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Property and Casualty Insurancelaxmikant2020-09-03T09:44:39+00:00

Property and Casualty Insurance

  • SECTION 1: COMPANY DETAILS

    Please state the name and address of the principal company for whom this insurance is required. Cover is also provided for the subsidiaries of the principal Company, but only if you include the data from all of these subsidiaries in your answers to all of the questions in this form:
  • 1.5 Please state the following:
  • SECTION 2: ACTIVITIES

  • Activity(In %) 
  • SECTION 3: CONTRACT INFORMATION

  • ContractContract valueTerritory 
  • SECTION 4: PRODUCT INFORMATION

    Please only complete this section if you have any products sales
  • Product descriptionDomesticThe USAEurope / AustraliaRest of the world 
  • Territory% sales income 
  • SECTION 5: PREMISES DETAILS

    5.1 Please provide below details of your premises:
  • 5.1 Please state whether the premises:
  • NOTE: We may refuse to pay a claim if all of the devices for the security of your premises (including locks and the intruder alarm) are not in full and effective operation whenever the premises are closed for business or otherwise left unattended.
  • NOTE: Assuming you have answered ‘yes’ to questions l) and m) above, it is important to keep records of all relevant inspections as we may ask for evidence of these before paying a claim.
  • SECTION 6:

    INSURANCE REQUIREMENTS AND CLAIMS HISTORY
  • NOTE: The amounts insured you state below should be the full rebuilding or replacement cost in each of the categories. If you understate these amounts you will be under-insuring and we may not pay the full amount of your claim. It is therefore essential that these amounts are as close to the true values of the insured items as possible.
  • 6.2 Please provide details of your current commercial general liability insurance, if applicable, and what you require for the next year of insurance:
  • Effective date (Current)(MM/YY):Limit (Current):Deductible (Current):Premium (Current):Insurer (Current):
  • Effective date (Required) (MM/YY):Limit (Required):Deductible (Required):
  • 6.3 Regarding all of the types of insurance to which this application form relates, AFTER INQUIRY:
  • If the answer to any of the above is ‘yes’, then please attach full details including an explanation of the background of events, the maximum amount involved / claimed, the status of the claim(s) or circumstance(s) and any reserve(s) or payment(s) made by you and / or by Insurers, and the dates of all developments and payments.
  • Drop files here or
    Accepted file types: doc, pdf, Max. file size: 1 MB.
    • • I declare that after proper enquiry the statements and particulars given above are true and that I have not mis-stated or suppressed any material fact.
      • I agree that this application form, together with any other material information supplied by me shall form the basis of any contract of insurance agreed upon.
      • I undertake to inform Underwriters of any material alteration to these facts occurring before the completion of the contract.
    • DD slash MM slash YYYY
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