PROPOSAL FORM FOR THEFT INSURANCE FROM BUSINESS PREMISES
DownLoad Proposal Form
(FORCIBLE AND VIOLENT ENTRY)
 
Personal Information
Full Name Address
Occupation or Bussiness Telephone No
General information
Address of Premises containing Property to be insured
 State Premises type. e.g, shop, warehouse
Are premises occupied at night? Yes No Is there any security arrangement during the day and\or during the night? Yes No
How long have you occupied the above premises? Are you the sole occupier
Is a burglary alarm system installed ? Yes No If yes, Please specify
Are all or any of the valuables secured in a thief-resisting safe when the premises are close ? Yes No If yes, Please specify details on the safe. e.g make,cost and date of purchase
Give full details of any loss or damage by theft,which you have sustained, or any attempt thereat.
If the premises have been entered, Please give steps taken to prevent further entry,
Previous Insurer Information
Are you or have you at any time insured against theft risks ? Yes No If Yes Please specify the insurer's name
Has any Insurer ever
Declined your proposal? Yes  No
Refused to renew or cancelled your policy? Yes  No
Increased your rate premium Yes  No
Imposed special conditions Yes  No
Do you keep detailed records of stock received and sold? Yes No Could the exact amount of the loss be ascertained from these records Yes No
When can the premises be inspected by our surveyor
Property Information

PROPERTY TO BE INSURED		 FULL VALUE OF PROPERTY
VALUE TO BE INSURED
STOCK-IN-TRADE, inclusive of goods in trust or on commission for which the proposer is resposible(excluding gold and silver article jewellery and fur)
Trade fixtures,Fittings, Utensils,Plants and machinery
Office furniture, fixture,fittings, Utensils, Printed books and stationery.
Cash in securely locked safe
If the proposal resides on the abovr premises, the household goods may also be insured.
Household goods and personal effect (excluding property described above)belonging to the proposer or the members of his family permanently residing with him , or to his domestic servants ot being property for which he is responsible, in the proposer's private dwelling rooms
Gold and silver articles, jewellery and furs in the proposer's private dwelling rooms(No one article included under heading above(Piano,Organs or furniture excepted))shall be deemed to be of greater value than 5% of the total sum insured
On the following
TOTAL AMOUNT FOR WHICH INSURANCE IS REQUIRED

Declaration
the above particulars are true and that this and any other written statement made by me/us or on my/our behalf for the purpose of the proposed insurance shall continue so long as the insurance remains in force to be the basis of the Contract between me/us and the company not only in respect of the employees including herein and any other employees who may hereinafter be included in the said insurance. The conduct and accounts of all the employees to be included in this insurance has always been satisfactory.
I Disagree I Agree