Money | FBIA

Personal Details

Risk Details

General Policy Details

Personal Details

Proposer Type

Bank Assurance Officer

Select Intermediary branch

Insurance Company

ID Type

ID Number

KRA Pin

First Name

Middle Name

Last Name

Type of Business

Occupation

Date Of Birth

Gender

Male Female

Contact Details

Mobile No.

Telephone No.

Email Address

Postal Address

Postal Office

Town

County

Region

Earth Quake Zone

Physical Address

Which FBBI branch do you want to be served from?

Do you have a Fire Industrial from FBIA?

Insurance cover period

Start Date

End Date

Risk Details

Name of Building

Plot Number

Name of Street

Area/Estate

City/Town

County

State the type of premises where the business is carried out

Please Specify

Nature of Business

What are your usual business hours?

Start Time

Closing Time

Will the premises be guarded during and after business hours?

Please provide the name and address of the security firm

Are the premises fitted with alarm system?

Please provide the name and address of the security firm giving back up services.

Particular of Safe

Do you require cover for cash contained in a locked safe or strong room?

Provide details of safe(s)/strong-room(s) the money is kept during and after business hours

Make of Safe or Strong Room

Type

Size

Weight

Where will it be kept?

How is the safe secured and/or anchored?

Transit Details

Describe how the money is conveyed

By Employees

By Security Firm

Police Escort

Other

Note: The transit cover is subject to an escort/transit warranty, a specimen wording of which is available on request.

Please specify

Do you have any Fidelity Guarantee policy?

State the Limit of Liability

What precautions are taken for the safety of the money in regard to character of employees on engagement

Limit of Liability

Money in Transit from premises to bank and vice versa.

Money in the Insured’s premises during business hours.

Money in the Insured’s premises out of business hours securely locked in cabinet/ drawer

Money in the hands of and or at the residences of the Insured’s principals or authorized employees

Money in the hands of sales persons/drivers and /or other employees authorized to collect sales money/proceeds

Money in locked safe or strong rooms

Damage to safe or strong-room

Estimated Annual Carry

Do you require hold up extension?

Hold-up extension Sum Insured

Do you require Hijack extension?

Do you require Riot and strike extension?

Riot and Strike extension Sum Insured

General Policy Details

Are you now or have you ever been insured for this type of policy ?

Has any insurance company ever

Declined your proposal ?

Cancelled or refused to renew your policy?

Required an increased premium or imposed special conditions?

Declined your claim?

Insurance and Loss History

Please provide below information on any insurance claims you have reported in the last 5 years

Type of loss

Year of Incident

Claim Amount/ Value

Add Loss

DECLARATION | Please Read Carefully *

I/ We do hereby declare that the above answers and statements are true and that I/ We have withheld no material information regarding this proposal. I/ We agree that this declaration and the answers given above as well as any proposal or declaration or statement made in writing by me/ us or anyone acting on my/ our behalf shall form the basis of the contract between me/ us and the Company. I/ We further agree to accept indemnity subject to the conditions in and endorsed on the Company’s policy.

CREDIT INFORMATION | Please Read Carefully *

I/we do hereby confirm that I/we have authorized Family Bank Insurance Agency to share my/our credit information and to access my/our credit profile from Credit Reference Bureau (C.R.B)

Money Proposal

Personal Details

Contact Details

Insurance cover period

Risk Details

Limit of Liability

General Policy Details

Has any insurance company ever

Insurance and Loss History

DECLARATION | Please Read Carefully *

CREDIT INFORMATION | Please Read Carefully *