Deterioration of stock in cold storage Insurance Form

Proposer is

ownerlessorlesseetenant

of the storage house

Period of insurance from:

Period of insurance to:

Cold storage house in operation

all the yearmonths in the year

Insulation

corkmineral woolfoam plastic

date of last check

date of last replacement

Alternative storage facilities

YesNo

Have these facilities been used in earlier instances?

YesNo

Refrigerating plant

Does a machinery breakdown policy exist?

YesNo

Is swichover from one unit to the other possible?

YesNo

If yes, attach basic circuit diagram (sketch)

Attach Documents

Refrigerant

NH3Freon 22Freon 21Other

Pipes carrying refrigerant are

on the ceilingon the wallson the floor

Supervision

by own staffby governmentby other

Maintenance

irregularregular at intervals of 3 months6 monthsother

Maintenance is carried out by

manufacturerlessorown staffmaintenance firm

Control and alarm system

Total number of measuring devices for

Is there also an independent calibrated reference thermometer in each cold-storage room?

YesNo

Check intervals (hours)

are there different arrangements for weekends or holidays

YesNo

Signalling devices

Installed to show disturbance or failure of the plant?

YesNo

If yes, alarm is given

AudiblyVisibly

Maintenance is carried out

irregularlyregularly at intervals of months by

Controlled atmosphere storage

Can the cold-storage rooms be entered and inspected while in use?

YesNo

Is the condition of the goods checked during storage?

YesNo

Power Supply

Is failure of power supply to be insured

YesNo

Public power supply

by ring mainby single dead-end feederby double dead end feeder

laid

undergroundoverhead

Own power supply

Interruptions of more than 2 hours in the last two years?

YesNo

Is operational standby generating equipment available at anytime, which can produce the electrical capacity required when the cold storage house is fully stocked?

YesNo

Goods to be insured

Note: The "No-claims period" is the period (eg. 12, 24, 48 hours or more) during the goods stored cannot under any circumstances
deteriorate due to a rise in temperature as a consequence of damage indemnifiable according to the conditions of a Machinery Breakdown policy
and/or failure of power supply. The "no-claims period" depends fundamentally on the type and quantity of goods stored and on the
specific features of the cold-storage insulation used.

#Estimated maximum selling price for the goods.

Goods are: SortedPacked

Declaration:

We hereby declare the statements made by us in this proposal are,
to the best of our knowledge and belief, complete and true and we hereby agree that
this proposal forms the basis and is part of any policy issued in connection with the above risk(s).

Specification of refrigeration plant

NOTES:

1. (Description of items column) Please give full description of all items including name of manufacture, type, cooling capacity, speed, pressure, etc..

2. (Remarks column) Please give details of spare units or spare parts available, internal repair facilities, replacement period, etc..

3. (Replacement value column) Please state the current cost of replacing the equipment by new equipment of the same kind and capacity plus freight charges, custom duties, costs of erection

Deterioration of stock in cold storage Insurance Proposal