Commercial
 
 
 
     
  INSURED
  BUSINESS/OCCUPATION
  RISK ADDRESS
  POSTAL ADDRESS
  OTHER LOCATIONS
  Contact number
  E-mail address
     
   
 

Provide details of all claims experienced in the last three years

   
  CLAIMS 2011
Description / Remark Type of Claim Amount
     
  CLAIMS 2012
Description / Remark Type of Claim Amount
     
  CLAIMS 2013
Description / Remark Type of Claim Amount
     
  CLAIMS 2014
Description / Remark Type of Claim Amount
     
  CLAIMS 2015
Description / Remark Type of Claim Amount
     
  Genrale
   
 
   
  Section 1. Fire
No. Premises / Description Sum Insured
     
 
Roof ConstructionSum Insured
     
 
Wall ConstructionSum Insured
     
  Section 2. Building Combined
Item No. 1Sum Insured
     
 
Premises: Sum Insured
     
  Description:
   
 
   
  Section 3. Office Contents
A (Contents)Sum Insured
     
 
C (Documents)Sum Insured
     
 
D (Liability for Documents)Sum Insured
     
  Section 4. Business Interruption
Item No. 1Sum Insured
     
 
Premises:Sum Insured
     
 
Item 1 Gross ProfitSum Insured
     
 
Item 2 Gross RentalsSum Insured
     
 
Item 3 RevenueSum Insured
     
 
Item 4 Additional Increased Cost of WorkingSum Insured
     
 
Item 5 Wages ( % For Weeks)Sum Insured
     
 
Item 6 Fines & PenaltiesSum Insured
     
  Section 6. Theft
PREMISES 1Sum InsuredPREMISES 2Sum Insured
     
  Section 6. Money
Details Sum Insured
     
  Section 8. Glass
Details Sum Insured
     
  Section 9. Fidelity Guarantee
Blanket Basis - Number of employeesSum Insured
     
 
Item No Named and or position basisSum Insured
     
  Section 10. Goods In Transit
DetailsLimit of Indemnity
     
  Section 11. Business All Risks
Property Description Sum insured
     
  Section 12. Accidental Damage
Details Sum Insured
     
  Section 13. Public Liability
Details Sum Insured
     
 
Security Check: