Contractor's Plant & Equipment Insurance- Specification of Insured Items

Please select the country/city where the form is to be submitted
1 Name of the Principal.
Address.
Telephone No:
Fax No.
E-mail Address.
Specification of Insured Items
Item No:
Quantity
Description of Items
(type, manufacturer, capacity)
Year of Manufacture
Deductible
Sum Insured
1
2
3
4
5
Total Sum Insured

In witness whereof the Undersigned being duly authorised by the Insurers and on behalf of the Insurers has(have) hereunto set his(their) hand(s).

 

[ To download the form please rightclick the Download button and select "Save target as" and Save.]

 Download the Form           Download Acrobat Reader
Top