All Risk Insurance Proposal Form

This Proposal Form is designed to provide us with much of the information we will need to be able to provide you with a detailed quotation. These notes in Italic will help you provide us with the information we need, but we will of course be pleased to help you if you need assistance.

Any information you give us will remain completely confidential.

General Details

Name of Company

Address

Trade or Business

Phone Number

Fax Number

Period of Insurance

From

Premises Area

Floors Number

How many staff do you employ?

How long has the company been in business?

Material damage

This section will cover your property if any of the Property Insured be accidentally physically lost destroyed or damaged other than by an Excluded Cause. Please supply the following information for each premises from which you operate (see Notes below for help in completing this section)

Address

Premises 1

Premises 2

Premises 3

Nature of Occupation (1)

Premises 1

Premises 2

Premises 3

Construction of

Premises 1

Premises 2

Premises 3

Walls (2)

Premises 1

Premises 2

Premises 3

Roof (2)

Premises 1

Premises 2

Premises 3

Value to be insured for

Premises 1

Premises 2

Premises 3

Buildings (3)

Premises 1

Premises 2

Premises 3

Machinery, Plant, Fixtures & Fittings (3)

Premises 1

Premises 2

Premises 3

Stock in Trade and Raw Materials (4)

Premises 1

Premises 2

Premises 3

Other (pls describe) E.g. Goods belonging to customers

Premises 1

Premises 2

Premises 3

1. Write the name of the Premises land owner? Date of Rental expiry if not owned by the premises owner?

2- Describe the nature of your stock in the

a. Premises Excluding Basement

b. Basement (if any) and of what value

3- Give the number, type and capacity of the fire fighting appliances?

4- What is the distance between the premises and the nearest Fire Department of Civil Defense Unit?

5- Will your premises to be unoccupied for more than 30 consecutive days in any One year?

6- If the premises are not in your sole occupation state how otherwise occupied?

7- Have you ever sustained any loss by fire or any other perils, if so, please give details?

8- Give particulars of any policies in force with any other company covering any of the Property to be insured?

9- Have you ever had a proposal for insurance of any kind or renewal of policy declined, or policy cancelled? if so, give particulars?

Notes to assist in the completion of this section:

1. Please describe the occupation of each building in sufficient detail — for example, "Factory manufacturing cardboard cartons", not just "Factory"

2. Include details of any framework and also part wooden construction.

3. The value to be insured for buildings, machinery, plant and all similar fixed assets should be based on their full cost to replace as new.

4. If you have any stock of precious metals, mobile phones or similar items which are attractive to thieves please give a separate sum insured. Do not include any money or cash under this section.