MARINE CUM ERECTION / STORAGE CUM ERECTION POLICY PROPOSAL FORM


THE INSURED INTERESTS
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



Will any sub-contractors be taking part in the work of erection? YesNo
If yes, what is their position as regards this insurance?

THE CONTRACT SITE

Location of where the Plant is to be erected?

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

Are any special risks of floods, fire or explosion involved YesNo

Distance from nearest river or sea with names and particulars

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

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

THE INSURANCE









Period of insurance required including Test Run

FROM

SUM INSURED



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










(sub divided as under)







(d) On Building in which the above Plant & Machinery is to be erected















Third Party Liability:




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Has any such proposal been withdrawn?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

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

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

Do you want cement to be covered? YesNo






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