Property All Risks ← BackThank you for your response. ✨ NAME OF PROPOSER(required) ADDRESS OF PROPOSER(required) CONTACT NUMBER(required) Email(required) WEBSITE VALUE OF THE BUILDING(required) VALUE OF STOCKS OR MERCHANDISE(required) VALUE OF FURNITURE, FIXTURES AND FITTINGS(required) VALUE ON OTHER PROPERTY TO BE INSURED, PLEASE PROVIDE DETAILS(required) REQUIRED DATE OF INCEPTION (FROM) (YYYY-MM-DD)(required) EXPIRY DATE (TO) (YYYY-MM-DD)(required) EXACT ADDRESS OR LOCATION OF THE PROPOSED RISK(required) HOW MANY ROOMS DO YOU OCCUPY?(required) 0 1 2 3 4 5 OTHERS IF OTHERS, PLEASE SPECIFY THE NUMBER OF ROOMS OCCUPIED IN WHICH FLOOR? ARE THE ROOMS INTERCOMMUNICATING, ADJACENT OR SEPARATED?(required) HOW LONG HAVE YOU OCCUPIED THESE PREMISES?(required) HAVE YOU CARRIED ON BUSINESS IN ANY FORMER PREMISES, AND WHERE?(required) OF WHAT MATERIALS ARE THE EXTERNAL WALLS OF THE BUILDING COMPOSED?(required) HOW IS THE BUILDING ROOF?(required) OF HOW MANY STOREYS, INCLUDING THE BASEMENT AND ATTIC OR LOFT IN THE ROOF, IS THE BUILDING COMPOSED?(required) NUMBER OF STOREYS(required) METERS WIDE METERS LONG WHAT IS THE SIZE OF THE BUILDING? IS THERE ANY GALLERY, VERANDAH, OR BALCONY TO THE BUILDING? IF SO, OF WHAT MATERIALS IS IT CONSTRUCTED? IS THERE ANY INSIDE COMMUNICATION BETWEEN THE GROUND& UPPER FLOORS? YES NO ARE THEIR ANY TRADE OR MANUFACTURE BEING CARRIED OUT IN THE PREMISES?(required) YES NO IF YES, PLEASE CLARIFY THE NATURE OF PROCESS AND POWER BEING USED IS THERE ANY ARTIFICIAL HEATING OR LIGHTING USED? IF SO, OF WHAT NATURE? YES NO IF YES, PLEASE CLARIFY IS MERCHANDISE OF A HAZARDOUS DESCRIPTION STORED IN THE BUILDING PROPOSED TO BE INSURED, SUCH AS BENZINE, BENZOLINE, BI-SULPHIDE OF CARBON, BRIMSTONE, CALCIUM CARBIDE, CAMPHINE, CANDLES, CAOUTCHOUC, CELLULOID & XYLONITE & OTHER SIMILAR SUBSTANCES, CHARCOAL (POWDERED), CHLORATE OF POTASH, CHLORATE OF SODA, COTTON, EXPLOSIVES OF ALL KINDS, FIREWORKS, GRASSES OF ALL KINDS, GUNNY BAGS (OTHER THAN IN BALES), GUTTA PERCHA, JUTE, LAMB BLACK, LIME, MATCHES OF ALL KINDS, MUNGO, NAPHTHA, NITRATE OF SODA, OILS OF ALL KINDS, PHOSPHOROUS, PITCH, POTASH RAGS, RESIN, SALTPETRE, SHODDY, SPIRITS OF ALL KINDS (NOT IN BOTTLES), STEARINE, STRAW, SULPHUR, TALLOW, TAR, TURPENTINE, VARNISH, VEGETABLE FIBRES OF ALL KINDS, WASTE OF ALL KINDS?(required) YES NO IF YES, PLEASE CLARIFY IN CASE THE BUILDING IS ISOLATED, WHAT IS THE DISTANCE BETWEEN IT AND THE NEAREST BUILDING CONSTRUCTED PARTIALLY OR ENTIRELY OF TIMBER, OR ROOFED WITH LEAVES OR THATCH?(required) IN CASE OTHER BUILDINGS ADJOINING, OR ARE WITHIN DISTANCE OF FIFTEEN METERS, PLEASE DESCRIBE THE EXTERNAL WALLS AND ROOFING(required) PLEASE PROVIDE DETAILS OF BUILDING AND SURROUNDING EXPOSURES TO THE RIGHT(required) PLEASE PROVIDE DETAILS OF BUILDING AND SURROUNDING EXPOSURES TO THE LEFT(required) PLEASE PROVIDE DETAILS OF BUILDING AND SURROUNDING EXPOSURES OF THE FRONT AND REAR(required) BY WHOM AND FOR WHAT PURPOSES ARE THE BUILDINGS OCCUPIED, AND WHAT IS THE NEAREST DISTANCE BETWEEN THEM AND ANY (C) ( BUILDINGS CONSTRUCTED PARTIALLY OR ENTIRELY OF TIMBER, OR ROOFED WITH LEAVES OR THATCH?(required) WHAT ASSISTANCE CAN BE RELIED ON IN CASE OF FIRE? PLEASE PROVIDE BRIEF DETAILS AND DISTANCE TO NEAREST FIRE BRIGADE OR CIVIL DEFENSE FACILITY.(required) DOES THE PROPOSER TAKE STOCK AT LEAST ONCE A YEAR? YES NO DOES THE PROPOSER KEEP A PROPER SET OF ACCOUNT BOOKS? YES NO DOES THE PROPOSER KEEP ACCOUNT BOOKS AND/OR COMPUTER BACK-UP IN A FIRE PROOF SAFE? YES NO IS THE PROPERTY PROPOSED FOR INSURANCE ALREADY INSURED IN ANY OTHER OFFICE? (required) YES NO IF SO, PLEASE PROVIDE DETAILS HAS THE PROPOSER EVER SUSTAINED ANY LOSS BY FIRE? (required) YES NO IF YES, PLEASE PROVIDE DETAILS HAS THE PROPOSAL BEEN AT ANY TIME DECLINED BY THIS OR ANY OTHER OFFICE?(required) YES NO IF YES, PLEASE CLARIFY THE REASON IF SIGN BOARD IS REQUIRED TO BE INSURED PLEASE PROVIDE THE EXACT LOCATION, WHETHER IT IS FIXED FLAT AGAINST THE WALL OR IS IT PROTRUDING, DIMENSIONS, AGE &CURRENT CONDITION AND ELECTRICAL WIRING CONDITION We hereby declare that the statements made by us in this online questionnaire are, to the best of our knowledge and belief, complete and true and we hereby agree that this online questionnaire forms the basis and is part of any policy issued in connection with the above proposed risks. (required) Submit Δ Share this:Tweet Share on WhatsApp (Opens in new window) WhatsApp More Email a link to a friend (Opens in new window) Email Like Loading...
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