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Marine Cum Erection / Storage Cum Erection Policy Proposal Form

    THE INSURED INTERESTS

    PrincipalContractorSub-Contractor

    YesNo

    YesNo

    YesNo

    ManufacturerImporterBuyerContractor

    Brand NewSecond HandUsed

    YesNo

    YesNo

    THE CONTRACT SITE

    Note: A complete layout of the factory and site may be enclosed)

    YesNo

    YesNo

    YesNo

    THE INSURANCE

    Period of insurance required including Test Run

    SUM INSURED

    i.e @ Exchange rate (sub divided as under)

    (sub divided as under)



    Third Party Liability:

    YesNo

    YesNo

    YesNo

    YesNo

    The following questions are to be answered if Marine/ Transit Insurance Cover is required

    YesNo

    YesNo


    YesNo

    DECLARATION
    I / We the underdesigned hereby declare that the above statements and particulars are true and complete and I / We declare and agree that this declaration and the answers given above shall be held to be promissory and shall be the basis of the contract between me/ us and the company