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Motor
Assets all Risk
Fire and Allied Perils
Workmen's Compensation
Money Insurance
Group Personal Accident
Fidelity Guarantee
Liability Policies
Asset All Risk Proposal Form
Motor Insurance Proposal Form
Fire Insurance Proposal Form
Asset All Risk Proposal Form
Asset All Risk Proposal Form
Full Name Of Proposer
*
Enter Name
Email(s)
*
Enter Email
Telephone Number(s)
*
Enter Telephone Number(s)
Property Value
Occupation or Business
Occupation or Business Details
Part A
Description of walls
Roofed with
*
Enter Roofed Details
The purpose of building
Residence
Office
Shop
Factory
Warehouse
Other
Is the tenancy multiple
Yes
No
If the premises form part of the building, which part of the building do you occupy?
Please enter the details of the buildings including the sum to be insured
How are the external windows and doors secured?
For how long have you occupied the premises
PART B
Has the Proposer ever suffered loss or damage by fire or burglary?
*
Yes
No
If so, give details.
Please enter the details of the buildings including the sum to be insured
Is the property proposed for insurance already insured with another Company?
*
Yes
No
Enter Details
Has any Insurance Company or Underwriter ever refused a Proposal from you or cancelled or refused to renew a Policy?
*
Yes
No
If so, give details.
Please enter the details of the buildings including the sum to be insured
PART C
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
If so, give details.
Enter Details
if it must be
done,
it must be
Donewell
.
Donewell
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