Plate Glass Insurance Proposal Form

Here is a brief summary of the cover provided by our Plate Glass policy. We will be pleased to discuss details of the cover that is best suited to your needs, and will supply a specimen policy which sets out the full terms and conditions in details which alone will govern any contract of insurance.

For the display of goods or for the admission of light the use of glass is a universal necessity. It is however, expensive to replace if broken. Not only has the glass to be re-installed, but the labour charges involved are sometimes higher than the cost of the replacement itself. It is, therefore, but a wise precaution to insure, for you will then rid yourself of the worry of possible heavy charges or annoying small outgoings. Complete protection can be very moderate yearly premium.

The Cover

Every description of glass - Plate, Sheet, Bent, Ornamental, Bevelled or Silvered - can be insured. The cost of temporary boarding or barricading of windows as a direct consequence of the breaking of glass covered by the Policy is covered without additional charge.

The cost of reparing damage to window frames or the cost of removal and replacement of fittings and fixtures as a direct consequence of breakage of glass is not covered by ordinary Glass Insurance but such policies may be extended to include this damage upto 50 percent of the net of the glass replaced at an additional premium of 50 per cent of the ordinary premium for the Glass Insrurance.
Please select the country/city where the form is to be submitted
1 Insured Name
2 Address
3 Telephone No:
4 Fax No:
5 E-mail
6 Business carried on at the Premises
7 What breakage, if any, have occured during the last two years and from what causes.
8 Is the glass at present, or has it ever been, insured

If so, state name of Insurers.


9 Have you had a Glass Insurance declined, cancelled or subjected to special terms by any Insurer?

If so, please give particulars.


10 Do you wish to cover damage to window frames and cost of removal and replacement or fittings and fixtured consequent upon glass breakage?
Particulars & Dimensions of Glass to be Insured 1 2 3 4
DESCRIPTION OF THE GLASS
Whether Plate or Sheet and if Plain, Rough, Silvered, Stained, Ornamental, Bent, Embossed, Bevelled or otherwise
POSITION OF THE GLASS
Window, Return, Door, Fanlight, Mirror, Partion, Showcase or otherwise
SIZE OF EACH IN SQUARE INCHES
(Add 1/2 inch each way for frame)
Height
Width 
Value of Embossed, Silvered, Bent Plate, Marmorite Stallrisers, Fascias, Showcases, Shelves
Description and Value of Lettering or Ornamentation
Please indicate if any of the glass is now cracked or broken
DECLARATION

I/We declare that the above statements are true and that I/We have not witheld or concealed any material information, and I/We hereby agree that this proposal and declaration shall form the basis of the contract between me/us and Compagnie Libanaise d'Assurances s.a.l and I / we agree to accept a policy subject to the terms, conditions prescribed therein.

Note : liability of the Company does not commence until the proposal has been accepted by the Company and the first premium paid.

 

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