Cash Insurance Policy Proposal Form

(For the purpose of Insurance Cash means Current Coins, Bank and Currency Notes, Cheques and Postage Stamps)

Company Name*

Phone*

Email*

Location/s of Risk with Identification No.*

Profession or Trade*

Description of Premises*ShopFactoryWarehouse

Period of Insurance*

CASH IN TRANSIT

Cash for Salaries & Wages

Average Daily Cash Transactions*

Estimated Annual Cash Transactions*

Maximum Limit Any one Loss*

Please ATTACH a file specifying places between which cash transactions take place with approximate distance in the format shown below:

FROM | TO | DISTANCE | MODE OF TRANSPORT (own vehicle/engaged vehicle/by foot/by abra/others) | TIME

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Only PDF, Excel and Word Files are accepted.
You can send up to 5 MB in attachments.

Previous Claims History

CASH IN SAFE

Maximum Amount of Cash in Safe*

SAFE DETAILS

Make

Weight

Dimensions

Identification

No.

Is the Safe fixed to the wall or the floor?

By whom are the keys of Safe/Strongroom held?

Are such keys removed from the business premises after business hours?*YesNo

CASH OTHER THAN IN SAFE
(Must be kept in locked Cupboards/Cabinets/Drawer/Cash Register)

With Cashier

With Owners/Partners

Others (Specify)

Note: A complete record of all Cash in Safe & Other Than in Safe must be maintained.
All Employees must be on Insured’s Visa.

DECLARATION
I/We desire to effect an Insurance with THE ORIENTAL INSURANCE COMPANY LIMITED, as set forth above. I/We warrant that the above statements are true and complete and that nothing materially affecting the risk has been concealed by me/us. I/We undertake to keep the records necessary for the due adjustment of the premium and to render at the end of each period of the insurance a statement in the form required by the Company of the total amount of Cash in transit which is the subject of this proposal and I/We agree that this Proposal and Declaration shall be held to be promissory and shall form the basis of the contract between me/us THE ORIENTAL INSURANCE COMPANY LTD.

We accept the terms & conditions of the above declaration.