Marine Cum Erection / Storage Cum Erection Policy Proposal Form

Name of Principal*

Phone*

E-Mail*

Type of Trade or Business*

Full Address of Principal*

Name and address of the Contractor

Name and address of the Sub- Contractor, if any

Type of Trade or Business*

Type of Trade or Business*

Whose interests are to be insured ?*PrincipalContractorSub-Contractor

THE CONTRACT WORKS

Is this a contract/ sub- contract forming part of an overall erection project of value exceeding DHS.3,000,000 YesNo

Have the plans, design and Materials been already tested in any previous erection?*YesNo

Is the Installation or part thereof built for the first time*YesNo

What is your role in the installation?*ManufacturerImporterBuyerContractor

Is the property brand new / second hand or used one?*Brand NewSecond HandUsed

If second hand or used state the age

Will the erection be carried out by your own personnel?*YesNo

If not, then state by whom

Past experience of the erectors

Will any sub-contractors be taking part in the work of erection?*YesNo

If yes, what is their position as regards this insurance?

Location of where the Plant is to be erected?

Nearest Port & or/ Railway Station & Distance

Are any special risks of floods, fire or explosion involvedYesNo

Distance from nearest river or sea with names and particulars

Elevation of erection site above normal river or sea level

Is there any record of the erection site having been submerged during floods?YesNo

Is there any record of the erection site having been submerged during floods?

Will there be a watchman on duty round the clock?*YesNo

If not what precautions will be taken against theft, malicious damage etc?

Probable date of first shipment or despatch

Expected date of first arrival at site

Expected date of last arrival at site

Probable Commencement Date of Erection

Probable Completion Date of Erection

Testing Period (including insurance)

FROM*

TO*

(a) On landed cost of imported machinery as at Factory Sitei.e @ Exchange rate (sub divided as under)

i) Invoice Cost

ii) Freight, Insurance Handling,Clearing & Transportation Charges up to Site

iii) Custom Duty

(b) On Machinery fabricated or manufactured in UAE(sub divided as under)

(i) Invoice cost including insurance, handling and clearing and transporting upto facotry site

(ii) Freight

(c) On Cost of Erection, including Salaries of all foreign and UAE Technicians and Wages of all skilled and unskilled labour employed at factory site during erection

(i) Permanent Civil Engineering Works

(ii) Temporary Works

Completely Erected Value

Clearance and Removal of Debris

Construction Plant and Machinery to be used at the Project site. Details as per attached list

Insured's own Surrounding Property

On Increased replacement value including duty on such additional replacement value which may have to be paid on replacement of imported plant and machinery as per Item (a)

On increased replacement value which may have to be paid on replacement of indigenous Plant & Machinery as per item (b)

Extra charges for Express Freight (Excluding Air Freight ) Overtime, Friday and Holiday rates of wages

For any One Accident

For all Accidents during the Period

Total Sum Insured

Have you approached any other Insurance Co.for Insurance Cover in respect of this proposal?*YesNo

Has any such proposal been declined?YesNo

Has any such proposal been withdrawn?*YesNo

Has any such proposal been accepted subject to an increased rate or special conditions?*YesNo

Are there any fragile items like Refractory materials, Asbestos Cement sheets, Porcelain materials, Glass Equipments, Fire Bricks Graphite Electrode etcYesNo

If yes please give their value, full description and mode of packing (whether packed in case or loose)

Do you want cement to be covered? YesNo
If yes, give its value and mode of packing (whether packed in gummy bags or paper bags)

Please give particulars of voyage for imports

What is the limit required per any one shipment ? (In case of imports )

How many Transhipments will be there?

Special Hazards, if any, in transporting goods from nearest station / port to erection site

Do you require War & S.R.C.C risk to be covered during overseas / inland transit?*YesNo