{"id":5621,"title":"BUSINESS SECURE PLUS PROPOSAL FORM & QUESTIONNAIRE","purpose":"proposal","insurer":{"slug":"zurich-kotak-general-insurance","name":"Zurich Kotak General Insurance Company (India) Limited"},"source_pdf":"https://cms.zurichkotak.com/uploads/Proposal_Form_Business_Secure_Plus_baab12e774.pdf","sha256":"a8619080e9ad23d8b13b4d958d62a6646c10fd9c8eaf4ac914a700d2638eed26","pages":16,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for Business Secure Plus insurance to be filled by the proposer (business owner or authorized representative) to apply for insurance coverage for their business assets and liabilities.","notes":["Fill the proposal form in BLOCK LETTERS.","All fields marked with * are mandatory.","If additional space is needed, attach extra sheets and mention the question number.","Information provided will be treated in strict confidence.","Submission of the proposal or payment does not oblige the company to issue a policy.","The company will refund any payment if the proposal is not accepted without interest.","Use original documents where required.","The proposer should fully understand the policy features before signing.","Policy and service communication will be sent via email unless physical copy is requested."],"title":"BUSINESS SECURE PLUS PROPOSAL FORM & QUESTIONNAIRE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer / Owner’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":"Enter full name of the proposer","type":"text","label":"Proposer’s Name*","options":[],"required":true,"pdf_field":""},{"help":"Specify the trade or business activity","type":"text","label":"Proposer's Trade or Business*","options":[],"required":true,"pdf_field":""},{"help":"Enter registered office or permanent address line 1","type":"text","label":"Registered Office Address / Permanent Address* - Address (Line 1)","options":[],"required":true,"pdf_field":""},{"help":"Enter registered office or permanent address line 2","type":"text","label":"Registered Office Address / Permanent Address* - Address (Line 2)","options":[],"required":true,"pdf_field":""},{"help":"Provide nearest landmark to the address","type":"text","label":"Nearest Landmark","options":[],"required":null,"pdf_field":""},{"help":"Enter city or district","type":"text","label":"City / District","options":[],"required":null,"pdf_field":""},{"help":"Enter postal pin code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"Enter state","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter country","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Is the Communication Address same as the Registered Office Address / Permanent Address?*","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"If communication address differs, enter line 1","type":"text","label":"Communication (Postal) Address* - Address (Line 1)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Corporate Customer Details","fields":[{"help":"City or district for corporate customer","type":"text","label":"City / District","options":[],"required":null,"pdf_field":""},{"help":"Postal pin code","type":"number","label":"Pin code","options":[],"required":null,"pdf_field":""},{"help":"State","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Country","type":"text","label":"Country","options":[],"required":null,"pdf_field":""},{"help":"Goods and Services Tax Identification Number","type":"text","label":"GSTIN","options":[],"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":"Central KYC Registry number","type":"text","label":"CKYC Identifier / Number (Generated by CERSAI)","options":[],"required":null,"pdf_field":""},{"help":"Permanent Account Number","type":"text","label":"PAN*","options":[],"required":true,"pdf_field":""},{"help":"Name of authorised signatory","type":"text","label":"Authorised Signatory Name","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"choice","label":"Any existing policy from Us","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter existing policy number if applicable","type":"text","label":"If ‘Yes’, Policy No","options":[],"required":null,"pdf_field":""},{"help":"Tick if new policy","type":"checkbox","label":"If ‘No’, New","options":[],"required":null,"pdf_field":""},{"help":"Enter rollover policy number if applicable","type":"text","label":"Rollover Policy No","options":[],"required":null,"pdf_field":""},{"help":"Name of previous insurer","type":"text","label":"Previous insurance company","options":[],"required":null,"pdf_field":""},{"help":"Bank name for hypothecation if any","type":"text","label":"Hypothecation Details: Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Enter paid up capital amount","type":"amount","label":"Paid up Capital of the firm","options":[],"required":null,"pdf_field":""},{"help":"Start date of insurance period","type":"date","label":"Period of Insurance: From","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Sections Opted For","fields":[{"help":"Tick if opting for this section","type":"checkbox","label":"Section I - Fire and Special Perils","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section II - Business Interruption (Fire)","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section III - Burglary & Housebreaking","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section IV - Electronic Equipments","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section V – Machinery Breakdown","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section VI - Boiler and Pressure Vessels","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section VII – All Risk","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section VIII - Money","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section IX - Fidelity Guarantee","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section X - Plate Glass","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section XI - Signage","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section XII - Baggage","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section XIII - Personal Accident","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section XIV - Employee Compensation","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section XV - Directors and Officers Liability","options":[],"required":null,"pdf_field":""},{"help":"Tick if opting for this section","type":"checkbox","label":"Section XVI – Commercial General Liability","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details","fields":[{"help":"Provide details of annual gross profit or revenue and indemnity period for each location","type":"table","label":"Business Interruption (Fire) - Loss of profit following Fire (insured peril under Section I) (Annual Gross Profit / Annual Gross Revenue, Indemnity Period in Months, Indemnity Period Gross Profit / Gross Revenue, Location Address)","options":[],"required":null,"pdf_field":""},{"help":"Describe security arrangements at the insured premises","type":"text","label":"Details of security arrangement at premises, including watch and ward facility","options":[],"required":null,"pdf_field":""},{"help":"List equipment details for machinery and boiler coverage","type":"table","label":"Electrical/Mechanical/Electronic Equipment/Boiler details for cover under Sections IV, V and VI (Description with Sr. No. & make, Year of manufacture, Sum Insured (Rs))","options":[],"required":null,"pdf_field":""},{"help":"Indicate if maintenance contract is valid and enclose copy if yes","type":"yes-no","label":"Valid maintenance contract Force? Yes / No (If yes, Copy to be enclosed)","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Specify maximum distance for money transit","type":"number","label":"Maximum distance in kms that the money will be carried","options":[],"required":null,"pdf_field":""},{"help":"Select mode of transportation for money","type":"choice","label":"Mode of Transportation","options":["By Foot","By Public Transport","Own 2 Wheeler","Own 4 Wheeler"],"required":null,"pdf_field":""},{"help":"Indicate if additional persons accompany money outside","type":"yes-no","label":"Additional person accompany the money outside?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if CCTV is operational at premises","type":"yes-no","label":"Is there a CCTV in the insured premises that is clearly operational all through?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide personal accident insured persons details","type":"table","label":"Personal Accident - Name of the insured person, Date of Birth, Occupation, Relationship with You, Details of existing infirmity or disability","options":[],"required":null,"pdf_field":""},{"help":"Provide details of directors and officers liability","type":"text","label":"Directors and Officers Liability - Nature of ownership (Pvt Company, Public Company, Others), Details of serving directors and officers, Limit of Liability required, Any other information","options":[],"required":null,"pdf_field":""},{"help":"Provide commercial general liability details","type":"text","label":"Commercial General Liability - Annual turnover, Nature of work, Limits required, List of premises to be Covered, Details of products to be insured, New products to be marketed, Products discontinued or recalled, Claims or losses in last five years","options":[],"required":null,"pdf_field":""},{"help":"Provide past 3 years loss experience if available","type":"table","label":"Details of Past claim experience under each section opted for (Date of Occurrence, Details of Loss, Amount of Loss (Rs.), Name of the Insurers)","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Has any Company in respect of any section included by you for this insurance declined your Proposal?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"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","type":"text","label":"Account Number","options":[],"required":null,"pdf_field":""},{"help":"Name of bank or branch drawn to","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":"Date of payment","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Name of bank","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Bank branch name","type":"text","label":"Bank and Branch Name","options":[],"required":null,"pdf_field":""},{"help":"Name of account holder","type":"text","label":"Account Holder name","options":[],"required":null,"pdf_field":""},{"help":"Reference number for transaction","type":"text","label":"Transaction Reference No","options":[],"required":null,"pdf_field":""},{"help":"Date of transaction","type":"date","label":"Transaction Date","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Electronic Insurance Account Details of Proposer","fields":[{"help":"Indicate if you have an Electronic Insurance Account","type":"yes-no","label":"Do you have an EIA Account?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide EIA number if applicable","type":"text","label":"If Yes, please quote EIA Number","options":[],"required":null,"pdf_field":""},{"help":"Name of insurance repository","type":"text","label":"Please mention name of Insurance Repository","options":[],"required":null,"pdf_field":""},{"help":"Tick 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":"Provide email registered with insurance repository","type":"email","label":"Email id (Registered with Insurance Repository)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","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":""},{"help":"Signature and stamp of intermediary","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":"Signature of intermediary or sales person","type":"signature","label":"Signature of Intermediary/ Sales Person","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer and intermediary"}],"deadlines":[],"applies_to":"Business Secure Plus insurance policy proposal","attachments":["Copy of valid maintenance contract if applicable","Additional sheets if more space is required to answer questions","Cancelled cheque for electronic fund transfer if applicable","Insurance Repository Application form if EIA account creation requested"],"declarations":["The statements made in this proposal form are true and complete to the best of the proposer’s knowledge and belief.","The proposal form and questionnaire form the basis of the insurance policy issued.","The company’s liability commences only after acceptance of the proposal and receipt of premium.","The policy shall be voidable if any material information is untrue, incorrect, or withheld.","The proposer consents to electronic communication for policy and service related communication.","The proposer consents to KYC verification through specified government portals.","All premiums are paid from bonafide sources and not from proceeds of crime as per AML declaration.","The proposer declares whether they or close relatives are politically exposed persons (PEP).","The proposer declares if they are a non-profit organization if applicable.","The insurance advisor/intermediary declares that the policy features and terms have been explained to the proposer.","Prohibition of rebates under Section 41 of Insurance Act 1938 is acknowledged."],"dropped_labels":23},"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/5621-business-secure-plus-proposal-form-and-questionnaire"}