Machinery breakdown insurance

Fax. No
Has any of the machinery to be insured previously?
Been covered by other companies?
Do you have any other machinery not included in this proposal
Do you wish to insure the foundations of the machinery?
Do you wish the cover to include extra charges?
Express frieght, overtime, night work, work on public holidays?
(In case of loss) for: air freight

Limit of indemnity for airfreight:

Has your machinery sustained any damage from breakdown or other cause during last 3 years? YesNo

Maintenance of Machinery

Is the last statutory report / certificate up-to-date and satisfactory

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 my policy issued in connection with the above risk(s).

1- Please give full description of all machines inluding name of manufacturer, type, capacity, speed, load, weight, voltage, amerage, cycles, fuel, pressure, temperature, etc..

2- Replacement value must be calculated on the current cost of replacing the machine by new machinery of same kind.

3- If you also wish to cover the foundations, declare the value of foundations separately for each machine.

4- If any of the machines is a "stand-by", by the same should be identified in the following schedule.

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