Contractors Plant And Machinery Insurance Policy Proposal Form

Name of Proposer*

Phone*

E Mail*

Address of Proposer*

Period of Insurance*

Geographical Scope of Cover*

Has there been any previous CPM Insurance ?* YesNo

Have the plant and machinery to be insured (partly or in total) been hired? *YesNo

Are the plant and machinery highly exposed to special hazards?*1) Fire, Explosion2) Earthquake, Volcanic Activity, Tsunami3) Storm, Cyclone4) Flood, Inundation5) Landslide6) Blasting7) Employment in Mountainous Terrain8) Others

Do you wish the cover to include extra charges for Overtime, night work, work on public holidays?*YesNo

Do you wish the cover to include inland transport? YesNo