JEWELLERS BLOCK INSURANCE POLICY PROPOSAL FORM




























ProposerEmployeeCaretakerNone


YesNo






(a) Give full details of the type of glass in all your display windows


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Please ATTACH a file specifying names of all items and individual limits in the following format:
Item No. | Name of Item | Limit
Name of file should be " Carrying outside premises Within City "

Only PDF, Excel & Word files accepted.


Please ATTACH a file specifying names of all items and individual limits in the following format:
Item No. | Name of Item | Limit
Name of file should be " Carrying outside premises Within UAE "

Only PDF, Excel & Word files accepted.


Please ATTACH a file specifying names of all items and individual limits in the following format:
Item No. | Name of Item | Limit
Name of file should be " Carrying outside premises Outside UAE "

Only PDF, Excel & Word files accepted.









Please ATTACH a file with names of all specified employees in the following format:
Sr. No. | Name | Nationality | Maximum Limit (AED) . Please add Total Aggregate Limit at bottom.
Name of file should be " Infidelity of Employees "

Only PDF, Excel & Word files accepted.


Unless proposing for renewal, give two references from your trade.





DECLARATION

I/We have read the above and agree that to the best of my/our knowledge and belief it represents a full and complete statement.
I/We agree that if this insurance is completed the protections and or safeguards mentioned above shall not be withdrawan or varied to the detriment of the interests of the underwriters without their consent.