Fire Insurance - Home and Property Cover

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Applicant Details

Name *

First

Last

Applicant Address

Address Line 1

Address Line 2

City

State / Province / Region

Country

Email *

Phone

Occupation

Name in which policy to be issued

Term of Insurance From *

Term of Insurance To

Property to be insured

Address

Address Line 1

Address Line 2

City

State / Province / Region

Country

Type of Construction

Year of Construction

Construction of External Walls

Construction of Roof

Number of Storeys

Type of Lighting/Energy Supply

EDSA
Solar
Generator
Wind Energy
Battery Storage System
Other

Is the whole building used for residential purposes only?

Is any retail trade going on?

What manufacturing process or repair work (if any) are carried out on the property?

How long have you been in this business?

Are any of the goods to be insured of a hazardous nature?

Are there any hazardous goods located outside the building (s)? And within 30ft thereof?

Please provide details

Do you take stock at least once a year?

Do you keep a proper set of accounts books?

Do you keep such books in a fire-proof safe?

Do you remove such books to another building when the above premises are closed?

Do you keep an online back up of such records?

For example, in the cloud

Any portable Fire Extinguisher?

Are there any adjoining or adjacent buildings?

Adjoining or Adjacent Buildings

Construction of External Walls

Construction of Roof

How are the buildings occupied?

What is the distance between adjacent building and property to be insured

Are adjacent buildings cut off by brick, stone or concrete walls, at least 9 inches thick, without openings, going up to and through the roof?

Please give details of the separation

Are there any circumstances apart from those dealt with above which may appear to increase the risk of loss or damage by any of the perils to be insured against?

Please give details

Amount to be insured which should be the full market value

On the building

N.B Boundary and Compound Walls, gates and fences are excluded from the insurance

On Office Furniture and Equipment, Trade fixtures and fittings therein

On machinery and plant therein

On stock and materials in trade therein

Important

The sum insured under each item will be separately subject to AVERAGE. This means that if the actual value of the property is greater than the sum insured you will bear a rateable proportion of the loss accordingly.

Is there any fire insurance in force on the same property?

Name of Insurer

Amount of Insurance

Please state:

Which of the following do you require insurance against?

Explosion
Earthquake and Volcano
Aircraft and Vehicle Impact
Flood
Tornado
Riot, Strike and Malicious Damage
Water Damage

Additional Questions if additional perils insured against

Do the premises abut the road?

Are the premises built on the hillside?

How far are the premises from the nearest River or Sea?

Upload photos of premises and adjacent buildings (if any)

Click or drag files to this area to upload. You can upload up to 5 files.

The photos should show all doorways, windows, or any other openings both in external and internal walls.

Declaration

I/We desire to effect an insurance in the terms of the usual Policy for Fire Insurance and declare that the above statements and particulars are true. I/We further declare that this proposal shall be the basis of the contract between me/us and the Insurer and that the amounts to be insured represent to the best of my/our knowledge and belief the full market value of the property stated.

been And on

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