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Please fill in the following form. Should you find any difficulties, just fill in fields marked with asterisk (*). Our sales team will contact you shortly.

 

 

* Full Name  
       
  CR/CPR No  
       
  Postal Address  
       
* Tel  
       
* Mobile  
       
  Fax No.  
       
* E-mail  
       
  Occupation:  
       
  Address of Dwelling at which the insurance is required:  
    House/Office No. Bldg. No  
    Road No. Block No  
    Area No    
       
  THE PROPERTY TO BE INSURED    
     
  NOTE 1. The SUM TO BE INSURED must represent the FULL VALUE of the property, the Proposer being required to sign a declaration to that effect below.  The insurance will be subject to average, which means that if at the time of loss or damage the sum insured is less than the full value of the property insured, the amount payable is proportionately reduced.  
   
   
         
    THE BUILDING     B.D.     
    THE CONTENTS   B.D.     
       
  Furniture Household Goods and Personal Effects (except as after mentioned) the property of the Proposer or any members of the Proposer’s family normally residing with the Proposer and Fixtures and Fittings which are the proposer’s own or for which the Proposer is legally responsible.  
       
     
  NOTE 2. No one article (Furniture, Household Appliances, Radio and Television Sets, Pianos and Organs excepted) will be deemed of greater value than five per cent of the Total Sum Insured on the said Contents unless such article is specially declared as a separate item.  
 
     
       
  Specify here any such articles of greater value that 5 percent of the Total Sum to be Insured on the said Contents B.D.    
  B.D.    
  B.D.     
       
  NOTE 3. The amount of insurance on Platinum, Gold and Silver Articles, Jewellery and Furs is limited to one-third of the Total Sum Insured unless the value thereof is stated and additional premium paid.  If the said value exceeds the proportion mentioned, please state the total value of such property.  
   
     
     
     
   

 

TOTAL VALUE   B.D. 

 
       
  NOTE 4. The insurance does not cover external television and radio antennae, aerials fittings, mast and towers nor does it cover property more specifically insured under another policy or, unless specially mentioned, Deeds, Bonds, Bill of Exchange, Promissory Notes, Cheques, Travellers’ Cheques, Securities for Money, Stamps, Documents of any kind, Cash, Currency Notes, Manuscripts, Medals, Coins, Pedal Cycles, Motor Vehicles and Accessories or Livestock.  
     
     
     
     
     
 

 

If you require increased limits of liability under the following Insured Perils, (please see next page) state the limits required :-

  
       
  Additional expense of alternative accommodation / loss of rent       
  Third party liability                                                                        
  Period of Insurance                 From                                 

                                                   To  

 
       

 


 

 

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