CONTRACTORS PLANT AND MACHINERY INSURANCE POLICY PROPOSAL FORM



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

SPECIFICATION OF ITEMS TO BE INSURED
Please ATTACH document of all items to be Insured, in the below format:

ITEM No. | DESCRIPTION OF ITEMS | YEAR OF MANUFACTURE | REPLACEMENT VALUE

DESCRIPTION OF ITEMS
Please give all and exact description of all plant and machinery.
REPLACEMENT VALUE
Please state current cost of replacing machine by new machinery of the same kind and capacity (including the case of transformers and switches) plus freight charges, customs duties, costs of erection.


Only PDF, Excel, Word & JPG Files are accepted.