All Risk Proposal Form

The Cover
Our "All Risks" Policy is designed to cover your valuables and personal belongings against accidental loss or damage from any cause, anywhere within the agreed territorial limits, subject only to the exceptions shown below. Cover applies inside and outside the home.

Exceptions
The main exceptions to the policy are:-
  • War and riot.
  • Radioactive contamination.
  • Theft or attempted theft by any relative of the Insured in his home, or any household servant.
  • General wear and tear.
  • Any process of cleaning, repairing or restoring
  • Action of light or atmospheric or climatic conditions.
  • Overwinding of clocks or watches, or damage to articles of a brittle nature.
  • Mechanical breakdown or application of electrical energy.
Additional Perils

In most cases you can have both policies extended for an additional premium to cover your following material damage caused by all or any of the listed perils(please tick those required)
  Please select the country/city where the form is to be submitted
1 Full name of Proposer.
2 Address
3 Tel No.
4 Fax No.
5 E-mail Address
6 Address of main residence
(State whether private dwelling house, flat, boarding house, hotel or apartment)
7 Occupation
Period of Insurance required:           From            To
1
Is the main residence regularly left unoccupied
during the day? at night ?
2 Have you ever made a claim or suffered a loss during the last 5 years in respect of any item which was or could have been covered by "All Risk" insurance?
If so, please give details.
3 Have you ever had an insurance against Fire, Theft or Accidental Damage on your property declined, terminated or subjected to special terms by an Insurer.
4 Have you at present an insurance against Fire, Theft or 'All Risk'? If so, with whom?

Property to be insured
State the FULL Value of the property to be covered by each item. Any property to be insured which is not described in items 1-4 and articles valued at over US$.500 (or currency equivalent should be listed under item
5. Failure to insure for FULL VALUE under items 1-5 may cause to bear a share of any loss.
Property to be insured Amount
1 Clothing and personal effects (excluding contact lenses, documents, motor vehicles and accessories, and property described in items 2-5 below)
2 Unspecified items of jewellery, gold and silver, watches and furs with no single item valued at more than US$.500 (or currency equivalent.)
3 Unspecified items of photographic, radio, T.V and recording of hi-fi equipment, binocluars and musical instruments, with no single valued at more than US$.500 (or currency equivalent.)
4 Sporting and camping equipment and pedal cycles (excluding clothing and personal effects) with no single item valued at more than US$.500 (or currency equivalent).
5 All other property, including those items valued at more than US$.500 (or currency equivalent) listed below.
Total Sum Insured(All Items)
 
Schedule of items over US$.500
(or currency equivalent)
Proof of value must be enclosed for all items
Description of Item Full Value Description of Item Full Value
1 6
2 7
3 8
4 9
5 10


DECLARATION

I/We declare that the answers given in the proposal are true to best of my/our knowledge and I/we have withheld no information whatever which might influence the decision of the Insurer regarding the Proposal.

I/We agree that the Proposal shall be incorporated in and shall from the basis of the contract between the Proposer and the Insurer and a Policy in the form issued by the Insurer for the insurance now proposed

I/We agree to inform the Insurer of any material change in risk.
N.B. Cover does not commence until the Proposal is accepted by the Insurer and the first premium paid.

 

[ To download the form please right click the Download button and select "Save target as" and Save.]
 Download the Form                Download Acrobat Reader
Top