Micro Biashara Proposalform

MICRO BIASHARA P R O P OSAL FO R M Please ensure that you answer all the questions. Where it is not applicable, put N/A. Dashes should not be used. Use block letters. D E T A I L S OF PR O P OS E R : Full Name of Proposer/s

Postal Address (ii) P.O Box Code: Town: (iii) Tel: Email: (iv) Profession or Occupation (Nature of Business) (v) Period of Insurance From To B U S I N E S S T O BE I NS U R E D :

1. What is the nature of the business

2. Details of Business. a) Name of business b) Name of building c) Plot number of building d) Street name e) Town 3. Occupancy Details a) Is the building solely in your occupancy? b) How long have you been in the building? c) Is the building detached from other building? d) Have thieves ever entered or attempted to enter the premises? If yes, state measures taken to prevent another entry otherwise state the security measures that have been put in place. 4. If the stock has financiers interest, state the name and address of bank/company.

5. Sum Insured a) Buildings b) Business stock c) Household chattels d) Machinery

6. Have you ever pro\posed for a Business All Risks cover before and it got declined or Renewal of policy declined or terminated or had your policy cancelled?

7. If you have had a previous Business All Risks policy, has premium been increased? Why?

8. Is the business currently covered by any other insurer? If Yes, please give details of Insurer

ACCOU NT S AND R ECORD S:

a) Do you maintain stock cards or records including both cash and credit?

b) How often do you take your stock?

c) When did you last take stock?

d) Where is stock records kept when the premises are closed for business?

N OMI N A T I O N : I wish to nominate the following person (s) to receive all my dues in case of my death

FULL NAME RELATIONSHIP ID NO. TEL NO.

NB: If more beneficiaries are nominated, please provide their full names in a separate sheet.

D ECLA R A T I O N

I hereby declare that all the information I have provided in this Proposal is true to my knowledge and that I have not withheld any information that might otherwise deem the Policy null and void due to breach of contract. I further declare that the value I have provided to be insured under each section is the true value. I realize and agree that this Contract has been made between me and the Insurer and I agree to abide by the terms and conditions provided under the Policy.

Proposers Signature: