Property All Risk Proposal Form

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

Rate-PAR

Rate-Plate Glass, Signboard & Cash (PG/SB/C)

Premium PAR

Premium PG/SB/C

Total Premium Location 1

Address Location 2

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

Rate-PAR

Rate-Plate Glass, Signboard & Cash (PG/SB/C)

Premium PAR

Premium PG/SB/C

Total Premium Location 2

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

Rate-PAR

Rate-Plate Glass, Signboard & Cash (PG/SB/C)

Premium PAR

Premium PG/SB/C

Total Premium Location 3