SME CombinedProposal

Building Details 1

Location details

Plot No.

Street / Road

Area

Postal Office

Town

County

Earth Quake Zone

Financier Interest

Note : Fire and Burglary sections are mandatory if you wish to apply for this insurance policy.

Note : At least 3 other covers have to be selected.

Construction details

Building name

Building sum insured

No. of storey of including the ground floor.

External walls

Construction roof

Use of building

Are there any ceiling or partition made of canvas or textile ?

How are the building heated?

How are the building lit?

Is the building attached or detached?

How far is the nearest adjoining building?(in meters)

If the nearest building constructed of either stone, concrete or brick ?

Are you the only occupant of the building ?

Does manufacturing take place in this building ?

Manufacturing details

Utilities

Analytical quality control laboratories

Boiler house

Dam

Effluent sewage treatment plant

Electric sub-station

Electric transmission / distribution lines

Pipelines (carrying water only)

Pipelines (others)

Pump house(water)

Pump house(other)

Railway tracks

Roads

Water treatment plant

Wireless transmitting stations

Is any power driven machinery used in this building ?

Provide details of power machinery

Are any hazardous goods kept within the building ?

Description of an item

Make

Model

Serial Number

Value

Add

Do you wish to cover goods held in the open premises ?

If yes, Value of goods held in open premises

Do you receive rental income from the building?

If yes, Rental amount (monthly)

If yes, Are they locked in a fire resistant safe or removed from the premises after business hours?

Do you wish to purchase electrical clause-II extension ?

Do you wish to purchase electrical clause-III extension ?

Business Interruption

Loss of Gross Profit

Standard charges

Loss of rental income

Increased cost of working

Do you require indemnity period cover?

Electronic Equipment

Description of Item

Make

Model

Serial Number

Value

. External Data Media

Data media

Type

Quantity

Value

Expenses for reconstruction and restoration of information

Total Sum Insured

Do you require indemnity period cover?

Item name

Make

Model

Serial number

Sum insured

Description of Stock

Make

Model

Serial Number

Value

Description of an item

Make

Model

Serial Number

Value

Description of an item

Make

Model

Serial Number

Value

Description of an item

Make

Model

Serial Number

Value

Description of an item

Make

Model

Serial Number

Value

Description of an item

Make

Model

Serial Number

Value

Description of an item

Make

Model

Serial Number

Value

Do you require hold up extension?

Do you require Hijack extension?

Do you require Riot and strike extension?

Glass details

No Banding, Letting, Embossing, Gilding, Silvering or any Ornamental work is insured unless stated herein and provided for in the policy.

Length

Width

Thickness

Number of Pieces

Sum Insured

Remove

Do you require Riot and Strike extension?

Details Of Employee To Be Guaranteed

Employee Details

Position/Name

Designation

Length of Service (in Years)

No. of Employee

Amount per event per person

Per Capita

Selection of Goods

How are the goods being transported?

Any one Carry

Estimated Annual Carry

What is the basis of valuation of the Goods?

Description of Property/Goods?

How will the goods be packaged whilst Transporting?

Political Violence and Terrorism

Hold Up and Hijack Extension

Selection Of Goods

How are the goods being transported

Any one Consignment

Estimate Annual value of Goods in Transit

Owned

Hired

Political violence and terrorism

Hold Up and Hijack extension

Work Injury Benefit Act (WIBA)

Occupation

No Of Employees

Type of Income

Estimated Salary (Per Employee)

Estimated Annual Salary (Per Employee)

Total Earnings

Remove

Employer’s Liability

	Any One Person	Any One Occurrence	Any One Year
Option A	2000000	10000000	20000000

Group Personal Accident

Group Name

No. Of Members in Group

Benefit Details of Group (Combined for all members)

Death

Permanent Total Disability

Temporary Total Disability

Medical expenses

Artificial Appliances

Hospital Cash Allowance

Last Expense

Evacuation Limit

Remove

Would you like an extension of cover at 25%

Specifications of Machinery to be replaced

Description of Item

Item number

Use of machine

Full description

Year of Manufacture

Give particulars of any part of the machinery to be insured which has had a break- down or failure during the last three years, which shows any signs of repair, or which is exposed to any special risk

Replacement Value

Remove

Extensions

Do you wish to cover the following?

Riot and Strike

Air Freight

Overtime

Night Work

Work on Public holidays

Surrounding property

Internal Fire

Loss of Content

Hull Risk

Third Party Liability

Escalation

Political Violence and Terrorism

Business Interruption

Electronic Equipment

Equipment Insured	Limit of Indemnity		Sum Insured
	Per Day	Per Month
Rental of Substitute Electronic Data Processing Equipment
Personnel Expenses
Expenses for Transport of Materials
			Total Sum Insured

SME Combined Quotation

Personal Details

Period of Insurance

Building Details 1

Location details

Construction details

Utilities

Coverage Details

Stock in Trade

Machinery and Tools

Office Furniture

Interior Fixtures

Goods in Trust

Unused Stationary

Others

Electrical Clause Extension

Business Interruption Section

Electronic Equipment Section

Material Damage

Do you want external data media?

. External Data Media

Data media

Do you want increased cost of working (ICOW)?

Increased Cost of Working (ICOW)

All Risk Section

Burglary Section

Coverage Details

Stock in Trade

Machinery and Tools

Office Furniture

Interior Fixtures

Goods in Trust

Unused Stationary

Others

Money Section

Limit of Liability

Plate Glass Section

Glass details

Fidelity Guarantee Section

Details Of Employee To Be Guaranteed

Employee Details

Goods in Transit Section

Limit of Liability

Carriers Liability Section

Public Liability Section

WIBA Section

Employee Details

PARTICULAR OF INSURANCE *

Group Personal Accident Section

Benefit Details of Group (Combined for all members)

Machinery Breakdown Section

Specifications of Machinery to be replaced

Description of Item

Extensions

Do you wish to cover the following?

Political Violence and Terrorism Section