First Name*
Last Name*
Designation*
Company*
Phone*
E Mail*
Address Location 1
1. Buildings
2. Stocks in trade
3. Furniture, Fixtures, Decorations etc.
4. Machinery & Air Conditioners
5. Computers, Electronics Items etc.
6. Sign Board
7. Plate Glass
8. Cash
9. On Loss of Rent (Annual Rent)
10. On Liability to Landlord
11. On Liability to Neighbours/Third Party
12. On Debris removal
Total Sum Insured
Rate-PAR
Rate-Plate Glass, Signboard & Cash (PG/SB/C)
Premium PAR
Premium PG/SB/C
Total Premium Location 1
Address Location 2
Total Premium Location 2
Address Location 3
Total Premium Location 3