Hazards of earthquake, volcanism, tsunami
Estimate, if possible, the probable maximum loss, expressed as a percentage of the sum insured, in a single occurrence.
Do you wish cover to include extra charges (in case of loss) for
express freight, overtime, night work, work on public holidays?
Items to be insured
Please indicate limits of indemnity required for the following perils:
1. Limit of indemnity in respect of each and every loss damage and/or series of losses or damage arising out of any one event.
2. Limit of indemnity in respect of any one accident or series of accidents arising out of one event.
Risk
Limits of indemnity (1)
Insured items
Limits of indemnity(2)
We hereby declare that the statements made by us in this Questionnaire and Proposal are, to the best of our knowledge and belief, complete
and true, and we hereby agree that this Questionnaire and Proposal forms the basis and is part of policy issued in connection with
above risk it is agreed that the insurers are liable in accordance with the terms of Policy only and that the Insured will not
lodge any other claims of what ever nature.
the Insurers undertake to deal with this information in strict confidence.