"yes-no","label":"Is there a Closed Circuit T.V. (C.C.T.V.) camera?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the premises protected by Armed Guards on 24 hr basis?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Please specify any other special means of protection","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Stock Records and Losses","fields":[{"help":"","type":"date","label":"When was your last annual stock-taking?","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you keep proper records of all sales, purchases and transactions?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If yes, give statement covering past 3 years with particulars including amount of each loss","type":"yes-no","label":"Have you ever sustained a loss or losses?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"number","label":"Number of Claims","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Remarks","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Claim amount","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Insurance Company","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Receipts and Entrustments","fields":[{"help":"For repairs, valuation, sale or other purpose and require surrender before return","type":"yes-no","label":"Is it your practice to give receipts for goods left with you by non-trade customers?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you use entrustment/approbation notes in respect of all entrustments?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Home Risks (Private Dwelling House)","fields":[{"help":"","type":"amount","label":"Maximum Value taken","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Is the property ever left unattended at the private dwelling house?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Exhibitions and Displays","fields":[{"help":"If yes, give full particulars including values and details of protections","type":"yes-no","label":"Do you exhibit goods in any showcase in any hotel, club or elsewhere away from your premises?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sum Insured Details","fields":[{"help":"Fill amounts for each category and aggregate","type":"table","label":"Section-II: Property Insured Including Cash & Currency Notes Whilst in Custody of Specified Persons - Maximum Amount Each and Aggregate Amount for various categories","options":[],"required":true,"pdf_field":""},{"help":"Fill amounts for each transport mode","type":"table","label":"Section-III: Property Insured Excluding Cash & Currency Notes Whilst in Transit Within India - Maximum Amount Each and Aggregate Amount for Airfreight, Angadia/Agreed/Named Couriers, Registered Post Parcel/Speed Post","options":[],"required":true,"pdf_field":""},{"help":"","type":"table","label":"Section-V: Exhibition Risks - Type of Exhibitions and Estimated Aggregate Sum Insured During Policy Period for Domestic and International Exhibitions","options":[],"required":false,"pdf_field":""},{"help":"","type":"table","label":"Section-VI: Other Property of the Insured - Location and Sum Insured on Reinstatement Value Basis for Furniture, Fixtures, Fittings, Trade Equipment, Safe at Residence","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Add on Covers","fields":[{"help":"If yes, provide names and addresses","type":"yes-no","label":"Extension of cover under Sec 2(i) & (iii) to include Common Employees of Group/Sister/Associate Companies operating from the same premises","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, provide sum insured limit","type":"yes-no","label":"Extension of cover under Sec. 2(i) to include Deemed Imports and Deemed Exports to EPZ","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify amount","type":"yes-no","label":"Extension of cover under Section 1(a) and 2 (a) to include Boiling Operations out of business hours","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Terrorism Cover","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, provide Any One Accident (AOA)/Single Loss Limit and Any One Year (AOY)/Aggregate Loss Limit","type":"yes-no","label":"Loss of Stock due to Mysterious Disappearance under Section I","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, percentage increase of Sum Insured","type":"yes-no","label":"Peak Season Increase under section I","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify sum insured","type":"yes-no","label":"First Buy Cover Clause under Section II","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify sum insured","type":"yes-no","label":"Spurious & Stolen Gold Clause under Section I","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify sum insured","type":"yes-no","label":"Infidelity Coverage (specific person other than employees) under Section IV","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify period, sum insured limit, itinerary, storage during sales trips","type":"yes-no","label":"Sales trip coverage endorsement","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify sum insured","type":"yes-no","label":"Certificates Of Diamond / Jewels Coverage","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify sum insured","type":"yes-no","label":"Full Cover for Pair And Set","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify sum insured","type":"yes-no","label":"Shop Lifting under Section I","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify sum insured","type":"yes-no","label":"Working upon property extension","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify sum insured","type":"yes-no","label":"Wearing Extension","options":["YES","NO"],"required":false,"pdf_field":""},{"help":"If yes, specify period, sum insured limit, venue, storage after event","type":"yes-no","label":"Fashion Show/Private Event Coverage Endorsement","options":["YES","NO"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Other Insurances and References","fields":[{"help":"","type":"yes-no","label":"Have any other insurer ever cancelled or refused to issue or continue any insurance for you?","options":["YES","NO"],"required":true,"pdf_field":""},{"help":"If yes, state insurer, risks covered, amount and attach copy of policy","type":"yes-no","label":"Have you previously been insured?","options":["YES","NO"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Important Notices and Declarations","fields":[{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature and Stamp of Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"signature","label":"Signature of Intermediary/Sales Person","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"","type":"amount","label":"Drawn Amount","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Account Holder Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"date","label":"Transaction Date","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details","fields":[{"help":"","type":"yes-no","label":"Do you have an EIA Account?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":false,"pdf_field":""},{"help":"If Yes, fill Insurance Repository Application form","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":"Policy and service communication will be sent here","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consents","fields":[{"help":"","type":"choice","label":"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":false,"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":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Jewellers Block Insurance Policy","attachments":["Copy of previous insurance policy if previously insured","Copy of maker's specifications for burglar alarm if available","Additional sheets if more space is needed to answer questions"],"declarations":["Statements made in this Proposal Form are true to the best of the proposer's knowledge and belief and form the basis of the contract.","The proposer agrees that protections and safeguards mentioned shall not be withdrawn or varied without company consent and additional premium if any will be remitted.","The company has the right to verify identity/address proof through government portals for KYC purposes.","Premiums have been/will be paid from bonafide sources and not from proceeds of crime.","The company may cancel the insurance contract if found guilty under money laundering laws.","The proposer consents to receive policy and service communication in soft copy unless physical copy is requested.","The proposer declares if they qualify as a High Net Worth Individual (HNI).","The proposer declares if associated with Politically Exposed Persons (PEP).","The proposer declares if they are a Non-Profit Organization (if applicable)."],"dropped_labels":59},"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/5616-jewellers-block-insurance-policy-proposal-form"}