Householder's Insurance Proposal Form

Name of the Proposer*

PO-Box*

City*

Country*

Business-Occupation*

Phone*

E-Mail*

Please provide full address of property to be insured.*

COVERAGE REQUIRED

SECTION 1:BUILDING
If Owned or Improvements made by Tenant if rented Loss of Rent

SECTION 2:CONTENTS

Against the risk of Fire, Allied Perils & Burglary & House-breaking risks (Other than Jewellery/ Ornaments & other valuables)

SECTION 3a:

Jewellery & Valuables kept in the locked Safe at premises - 30% allowed outside Safe for daily use

SECTION 3b:

Jewellery & valuable watches for World-wide All Risks Cover (Please provide a detailed list of all items with individual value. For Diamond & Precious Stones jewellery, you have to provide a copy of Invoice or a Jeweller’s valuation certificate)

SECTION 4:

If Owned or Improvements made by Plate Glass (fixed Plate-glass only)

SECTION 5a:

Personal Computer & Laptops

SECTION 5b:

Laptop Worldwide Coverage

SECTION 6:

Baggage Insurance (Maximum Coverage AED 25,000/) Excluding personal jewellery/watches, cameras of any kind, laptops, money, mobile phones, I-Pods, furs, eye glasses & goggles

SECTION 7:

Personal Accident for Insured/Spouse/Up to 65 yrs, Children & Domestic Servants (Age group of 10 yrs & above)

For Self/Spouse: AED 100,000 each
Children: AED 50,000 each
Domestic Servants: AED 25,000 each
SECTION 8:
Public Liability including legal liability to Landlord (rented premises) and neighbours Up to an Indemnity limit of AED 250,000 Inclusive of cost of litigation with the consent of the Company