Micro Biashara Proposalform
MICRO BIASHARA PROPOSALFORM
Please ensurethatyouanswer allthequestions. Whereit is not applicable, put N/A. Dashes shouldnot beused. Useblockletters.
DETAILSOFPROPOSER:
FullName ofProposer/s
Postal Address(ii) P.O Box Code: Town: (iii) Tel: Email:
(iv) Profession or Occupation (Nature of Business)
(v)Periodof Insurance From
BUSINESS TOBEINSURED:
To
2. DetailsofBusiness.
a) Name of business b) Name of building
c) Plotnumber ofbuilding d) Streetname
e) Town
3. Occupancy Details
a) Isthe buildingsolely inyour occupancy?
b) Howlonghave you been in the building?
c) Isthe buildingdetachedfromother building?
d) Havethievesever enteredor attempted to
enter the premises? If yes, state measurestaken to prevent another entryotherwise state the security measuresthat have been putinplace.
4. Ifthe stockhasfinanciersinterest, state the name and
addressof bank/company.
5. Sum Insured a) Buildings
b) Businessstock
c) Householdchattels d) Machinery
6. Have youever pro\posed for a Business AllRiskscover
before anditgotdeclinedor Renewalofpolicy declinedor terminatedor hadyour policycancelled?
7. Ifyouhave hadapreviousBusinessAllRiskspolicy, has
premium been increased? Why?
8. Isthebusinesscurrently covered by any other insurer? If
Yes, please give detailsof Insurer
ACCOUNTS AND RECORDS:
a) Doyoumaintainstockcardsor recordsincluding bothcash andcredit?
b) Howoften doyou takeyour stock?
c) When didyoulasttake stock?
d) Where isstockrecordskept when the premisesare closed for business?
NOMINATION:
I wishtonominate the followingperson(s) toreceive allmy duesincase ofmy death
FULLNAME / RELATIONSHIP / IDNO. / TELNO.1.
2.
NB:Ifmore beneficiariesare nominated, please provide their fullnamesina separate sheet.
DECLARATION
Ihereby declare that allthe information Ihave providedinthisProposalistrue tomy knowledgeandthat Ihave not withheldany information thatmightotherwise deemthe Policy nullandvoiddueto breach ofcontract. Ifurther declare thatthe value Ihave providedto be insured under eachsectionisthe true value. Irealize andagree that this Contract has been made between me and the Insurer andIagree toabide by the termsand conditions provided under the Policy.
ProposersSignature: Date: