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Fire and Special Perils Insurance

 

Please fill in the following form. Should you find any difficulties, just fill in fields marked with asterisk (*). Our sales team will contact you shortly.

 

 

* Full Name  
       
  CR/CPR No  
       
  Postal Address  
       
* Tel  
       
* Mobile  
       
  Fax No.  
       
* E-mail  
       
  Occupation:  
     
  Period of Insurance                 From       To  
     
  The Building    
  Situation: Flat/House No. Bldg.No.
    Block No. Area
         
  Construction Walls Roofs
    Floors Ceilings
    Number of Stories Year of Construction
    Occupied as Owned by
    Year of Renovation if any  
         
  Interests to be covered   Sum to be Insured
 

1)

   Building, Fixtures, Fittings and Decoration B.D.
  2)   Furniture, Household & Personal Effects B.D.
  3)   Gold and Silver articles, jewellery, watches, furs, cameras and binoculars (please list separately all items with individual values) B.D.
  4)   Machinery and Plant B.D.
  5)   Stock in Trade consisting of the Proposer’s own or held by him in trust or in commission for which he is responsible. B.D.
           
  6)   Other items, if any, as per details mentioned below:    
    (A)  Debris Removal B.D.
    (B)  Architects & consultants fees B.D.
    (C)  Loss of rent:    
      (i)  for alternative accommodation B.D.
      (ii)  If legally liable to pay as tenant to the owner of the building B.D.
      (iii)  If receivable (in respect of building rented out) B.D.
           
      Rent per month B.D.
     

Number of Months for which rent is to be covered

  

 


 

 

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