Donewell Insurance Company Limited

Full Name Of Proposer^*

Email(s)^*

Telephone Number(s) ^*

Property Value

Occupation or Business

Details Of Property

Description of walls

Roofed with ^*

The purpose of building

Is the tenancy multiple

If the premises form part of the building, which part of the building do you occupy?

How are the external windows and doors secured?

For how long have you occupied the premises

Has the Proposer ever suffered loss or damage by fire or burglary?^*

If so, give details.

Is the property proposed for insurance already insured with another Company?^*

Has any Insurance Company or Underwriter ever refused a Proposal from you or cancelled or refused to renew a Policy?^*

If so, give details.

Provide the Values of the properties to be insured below;

The building including domestic offices, garage and outhouse

Stock-In-Trade

Office equipment fixtures and fittings etc

Goods held in trust or commission

Enter Sum to be Insured

Other Property to be insured.

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