Please complete the following
Type of Storage
If "Outside Contractor", name of contractor
Please list five year loss history.
This must include, Type of loss, Cause of Loss, Date of Loss and Total Monetary Value of Loss
What preventative measures have been enacted to prevent re-occurrence?
Risk Information & Values
Address of Property to be Insured
Occupation / Main Function
Machinery, Equipments & Tools
Stock (Finished or Raw Materials)
Coverage Extensions Required
Cash In Safe
Tenants & Neighbors Liability
Customer's/ Suppliers Contingent Cover
Photos are required with submission of this application form.
DECLARATION: 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)