Fire Insurance Proposal Form   Please select the country/city where the form is to be submitted -Select Country- Kuwait Lebenon Saudi Arabia U.A.E Insured Name (in Block Capitals) : (as will appear on the Policy) If Property is Mortgaged- Name of the Bank/Financial institution. Address of the Bank/Financial institution. Telephone No: Fax No: E-mail Address Postal Address Name of the Building to be Insured Location of the Property Insured     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) 1 Explosion 2 Aircraft and aerial devices 3 Earthquake fire 4 Earthquake shock 5 Windstorm 6 Flood 7 Burst pipes and over flowing water tanks 8 Impact by road vehicles, horses or cattle 9 Any other additional perils (please give details below)     Property to be Insured Include in the sum insured under the appropriate item below the value of: the building and contents of any small outside building, extension, annex, and gangway, and boundary walls, fences and gates. For any other outside building, etc., please supply a separate sum insured under each item below: Sum to be Insured (Full Value) 1. Stock and materials in trade the property of the Proposer or held by him in trust or on commission for which he is responsible. 2. Machinery, plant and all other trade contents the property of the Proposer or held by him in trust or on commission for which he is responsible excluding landlord's fixtures and fittings and stock and materials in trade. N.B.: Computer systems records are not covered unless mentioned in item 5 below. 3. The building or buildings all communicating including landlord's fixtures and fittings. An amount should be included for the fees and expenses, which might be incurred following, insured against, i.e.: (a) Architects', surveyors', consulting engineers' and legal fees (b) Dismantling/demolishing, debris removal and shoring-up. In the absence of professional guidance, it is recommended that the amount included should be in the region of 10% of the value of the property insured by item 2 and 20% for item 3. 4 months rent receivable / payable (delete as appropriate) N.B. This cover is not normally required if rent is fully insured under a Consequential Loss Policy.   5 Other property (Please specify)   Total N.B. You must insure for the full value of the property or you will run the risk of any claim settlement being reduced. Please answer the following questions regarding the premises (please give full details) 1 When were the buildings constructed ? 2 What is the Construction of:- Description   (a)External Walls   (b)Roof   (c)Floors 3 What external woodwork is there apart from doors and shutters? 4 Are the buildings in a good state of repair? select Yes No 5 What is the method of: Description   Lighting   Heating 6 What manufacturing processes are carried out? 7 . Is the machinery (if any) powered solely by electricity ? select Yes No 8 (a) What fire extinguishing appliances are there on the premises ? (i.e. number & type) (b) How often are they serviced and by whom? 9 What material or stock of any easily inflammable or easily damageable nature is stored, or likely to be stored, on the premises? (please give full details including quantities and values) 10 (a) When are the premises left unoccupied ?   (b) Is a watchman employed at all times whilst they are unoccupied and if so, how are his rounds controlled? 11 How far is the nearest full time and adequately equipped Fire Brigade ? 12 If stock is to be insured are proper books of accounts kept and will they continue to be kept? If so, please give details of how and when they will be stored. 13 Please provide the following information in respect of adjacent buildings: (a) Construction (b) Occupation (c) Separation from the premises to be insured. The following questions should be answered by selecting either "YES" or "NO". If the answer is "YES" to any of these questions please give the fullest possible details. Is the property to be insured mortgaged ? Details select Yes No Are there any other insurances in force on the same property? Details select Yes No Is any of the property specially liable to damage by any of the perils to be insured against ? Details select Yes No Have you ever sustained a loss at these or any other premises by any of the perils to be insured against ? Details select Yes No Has any insurer ever canceled or refused to renew any insurance, declined to insure you, or required special terms or conditions. Details select Yes No Period of insurance required :                 From To Declaration I/We declare that the answers given in the Proposal are true to the 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 be incorporated in and shall form the basis of the contract between me/us and the Insurer and I/We shall accept 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 [ To download the form please right click the Download button and select "Save target as" and Save.]  Download the Form           Download Acrobat Reader Top