HOMEOWNERS & HOUSEHOLD CONTENTS INSURANCE PROPOSAL FORM
|
|
- Pierce Gardner
- 8 years ago
- Views:
Transcription
1 PLEASE ANSWER ALL QUESTIONS FULLY; WHERE QUESTIONS DO NOT APPLY, PLEASE INSERT N/A. PROPOSER INFORMATION (Photo Identification and Proof of Address required) 1. First Name: 2. Middle Name: 3. Surname: 4. Date of Birth: 5. Place of Birth: 6. Nationality: 7. Gender: TRN: 8. Home Address: 9. Mailing Address: 10. Work/Business Address: 11. Address: 12. Home Phone #: 13. Mobile #: 14. Work Phone#: 15. Type of Identification: 16. Identification Number: 17. Expiry Date of Identification: 18. Occupation/Type of Business: (Describe in full and be specific; avoid vague terms like Businessman, Director ) 19. Name and Place of Employment: 20. Do you have any other type of insurance with JNGI? Yes No If Yes, give details: 21. Are you a Director of any company insured with JNGI? Yes No If Yes, give details: 22. Have you or any relative or close associate been entrusted with Yes No If Yes, give details: prominent public function (e.g. Politician, Senior Government, Judicial or Security Force Officials) in any country? 23. To the best of your knowledge, are you or any close relative (spouse, Yes No If Yes, give details: children, parents or siblings) connected in any way (personal or business) to JNGI or any other member company within the Jamaica National Group)? 24. Period of Insurance: From: To: 25. Source of Funds (used for paying the Insurance Premium): ADDITIONAL PROPOSER INFORMATION (IF PROPOSER IS AN ENTITY) 26. Name of Chief Executive Officer: 27. Name of Contact Person/Authorized Signatory for the Entity: 28. Contact s Relationship to Insured: 29. Contact s Address: 30. TRN: 31. Type of ID: 32. ID Number: 33. ID Expiry Date: 34. Names and Addresses of Shareholder(s) with 10% or more shareholding: Name Address 1) 2) 3) 35. Names and Addresses of Directors: Name Address 1) 2) 3) NB: Copy of Certificate of Incorporation for the Entity is required Form #: JNGI-HSC-PROP-v1-Oct of 6
2 THE BUILDING AND OR CONTENTS TO BE INSURED 36. Address of Apt #: Street #: Street Name: Town/ District: Post Office/Agency: Parish: the Home 37. In what year was the Building constructed? 38. # of Storeys: 39. Geo Code: 40. Building Sq.Ft.: 41. Is there a Mortgage on the Building? Yes No If Yes, give Name and Address of Mortgagee. 42. Will the Building be left unoccupied for any consecutive Yes No If Yes, give details: period of more than 60 days? 43. Is/Are the building/s in good condition and will it/they Yes No If No, give details: be so maintained? 44. Are any Business goods stored in the Building? Yes No If Yes, give details: 45. Is the Building used for any business or profession of Yes No If Yes, give details: any kind? 46. Has any loss or damage been sustained in the last 3 years Yes No If Yes, give details: on this property? 47. Is this a Waterfront Property? Yes No If Yes, state distance from the waterline: 48. Does the Building have any of the following security features? Yes No If Yes to any of these questions, give details where appropriate. a) Burglar Alarm b) Burglar Bars c) Watchman d) Panic Buttons e) Dogs f) Security Guards (Name the Company) g) Gated Community h) Neighbourhood Watch i) Fire Extinguishers j) Smoke/Heat Detectors k) Hurricane Shutters l) Other (Please specify) 49. Is the Building? Yes No a) A Private Dwelling House b) A Townhouse c) A Self-contained Flat with separate entrance under your exclusive control or that of your immediate family d) An Apartment or Rooms to which occupants other than your immediate family have access 50. Is the Building? Yes No If Yes to c) to f), give details. a) Owner Occupied b) Occupied by Tenants c) Rented by you from someone else d) Rented out on a short term basis e.g. for 6 mths e) All or a part of a Strata Plan f) All or part of a building which exceeds 5 storeys 51. Is the Building exposed to any of the following hazard? a) Flooding b) Landslip c) Hurricane d) Earthquake e) Other Yes No If Yes, give details Form #: JNGI-HSC-PROP-v1-Oct of 6
3 52. Has any Insurer refused to insure you or imposed any special conditions 53. Has any Insurer refused to insure the Building or imposed any special conditions Yes No If Yes, give details Yes No If Yes, give details CONSTRUCTION 54. What is the Building constructed of? a) Block and Steel b) Precast Concrete c) Spanish Walls (stone and mortar) d) Nog e) Brick f) Cut-stone g) Timber h) Other (Specify) Walls a) Reinforced Concrete (poured or precast) b) Cement, Spanish, Clay Tiles c) Slates d) Zinc Sheets e) Alu-Steel f) Corrugated Asbestos g) Decra-bond, Mastic Tiles h) Timber Shingles i) Timber Sarking covered with Felt and/or Paroid j) Aluminium Sheet or Shingles k) Continuous Aluminium (any profile) l) Fiberglass Shingles m) Thatch n) Other (Specify) Roof SUMS TO BE INSURED 55. BUILDINGS AND STRUCTURES: a) Main Building b) Domestic Outbuilding c) Boundary Walls (excluding Retaining Walls) d) Retaining Walls/Sea Walls e) Gates, Fences, Hedges f) All Landlord Fixtures and Fittings g) Solar Water Heaters h) Solar Panels i) Air Conditioning Units j) Awnings k) Paved Areas l) Gazebos Radio and Television Aerials and Antennae (other than Satellite Dishes) m) Satellite Dishes n) Generators o) Swimming Pool (including Pool Deck, Pump House, related pipes and fixed pool accessories) p) Water Tanks q) Other (Describe) NB: - The Building Sum Insured must be based on the cost of rebuilding or replacing and not the Market Value; JNGI recommends that you obtain a professional valuation to establish your Building Sum Insured - Claims are settled on a Replacement Basis, provided the sums insured are adequate and the insured items are maintained in a good state, in keeping with the Terms and Conditions of the Policy - You are required to sign the attached Average Clause before JNGI can enter into an insurance contract with you. Sum Insured ($) Form #: JNGI-HSC-PROP-v1-Oct of 6
4 56. CONTENTS: Sum Insured ($) a) GENERAL CONTENTS - All household goods, electronic equipment and personal belongings, owned by the Proposer or for which the Proposer is responsible while they are in the Building described above. b) SPECIFIED CONTENTS If any item(s) included in the Sum Insured under General Contents at 57. a) above, is/are individually of a value greater than 5% of the total Sum Insured on the said General Contents (items like Jewelry, Paintings, Sculptures, Cameras, Curios, and the like, Audio and Video Equipment, Televisions, Computers and Accessories, External and Internal Components of Satellite Receiving Systems, C.B. Short Wave and Two-way Radio Systems, and so on), please list them below; you may continue on a separate sheet of paper if necessary. NB: For items not specified below, the Limit is 5% of the Sum Insured on General Contents for any one item with a maximum Limit of 1/3 rd of the Total Sum Insured on General Contents for all such items combined. Specified Contents to be Insured Description/Serial # Sum Insured ($) 57. ALL RISKS: List below all individual items which you wish to insure against Accidental Loss or Damage, in addition to the standard perils covered under this policy. Please continue on a separate sheet of paper if necessary. Sums Insured on All Risks items must not be included in the Contents Sum Insured at 55. above. Please note that Valuations or Purchase Receipts will be needed for items valued over $5, Items to be Insured Description/Serial # Portable Items: (e.g. Jewelry, Eye Glasses & Contact Lenses; Sporting & Photographic Equipment; Portable Computers; Cellular Phones, and so on) Jamaican or Worldwide Cover Sum Insured ($) Fixed Items: (e.g. Paintings & Works of Art; Cups & Trophies; Personal Computers & Peripheries; Satellite TV Equipment (internal & external); Television; VCR & DVD; Compact Disc, and so on ) 58. Does the Total Sum Insured for Goods under Specified Contents and All Risks combined, exceed 1/3 rd of the Sun Insured on General Contents? REFEREES (Applicable to Individual Proposers) Form #: JNGI-HSC-PROP-v1-Oct of 6
5 Name: Name: Address: Address: Telephone #: Telephone #: Occupation: Occupation: DECLARATION OF THE PROPOSER I/We warrant that: - The above statements and particulars which I/We have read and checked are true - I/We have not suppressed or misstated any fact - The vehicle(s) referred to above is/are in good condition and repair I/We desire to effect insurance in accordance with the terms, conditions and exceptions of the Company s standard policy. I/We agree that this Proposal shall form the basis of the Contract between me/us and the Company and shall be deemed as incorporated in the policy to be issued. I/We further declare and agree that if the above statements and particulars have been filled in by a person other than the undersigned, such person shall be deemed to be my/our Agent for the purpose of filling in this Proposal Form. I/We agree to my/our personal information being shared with JNGI s parent company and/or any of JNGI s fellow subsidiaries. I/We further agree that JNGI may record and store all information on my/our account in such form and means it deems fit including use of the services of its parents or fellow subsidiaries and affiliates or any electronic data processing service provider. Signature of Proposer: Date: NB: - If you are signing on behalf of a Company, state the capacity in which you are signing and affix the Company stamp. - At the inception of the insurance, your Policy may not be immediately available and so you may request a Specimen of the Policy in addition to any Explanatory Notes. - All outstanding premiums become payable in the event of an accident or any incident that may give rise to a claim being made against this insurance. Form #: JNGI-HSC-PROP-v1-Oct of 6
6 Notice to Insured on the Nature and Effect of the Pro Rata Condition of Average (Average Clause) in Accordance with the Insurance (Amendment) Regulations 2004; Regulations 126 (4) and (5) of the Insurance Act Name of Proposer(s): Dear Proposer(s), Please note that any property that is insured or to be insured under the policy mentioned above is subject to the Pro-rata Condition of Average (Average Clause). This means that, under certain circumstances, if the property covered under this policy is, at the time of any loss or damage from an insured peril, of greater value than the sum for which the property is insured, you will only be entitled to recover under this policy such proportion of the loss as the Sum Insured under this policy bears in relation to the total value of the property. You are said to be under-insured because the sum insured at the time of the loss is less than the actual value of the insured property and so a part of the insured loss will not be covered under this Policy. In this case, you are considered as being your own insurer for the part of your loss, which is not covered under this policy. For example, should you have a property which has a value of $10,000,000 and you decide to insure for $7,000,000 and you suffer a loss from an insured peril, there are three possible scenarios depending on the size of the loss. The formula that is applied in each case is as set out below. Sum Insured x Amount of the Loss = Amount Recoverable Value 1 1 Example 1 Where the loss is less than value and less than Sum Insured: Assume the loss is $5,000,000 7,000,000 x 5,000,000 = 3,500,000 10,000, You will be paid $3,500,000 or 70% of your loss less any deductible stated in the policy. Example 2 Where the loss is less than value but greater than Sum Insured: Assume the loss is $8,000,000 7,000,000 x 8,000,000 = 5,600,000 10,000, You will be paid $5,600,000 or 70% of your loss less any deductible stated in the policy. Example 3 Where the loss is equal to the value: Should you have a total loss, that is, $10,000,000 then you will only receive the amount you insured the property for that is, $7,000, less any deductible stated in the policy. However, in respect of Home Owners Comprehensive policies on Private Dwellings and / or Contents contained therein, you may be entitled to the full amount of the insured loss if the Sum Insured is equal to or more than 85% of the value. This will depend on the terms of your Policy. Please review the terms of your policy carefully, including checking on the adequacy of the sum for which the property is insured or is to be insured. This will enable you to identify whether you are or will be under insured in a manner, which will cause the Pro-rata Condition of Average to be applied. You may check with your insurer, agent or broker for further clarification on the terms of your policy and the nature and effect of the Pro-rata Condition of Average contained therein. This notice is given to you in fulfillment of the legal requirement to provide you with information on the nature and effect of the Prorata Condition of Average stated in your policy/ to be inserted in the policy of insurance mentioned above. Please note that the extent to which the condition applies is governed by the terms of your policy. Signed by Insurer:... Signature of Proposer:. Date:. Form #: JNGI-HSC-PROP-v1-Oct of 6
www.butterfieldgroup.com
Home Insurance P.O. Box 705 Grand Cayman KY1-1107, Cayman Islands www.butterfieldgroup.com Heritage HomeCover Proposal CUSTOMER INFORMATION Please answer all questions fully Please note that you must
More informationINSURANCE PROPOSAL FORM
INSURANCE PROPOSAL FORM NOTE: Please fill in this form carefully. We will use the information you give on this form to decide whether we can insure you and to decide the premium and the conditions of insurance.
More informationPROPOSAL FORM FOR HOME INSURANCE
United Insurance Company PSC PROPOSAL FORM FOR HOME INSURANCE IMPORTANT NOTES Filling and signing this application form does not automatically result in a contract. Insurance becomes in force once United
More informationme Insurance Proposal for Home Insurance Home Insurance Proposal for Proposal for COSMOS INSURANCE COMPANY PUBLIC LTD HEAD OFFICE
Proposal for Proposal for Proposal for Home Insurance Home Insurance me Insurance COSMOS INSURANCE COMPANY PUBLIC LTD HEAD OFFICE 46, Griva Digeni Avenue, 1080 Nicosia, P.O.Box 21770, 1513 Nicosia Tel:
More informationN.E.M. INSURANCE COMPANY (JAMAICA) LIMITED MOTOR INSURANCE PROPOSAL FORM
N.E.M. INSURANCE COMPANY (JAMAICA) LIMITED MOTOR INSURANCE PROPOSAL FORM Please complete this form fully and carefully, Bear in mind the declaration to be signed below any mis-statement could render the
More informationHow To Write A Home Protection Insurance Policy
Argus Insurance Agencies Limited La Concorde Tel: +356 2342-2000 Triq Abate Rigord Fax: +356 2342-2190 Ta Xbiex XBX 1121 home@argus.com.mt www.argus.com.mt THE NEW HOME PROTECTOR EXTRA INSURANCE PROPOSAL
More informationHome Insurance www.butterfieldbank.ky Butterfield House 68 Fort Street P.O. Box 705 GT Grand Cayman Cayman Islands
Home Insurance About Your Plan Butterfield Bank is a leading financial institution in the Cayman Islands. We offer a comprehensive range of private and commercial banking services to our customers. We
More informationHoliday Home Insurance PROPOSAL FORM
Holiday Home Insurance PROPOSAL FORM Holiday Home Insurance Summary of Cover available There are conditions, limitations, exclusions and excesses within the wording a copy of which will be provided on
More informationUnoccupied Property Insurance Proposal Form
Unoccupied Property Insurance Proposal Form This proposal form is not for use by Consumer Customers It is essential you provide us with ALL MATERIAL FACTS. Failure to disclose any material facts may invalidate
More informationProperty Owners Insurance Proposal Form
Property Owners Insurance Proposal Form This proposal form is not for use by businesses or Commercial Entities If you do not answer any questions honestly, accurately or withhold information we may refuse
More informationProperty Owners Insurance Proposal Form
Property Owners Insurance Proposal Form This proposal form is NOT for use by Consumer Customers It is essential you provide us with ALL MATERIAL FACTS. Failure to disclose any material facts may invalidate
More informationLandlord Underwriting Guide
Landlord Underwriting Guide Definitions/Excesses The Allianz Landlord Insurance Policy is designed for people who own individual properties or for those who own multiple properties. The Policy provides
More informationQBE HOME Cover HOME PROTECTION INSURANCE
QBE HOME Cover HOME PROTECTION INSURANCE for Home Basic for Building for Contents for Home Plus for Building for Contents for Valuables for Domestic Workers' Compensation for Personal Liability Please
More informationHOME INSURANCE APPLICATION FORM
HOME INSURANCE APPLICATION FORM Sesame Insure ref no: Firm name: Please complete this form, remembering to sign and date the Declaration at the end. Write in capital letters and tick the boxes as appropriate.
More informationLandlords Insurance. Application
Landlords Insurance Application Landlords Insurance Application Form Important Information Product Disclosure Statement This application is for Australian Unity Landlords Insurance. Please read the product
More informationHome Insurance Proposal Form
Home Insurance Proposal Form Section 1: Personal Details Proposer Joint Proposer/Partner Title: Full Name: Correspondence Address: Postcode: Date of Birth: Occupation: Nature of Business: Day Time Telephone:
More informationUnoccupied Property Insurance Proposal Form
Unoccupied Property Insurance Proposal Form This proposal form is NOT for use by Consumer Customers It is essential you provide us with ALL MATERIAL FACTS. Failure to disclose any material facts may invalidate
More informationHome Insurance Questionnaire Republic of Ireland
Home Insurance Questionnaire Republic of Ireland Home Insurance Policy Republic of Ireland Questionnaire There are conditions, limitations, exclusions and excesses within the wording, a copy of which will
More informationPROPERTY OWNERS INSURANCE PROPOSAL
PROPERTY OWNERS INSURANCE PROPOSAL Please use BLOCK CAPITALS and tick boxes where applicable. Where requested enter further details in the space provided. If there is insufficient space please continue
More informationCamberford Law plc COMMERCIAL COMBINED PROPOSAL FORM (EXCLUDING LIABILITIES) Innovative Insurance Solutions Since 1958
A UNIQUE AND COMPREHENSIVE INSURANCE SCHEME FOR THE CLEANING INDUSTRY COMMERCIAL COMBINED PROPOSAL FORM (EXCLUDING LIABILITIES) Camberford Law plc Innovative Insurance Solutions Since 1958 Insurance Brokers
More informationProperty Owners Proposal Form
Property Owners Proposal Form When completing this Proposal Form, ALL sections of the form must be completed. You must disclose all material facts (i.e. information likely to influence the underwriters
More informationSteadfast Extra Care Home and Contents Insurance Application
Steadfast Extra Care and Steadfast Elite Care Home and Contents Insurance Application Steadfast Extra Care and Steadfast Elite Care Home and Contents Insurance Application Form IMPORTANT NOTICES Product
More informationTOGETHER WE CAN FIGHT FRAUD
HOME PROPOSAL FORM Please complete in BLOCK CAPITALS throughout and tick or in the appropriate boxes. 1. Personal Information Title (Mr, Mrs, Miss or other) Full Name I.D Card No. or Passport No. Date
More informationHome Insurance Choices Proposal Form.
Home Insurance Choices Proposal Form. This policy is provided and administered by Legal & General Insurance. Points to remember when completing this form: You need to fully complete all the sections on
More informationOverseas 606 Home Insurance Proposal form
Please read the following questions carefully and answer them all providing additional information where required. If you need more space, please provide answers on a separate sheet of paper, clearly highlighting
More informationPRO. ProSurance PRO Application Form INSURANCE FOR PROFESSIONALS
PRO INSURANCE FOR PROFESSIONALS ProSurance PRO Application Form This is an application for an Errors and Omissions package policy aimed at a wide range of small and medium-sized professionals. As well
More informationLandlords Buildings & Contents Insurance
Landlords Buildings & Contents Insurance NW Brown Insurance Brokers Landlords policy has been designed to offer a comprehensive buildings and contents insurance. We provide in-house and claims administration
More informationCamberford Law plc PROPOSAL FORM. Innovative Insurance Solutions Since 1958
A UNIQUE AND COMPREHENSIVE INSURANCE SCHEME FOR UNOCCUPIED PROPERTY PROPOSAL FORM Camberford Law plc Innovative Insurance Solutions Since 1958 Insurance Brokers Underwriting Agents Authorised and Regulated
More informationHOUSEHOLD INSURANCE PROPOSAL FORM
HOUSEHOLD INSURANCE PROPOSAL FORM Please read the following questions carefully and answer them all providing additional information where required. Should you require more space please provide answers
More informationHome Insurance Proposal Form
Home Insurance Proposal Form Agent s Name Agent s Number Policy Number te: Please use BLOCK CAPITALS, insert YES or NO where appropriate and initial amendments. Personal Details 1st Proposer Title (Mr,
More informationJelf Group plc OVERSEAS PERSONAL INSURANCE PROPOSAL FORM
Jelf Group plc OVERSEAS PERSONAL INSURANCE PROPOSAL FORM effected with Lloyd's through Jelf Insurance Brokers Ltd Clarendon House, 59/75 Queens Road, Reading, RG1 4BN. Tel 44 (0) 118 983 9943/4 Fax 44
More informationTECHNOLOGY COMPANY INSURANCE APPLICATION
TECHNOLOGY COMPANY INSURANCE APPLICATION HOW TO COMPLETE THIS FORM Whoever fills out the form must be a principal, partner or director of the applicant firm and should make all the necessary enquiries
More informationCPM. Application Form INSURANCE FOR CYBER, PRIVACY & MEDIA RISKS
CPM INSURANCE FOR CYBER, PRIVACY & MEDIA RISKS Application Form This is an application for a cyber, privacy and media liability package policy aimed at a wide range of companies and professionals. CPM
More informationHOME INSURANCE PROPOSAL FORM HOME INSURANCE PROPOSAL FORM
Allied Cooperative Insurance Group (ACIG) شركة املجموعة املتحدة للتاأمني التعاوين ) أ سيج( Call us: 920012331 www.acig.com.sa When completing this Proposal Form... - Please answer all questions giving
More informationCommercial Property Insurance Proposal Form
Please use BLOCK CAPITALS and answer all questions in full Commercial Property Insurance Proposal Form Salisbury House, 81 High Street, Potters Bar, Herts. EN6 5AS Tel: 01707 291 200 Fax: 01707 291 202
More informationTECH. Esurance TECH Proposal Form INSURANCE FOR TECHNOLOGY COMPANIES
TECH INSURANCE FOR TECHNOLOGY COMPANIES Esurance TECH Proposal Form Esurance TECH is an insurance package designed specifically for the technology sector. The policy includes professional indemnity, products
More informationP A L L A D I U M H o m e I n s u r a n c e P r o p o s a l F o r m
P A L L A D I U M H o m e I n s u r a n c e P r o p o s a l F o r m P R O V I D I N G P E A C E O F M I N D The Proposer You must take reasonable care to provide complete and accurate answers to all questions.
More informationSecurus Insurance Limited. Property Owners Proposal Form
Securus Insurance Limited Property Owners Proposal Form Securus Insurance Limited Unit C2, Airside Enterprise Centre Swords Co Dublin Phone (01) 8074550 Fax (01) 8074553 Email info@securus.ie Web www.securus.ie
More informationPROPOSAL FORM. D D M M Y Y Y Y D D M M Y Y Y Y RAINBOW HOME INSURANCE. Points to remember when completing this form: AGENT APPLICANTS
RAINBOW HOME INSURANCE PROPOSAL FORM. Points to remember when completing this form: You need to fully complete all the sections on this form using BLOCK CAPITALS, which we use to determine whether to offer
More informationFLATS INSURANCE. Proposal Form November 2004 Edition
FLATS INSURANCE Proposal Form vember 2004 Edition Completing the Proposal Form To apply for the Flats Insurance Policy, complete this Proposal Form in BLOCK CAPITALS using a ball-point pen (blue or black
More informationKC Crystal. Home Insurance Proposal Form
KC Crystal. Home Insurance Proposal Form Household Claims Helpline Open 24 hours a day, 365 days a year 0845 122 3019 Page 2 HH94 Jul 2014 KC Crystal Proposal Form All sections must be completed. If necessary,
More informationPROPOSAL FORM FOR HOME INSURANCE POLICY
PROPOSAL FORM FOR HOME INSURANCE POLICY Name: Address: P. O. Box: Tel. No. Office: Res: Occupation Address of Dwelling at which the insurance is required: House/Office No. Bldg. No Road No. Block No Area
More informationHome Insurance Proposal Form
Home Insurance Proposal Form Home Insurance Proposal Form Proposal Form There are conditions, limitations, exclusions and excesses within the wording, a copy of which will be provided on request. A copy
More informationINSURANCE FOR PROFESSIONAL EMPLOYER ORGANIZATIONS
PEO INSURANCE FOR PROFESSIONAL EMPLOYER ORGANIZATIONS APPLICATION FORM INTRODUCTION The purpose of this application form is for us to find out who you are and to obtain information relevant to the cover
More informationCOMPREHENSIVE HOME INSURANCE
COMPREHENSIVE HOME INSURANCE Protect Everything Youre Worked So Hard To Get Rest Assured With Flexible, Affordable Home Insurance Premium Fully Refundable Within 30 Days of Inception The Home Insurance
More informationHome Insurance Proposal Form
Home Insurance Proposal Form www.towergate.co.uk Please read the Policy Summary prior to completing this application. A specimen Policy document setting out full terms and conditions is also available
More informationSAFEHOME SELECT PROPOSAL
SAFEHOME SELECT PROPOSAL THIS DOCUMENT FORMS THE BASIS OF YOUR CONTRACT This document is a record of the information advised to RSA Insurance Ireland Limited (RSA) for the purposes of concluding a contract
More informationPRO PRO. ProSurance TM. Application Form INSURANCE FOR PROFESSIONALS
PRO INSURANCE FOR PROFESSIONALS ProSurance TM PRO Application Form This is an application for an errors and omissions package policy aimed at a wide range of small and medium-sized professionals. As well
More informationTECH. Esurance TECH Application Form INSURANCE FOR TECHNOLOGY COMPANIES
TECH INSURANCE FOR TECHNOLOGY COMPANIES Esurance TECH Application Form Esurance TECH is an insurance package designed specifically for the technology sector. The policy includes errors and omissions, products
More informationSUMMARY OF INSURANCE COVER GLASGOW WEST HOUSING ASSOCIATION LTD GLASGOW WEST ENTERPRISES LTD PREPARED BY BRUCE STEVENSON INSURANCE BROKERS LTD 38-40
SUMMARY OF INSURANCE COVER GLASGOW WEST HOUSING ASSOCIATION LTD GLASGOW WEST ENTERPRISES LTD PREPARED BY BRUCE STEVENSON INSURANCE BROKERS LTD 3840 NEW CITY ROAD GLASGOW G4 9JT 0141 354 2883 CE SUMMARY
More informationHome Insurance Questionnaire Republic of Ireland
Home Insurance Questionnaire Republic of Ireland Home Insurance Policy Questionnaire There are conditions, limitations, exclusions and excesses within the wording, a copy of which will be provided on request.
More informationSauna & Bath House Insurance Presentation/Proposal
In order to obtain the best possible terms please answer EVERY question in this form. The more information the better the terms. BROKER NAME: BROKER EMAIL: BROKER TELEPHONE: INSURED FULL NAME & TRADING
More informationTECH. Esurance TECH Proposal Form INSURANCE FOR TECHNOLOGY COMPANIES
TECH INSURANCE FOR TECHNOLOGY COMPANIES Esurance TECH Proposal Form Esurance TECH is an insurance package designed specifically for the technology sector. The policy includes professional indemnity, products
More informationA&E A&E. ProSurance TM. Application Form INSURANCE FOR ARCHITECTS & ENGINEERS
A&E INSURANCE FOR ARCHITECTS & ENGINEERS ProSurance TM A&E Application Form This is an application for an errors and omissions package policy designed specifically for architects and engineers. As well
More informationYour home insurance policy Features and benefits HMP FAB 2014 05 V1.0. FBD Insurance plc is regulated by the Central Bank of Ireland
Your home insurance policy Features and benefits HMP FAB 2014 05 V1.0 FBD Insurance plc is regulated by the Central Bank of Ireland FBD has over 40 years insurance experience and today we are one of Ireland
More informationSelections Proposal form
Selections Proposal form High quality insurance for the recruitment industry. Important Note Before completing the proposal form please refer to the summaries of cover. This will assist you to select the
More informationBUSINESS PACKAGE PROPOSAL
BUSINESS PACKAGE PROPOSAL RM Insurance Company (PRIVATE) LIMITED RM 317A INDEX SECTION S. PAGES 1 Fire 1 2 Business Interruption 2 3 3 All Risks 3 4 Theft 4 5 Money 4 6 Glass 5 7 Goods in Transit 5 8 Liability
More informationHIGH VALUE HOUSEHOLD INSURANCE FACT FINDER
HIGH VALUE HOUSEHOLD INSURANCE FACT FINDER Genavco Insurance Limited Michael s House 10-12 Alie Street London E1 8DE Tel: 020 7702 4300 Fax: 020 7702 4585 HVHIFFv1 Page 1 of 1 02/09 HOUSEHOLD INSURANCE
More informationfirst choice home insurance application first choice home
first choice home insurance application first choice home CGU Insurance Limited ABN 27 004 478 371. An IAG Company. Please read the following information before you complete the application. Keep this
More informationCAMBERFORD LAW PLC ELECTRICAL, HEATING, VENTILATION, PLUMBING AND AIR CONDITIONING CONTRACTORS INSURANCE PROPOSAL FORM
CAMBERFORD LAW PLC ELECTRICAL, HEATING, VENTILATION, PLUMBING AND AIR CONDITIONING CONTRACTORS INSURANCE PROPOSAL FORM Please note that 'You' or 'Your' in the context of this Proposal Form means the persons
More informationOffice insurance proposal form
Office insurance proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters within the spaces provided. A principal
More informationHousehold Insurance Quote Form
Household Insurance Quote Form Ref: Babraham 2015 Please complete all of the following information in order for us to provide you with our most competitive quotation. Personal Details: Title: Full Name:
More informationHome Insurance Proposal Form
Home Insurance Proposal Form Introduction You must take care in answering all the following questions which are relevant to us in providing this insurance and setting the terms and premium. Please contact
More informationPROPERTY Fact Finder
PROPERTY Fact Finder In completing this form, please tick the appropriate boxes and answer all questions in BLOCK CAPITALS Important note The information submitted in this form is used by your insurance
More informationBROXTOWE BOROUGH COUNCIL REMINDS ALL TENANTS TO TAKE OUT HOUSEHOLD CONTENTS INSURANCE
BROXTOWE BOROUGH COUNCIL REMINDS ALL TENANTS TO TAKE OUT HOUSEHOLD CONTENTS INSURANCE You can do this either through this scheme arranged by the council or by making your own private arrangements. Many
More informationCAMBERFORD LAW PLC. RECRUITMENT AGENCY and EMPLOYMENT BUSINESS INSURANCE PROPOSAL FORM
CAMBERFORD LAW PLC RECRUITMENT AGENCY and EMPLOYMENT BUSINESS INSURANCE PROPOSAL FORM Please note that 'You' or 'Your' in the context of this Enquiry Form means the persons named as Proposer and/or any
More informationSAFEHOME OPTIONS PROPOSAL
SAFEHOME OPTIONS PROPOSAL THIS DOCUMENT FORMS THE BASIS OF YOUR CONTRACT This document is a record of the information advised to RSA Insurance Ireland Limited (RSA) for the purposes of concluding a contract
More informationCGU Padlock. insurance application
CGU Padlock insurance application CGU Insurance Limited ABN 27 004 478 371 Please read the following information before you complete the application. Keep this information for your records. Please read
More informationMARSH BIZSECURE INSURANCE PROPOSAL FORM
MARSH BIZSECURE INSURANCE PROPOSAL FORM Name of Company : PARTICULARS OF PROPOSER Correspondence Address : Telephone Number : Website : Fax Number : Description of Business/Trade : Period of Insurance
More informationCOMMERCIAL PACKAGE POLICY - PROPOSAL FORM
IMD Code : Bajaj Allianz General Insurance Company Limited IMD Name : Sub IMD Code : COMMERCIAL PACKAGE POLICY - PROPOSAL FORM Important: This proposal for insurance will be the basis of any subsequent
More informationGeneral Insurance. AMP Landlord Plan Policy
General Insurance AMP Landlord Plan Policy June 2010 Landlord Plan Policy Document Thank you for choosing us to provide you with your insurance cover. Arranging insurance means you are making a legal contract
More informationProposal Form Hiscox Overseas 606 Home Insurance
Hiscox Overseas 606 Home Insurance 01 Hiscox Overseas 606 Home Insurance Please read the following questions carefully and answer them all providing additional information where required. If you need more
More informationHome Insurance. Our Policy is You
Home Insurance Our Policy is You 1 Contents Quick Guide to Home Insurance 2 Why Choose FBD Home Insurance? 4 What is Covered? Buildings 5 What is Covered? Contents 6 Liability Protection 7 Additional Standard
More informationTENANTS CONTENTS INSURANCE MADE SIMPLE
TENANTS CONTENTS INSURANCE MADE SIMPLE in association with Sandwell Metropolitan Borough Council has negotiated a Home Contents Insurance Scheme designed specifically for our tenants and leaseholders.
More informationTENANCY AGREEMENT (FIXED TERM)
TENANCY AGREEMENT (FIXED TERM) AN AGREEMENT made the day of 200 BETWEEN Of:.. ( the Tenant ) and. Of: ( the Landlord ). WHEREBY IT IS AGREED as follows: 1. The Landlord agrees to let and the Tenant agrees
More informationFreetime Home Insurance. Proposal Form
Freetime Home Insurance Proposal Form Freetime Home Insurance Proposal Form Please read the Policy Summary prior to completing this proposal form. A specimen Policy document setting out full terms and
More informationLandlord s Household Insurance Policy Summary
Landlord s Household Insurance Policy Summary This document is a guide to the cover provided under Your Landlords Household policy. It is only a summary and does not contain the full terms and conditions
More informationCommercial Theft Insurance PROPOSAL
Commercial Theft Insurance PROPOSAL SPECIAL NOTE: For the purposes of this Insurance Theft means theft accompanied by an actual forcible and violent entry of or exit from the premises. Please ensure that
More informationHow To Insure A Mobile Home
Wilshire Insurance Company ARIZONA MOBILE HOME PROGRAM PREFERRED, ELITE, SEASONAL, RENTAL/COMMERCIAL P. O. Box 30527 Phoenix, AZ 85046 (602) 494-6900 FAX: (602) 494-6999 www.statewide-insurance.com EFFECTIVE
More informationEquestrian Property & Property Owners Liability Insurance Proposal Form FOR COMMERCIAL ESTABLISHMENTS & PRIVATE YARDS
Equestrian Property & Property Owners Liability Insurance Proposal Form FOR COMMERCIAL ESTABLISHMENTS & PRIVATE YARDS IMPORTANT NOTICE: You are under a duty to disclose to the Insurers all facts likely
More informationPolicy Number: Period of Insurance: To:
COMPANY LOGO TO P.O BOX BURGLARY INSURANCE POLICY Policy Number: Period of Insurance: From: To: (Both dates inclusive) and any subsequent period for which the Insured shall pay and the Company shall accept
More informationAffordable Home Contents Insurance
Affordable Home Contents Insurance We remind all tenants and leaseholders to take out household contents insurance. You can do this either through this scheme, arranged by WDH, or by making your own private
More informationIMPORTANT NOTE YOUR DETAILS GENERAL QUESTIONS FOR INTERNAL USE ONLY. Agent Name. Agency Code
HOTEL PROPOSAL FORM FOR INTERNAL USE ONLY Agent Name Agency Code When completing this form, please tick the appropriate boxes and answer all questions in BLOCK CAPITALS IMPORTANT NOTE You (or the broker
More informationJUST FOR YOU HOME CONTENTS INSURANCE. Low cost peace of mind. Easy payment weekly with your rent. No excess payment required if you claim
HOME CONTENTS INSURANCE JUST FOR YOU Low cost peace of mind Easy payment weekly with your rent No excess payment required if you claim Cover for most household items including TV, video, DVD players and
More informationBLOCK OF FLATS PROPOSAL FORM SUMMARY OF COVER
BLOCK OF FLATS PROPOSAL FORM SUMMARY OF COVER Insurance Corporation s Block of Flats insurance is a modern, convenient policy giving wide cover at a competitive price. It has been designed to meet the
More informationSmartHome Prestige. The Ultimate Security for your Home
SmartHome Prestige The Ultimate Security for your Home SmartHome Prestige, an All Risks insurance, offers maximum protection for the discerning home owners buildings, fixtures, fittings, renovation, contents,
More informationHome Insurance Proposal
Amlin UK Home insurance proposal The Home Insurance Keyfacts document should be read before you complete this proposal. Please complete all details on this proposal in BLOCK CAPITALS. A. DETAILS OF PROPOSER(S)
More informationhome insurance Policy summary 24 hour claim notification line 0845 001 0043
home insurance Policy summary 24 hour claim notification line 0845 001 0043 home insurance A tailored approach Our exclusive insurance product offers you the opportunity to tailor a Buildings and/or Contents
More informationGuide to Home Buildings and Contents Insurance. April 2012
Guide to Home Buildings and Contents Insurance April 2012 ABI GUIDE TO HOME BUILDINGS REPORT AND ON CONTENTS BOARD EFFECTIVENESS INSURANCE 3 What this guide is for and how it works We, the Association
More informationBusiness Insurance Proposal
Business Insurance Proposal Important Notices You must read the notices below. If you have any questions please contact GWS Genco Group (AFSL No. 231210) Duty of Disclosure This Policy is subject to the
More informationHousehold Contents Insurance Application Form
Housing Services Household Contents Insurance Application Form Immediate cover. The opportunity to pay fortnightly with rent. Realistic minimum sums insured. New for Old Insurance. in association with
More informationHome Solutions Insurance. Proposal form
Home Solutions Insurance Proposal form Home buildings and contents insurance IMPORTANT Please read before completing this form. Please complete this form in block capitals giving full answers. Tick boxes
More informationTOUCHSTONE UNDERWRITING LIMITED TRAVEL OFFICE INSURANCE FOR TRAVEL AGENTS / TOUR OPERATORS
TOUCHSTONE UNDERWRITING LIMITED TRAVEL OFFICE INSURANCE FOR TRAVEL AGENTS / TOUR OPERATORS FULL NAMES of PROPOSERS (including Associated/Subsidiary Companies & Trading/Partners names) Postal Address Contact
More informationTENANTS CONTENTS INSURANCE MADE SIMPLE
TENANTS CONTENTS INSURANCE MADE SIMPLE in association with Birmingham City Council has negotiated a Home Contents Insurance Scheme designed specifically for our tenants. At these prices, can you afford
More informationLandlords Insurance. This policy is provided by Legal & General Insurance.
UNDERWRITING AUTHORITY GUIDE Landlords Insurance This policy is provided by Legal & General Insurance. This is not a consumer advertisement. It is intended for professional insurance intermediaries and
More informationUnoccupied Commercial Property Owners
Unoccupied Commercial Property Owners Insurance Schedule Please check this document. This Insurance is subject to the information detailed in this document. The Insured and their insurance intermediary
More informationPROPERTY OWNERS PROPOSAL FORM
PROPERTY OWNERS PROPOSAL FORM For Internal Use only agent name agency Code In completing this form, please tick the appropriate boxes and answer all questions in BloCk CaPItals Important note You (or the
More informationOur landlords policy has been designed to offer a comprehensive buildings and contents insurance.
Our landlords policy has been designed to offer a comprehensive buildings and contents insurance. We provide in-house policy and claims administration to further enhance our ability to rapidly respond
More informationSTRATA PROPOSAL & QUOTE FORM RESIDENTIAL & COMMERCIAL IMPORTANT NOTICES. This is an important document. Please read it carefully.
STRATA PROPOSAL & QUOTE FORM RESIDENTIAL & COMMERCIAL IMPORTANT NOTICES This is an important document. Please read it carefully. The information you provide in this document and through any other documentation,
More informationTexas Fair Plan Association
Texas Fair Plan Association FREQUENTLY ASKED QUESTIONS What is the Texas FAIR Plan Association and its purpose? The Texas FAIR Plan Association is an entity established by Texas Insurance Code Article
More information