ZKGI Renewal Info Page

Welcome

Kindly review and confirm your renewal details for policy number

Product Name

XXXXXXXX

Proposal Number

XXXXXXXX

Customer ID

XXXXXXXX

RID

XXXXXXXX

Sum Insured

XXXXXXXX

Premium`XXXXXXXX

GST`XXXXXXXX

Net Premium`XXXXXXXX

Review Proposal Details

New Policy Details

Policy Effective Date: -

Policy End Date: -

Policy Term: -

Policy Type: -

Partner App.No: -

Quote Number: -

Proposer Details

Customer Id: -

Customer Name: -

Mobile Number: - -

Email Address: - -

Date of Birth: -

Pan Number: - -

Mailing Address: -

E-IA Required

Insurance Repository

E-IA Number

I hereby agree and allow Zurich Kotak General Insurance to share my data including PAN Card or Aadhaar card (last 4 digit) with the concerned “e-Insurance Account Repository” for opening the e-Insurance Account. I also understand that Insurance Repository may connect with me for completion of any formalities required for opening the account

Member Details

Sr. No.	Name	Age	Relationship	Sum Insured

Nominee Details

Nominee: -

Relationship with insured: -

Nominee DOB: -

Appointee (only if nominee is minor): -

Appointee Relationship: -

Auto renew the policy in the name of policy holder before it expires as per renewal mandate

Proposal Details

Payment Details

Proposal Number: -

Total Premium: -

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Account Card

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