Electronic Equipment Insurance Proposal

Steel Skeletonbrickworkconcrete



Condition of equipment


Quality of staff



bodies of watertorrential rainfallsewer backflowother


acidsprepared or sensitized paperslyestest solutionsdevelopersexplosivesisotopesothers

We hereby declare that 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).


1. Please give full and exact description of all equipment in column 2 including same of manufacturer, type, serial number, voltage, power, input, etc. in the case of outdoor lines, indicate length and method of laying.

2. Under column 4 please give particulars of any part of the equipment to be insured which has had a breakdown or failure during the last three years, In the case of mobile equipment, state means and frequency of transport, areas of operations and distances.
Please State if picture or admitted tubes are built in.

3. Replacement value in column 5 must be calculated on the current cost of replacing the equipment by new equipment of the same kind plus freight charges, custom duties, costs of erection, packaging material.

4. For the insurance of electronic data processing (EDP) equipment, and additional questionnaire for EDP equipment has to be completed.