Erection All Risks Proposal Form   Please select the country/city where the form is to be submitted -Select Country- Kuwait Lebenon Saudi Arabia U.A.E 1 Title of contract (if project sections, specify section(s) to be insured) 2 Location of erection site. 3 Country -Select a Country- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Canton and Enderbury Islands Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Democratic Yemen Denmark Djibouti Dominica Dominican Republic Dronning Maud Land East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bisseu Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Johnston Island Jordan Kazakstan Kenya Kiribati Korea Democratic People's Republic Korea, Republic Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Midway Islands Moldova, Republic Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles Neutral Zone New Calidonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pacific Islands Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda S. Georgia and S. Sandwich Isls. Saint Lucia Saint Vincent/Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Helena St. Kitts Nevis Anguilla St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syran Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States United States Pacific Islands Upper Volta Uruguay Uzbekistan Vanuatu Vatican City State Venezuela VietNam Virgin Islands, British Virgin Islands, Unites States Wake Island Wallis and Futuma Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe 4 City,town,village 5 Name of Principal 6 Address of Principal   Telephone No:   Fax No:   E-mail Address 7 Subcontractor(s) 8 Name(s) and address(es) 9 Firm supervising erection 10 Consulting Engineer's Name and address 11 Proposer: Please indicate which of the parties Nos 3 to 8 above is the Proposer of the insurance and which parties are to be declared as Insured in the Policy. Proposer No   Insured No(s)   12 Exact description of the property to be erected (if second-hand items are to be erected, please state). In case of machines: manufacturer's name, number, type, size, capacity, weight, pressure, temperature, revolutions, year of construction of major units. In case of complete factories: general drawing of plant, nature of civil engineering work(if any). 13 Period of Insurance Commencement of insurance       Duration of pre-storage months prior to beginning of erection work Commencement of erection/construction Months Duration of testing Weeks If maintenance coverage required Duration of maintenance Months Type of Coverage required     Termination of insurance     14 Have Plans, designs and materials of the kind used in this project been used and/or tested in a previous construction? select Yes No b previous constructions by the contractor(s)? select Yes No If so, please give details of similar projects carried out by contractor(s). 15 Is this an extension of an existing plant? If so, will operation of existing plant continue during erection period? Enclose plans. select Yes No select Yes No 16 Have the buildings and civil engineering works already been completed ? select Yes No 17 Work to be carried out by subcontractors Please also give answers to the questions below as far as information obtainable: 18 Is there any aggravated risk of: fire? select Yes No explosion? select Yes No If so, give details. 19 Ground water level 20 Nearest river,lake,sea,etc. Name Name   Levels of such river, lake, sea, etc. Low water Mean water highest level recorded Mean level of site     21 Meteorological conditions Rainy seasons from to Max rainfall(mm) per hour per day per month Max wind (mm) storm frequency low  medium  high 22 Hazards of earthquake, volcanism, tsunami Is there a history volcanism, tsunami at the site? select Yes No   Have earthquakes, etc. been observed in this area? select Yes No   If so, please state intensity Magnitude   Subsoil conditions Is the design of the structures to be insured based on regulations regarding earthquake resistant structures? select Yes No   rock gravel sand clay filled site     Other types     Do geological faults exist in the vicinity? select Yes No 23 Estimate, if possible, the probable maximum loss, expressed as a percentage of the sum insured, in a single occurrence due to earthquake due to fire due to other cause 24 Is coverage of construction/erection machinery (excavators, cranes, etc.) required? select Yes No Please give brief description and state new replacement value under No 30.3   25 Is coverage of construction/ erection equipment(scaffolding, huts, tools, etc. required? select Yes No Please attach list of major machines showing individual new replacement values and state total value. 26 Are existing buildings and/or structures on or adjacent to the site, owned by or held in are, custody or control of the contractor(s) or the principal, to be insured against loss or damage arising our of or in connection with the contract works? State limit under No 28.5. If so, give the exact description of these buildings/structures. select Yes No 27 Is third party liability to be included? If so, give brief description of surrounding and existing buildings and/or structures not belonging to the principal or contractor(s) (enclose maps, if possible). State limits under No 28, Section II. select Yes No 28 Do you wish cover to include extra charges (in case of loss) for express freight, overtime,night work, work on public holidays? select Yes No air freight select Yes No 29 Give details of any report of any special extension of cover required 30 Please state here under the amounts you wish to insure or where applicable the limits of indemnity required (see Policy wording, Section I, Memo 1 and Section II): Currency: Section I - Material damage Items to be insured Sums to be insured (state below separately)   1 Erection works, split up as follows: 1.1 Items to be erected   1.2 Freight   1.3 Customs duties and dues   1.4 Cost of erection   2 Civil engineering works   3 Construction/erection equipment   4 Clearance of debris (limit of indemnity)   5 Property located on the principal's premises or on the site, belonging to the principal or held in care, custody or control (limit of indemnity see Memo 4 of Policy)   Total sum to be insured Section I   Please indicate limits of indemnity required for the following perils:   Risk Limits of indemnity   Earthquake, volcanism, tsunami   Storm, cyclone, flood, induation, landslide       Section II - Third party liability       Insured items Limits of indemnity   Bodily injury - any one person   Bodily injury - total   Property damage   Or alternatively Combined single limit of         1 Limit of indemnity in respect of each and every loss or damage and/or series of losses or damage arising out of any one event. 2. Limit of indemnity in respect of any one accident or series of one event.         We hereby declare that the statements made by us in this Questionnaire and Proposal are, to the best of our knowledge and belief, complete and true, and we hereby agree that this Questionnaire and Proposal forms the basis and is part of any policy issued in connection with the above risk. It is agreed that the insurers are liable in accordance with the terms of the Policy only and that the Insured will not lodge any other claims of whatever nature. The Insurers undertake to deal with this information in strict confidence. [ To download the form please right click the Download button and select "Save target as" and Save.]  Download the Form           Download Acrobat Reader Top