The New India Assurance Company Limited
Registered & Head Office : New India Assurance,87,M.G. Road,Fort,Mumbai - 400 001

Proposal for insurance against loss of profit resulting from fire

Machinery Loss of Profit

1. The Proposer and the business ______________________________
(a) Names of all your business(es) to be insured ______________________
(b) Registered address _________________________________________
(c) Full description of the trade ___________________________________
(d) How long has the business(es) been established ___________________
Year________
(e) Address of all premises from which the business do trade ____________
________________________
(f) By whom are your accounts audited ? ___________________________
(g) When does your financial year end ? ___________________________
(h) Is the proposer a corporate body ? If so, state the paid up
Capital ____________________________

2. INSURANCE HISTORY ______________________________________
(a) Names of the insurers covering the contents of your premises ______
(b) Have you any other consequential loss
insurance in force ? Yes/No
(c)) Have you ever suffered a loss by any perils
against which you wish to insure ? Yes/No
(d) Has any insurer refused to insure you or If you answer
imposed increased terms for any peril against YES to ques-
which you wish to insure ? Yes/No tions (b),(c)
(d) or (e) Please submit details.
(b)
(c)
(d)
(e) Details of Past interruption (e)
(i) Period of Interruption (i) (ii) Nature of Interruption with reasons (ii)
(iii) Loss in Gross Profit/turnover during (iii)
Interruption Period.
3. COVER REQUIRED _________________________________________
(a) Maximum Indemnity Period______________months.
(b) Amount of Insurance required________________Rs.
(a) (i) On Annual Net Profit before providing for Taxation and Development
Rebate Rs.___________
(ii) On Annual Specified Standing Charges Rs.___________
(iii) On lay-off and Retrenchment Compensation payable under the
Industrial Disputes Act 1947 as amended up to date with/without
Notice wages liability Rs.____________ as amended up to date with/without Notice wages liability Rs.___________
The standing Charges to be covered are as follows :
Interest on Debentures, Mortgages, Loans & Bank Overdrafts Insurance Premium, Advertising Rent, Rates & Taxes excluding Taxation chargeable on Profit Office expenses Salaries to permanent staff & wages to skilled employees Postage, telegrams & telephone, Printing & Stationery Company’s contribution to the Provident Fund Electrical energy and/or power charges Company’s contribution to the Gratuity Fund Maintenance of building, Plant & Machinery Labour welfare charges Depreciation (excluding stocks and stores) Director’s fees, Auditor’s fees, Legal expenses Miscellaneous standing charges not exceeding 5% of the Travelling expenses, Motor Car expenses amount of the Standing Charges specified.
N.B. : Delete the Standing Charges not required to be covered
Add any other standing Charges desired to be covered ________________________________________________________________
( b) Please state whether insurance is required on Turnover or output
basis____________________________________________________ If on Output basis :-
(a) The nature of output ___________________________________
(b) The unit of production _________________________________
(c)Have your Insurance in force against any peril other than fire such as
Riot,Malicious Damage,Explosion,Earthquake,in respect of your building,
Machinery & Stock ? ______________________ Ma Explosion, Earthquake, in respect of your Building, Machinery & Stock ?______________

(d)If so, in case you desire protection against such other perils in respect
of this insurance, please specify each of them separately ___________ please specify each of them separately___________________________________________
I/We hereby apply for an insurance subject to the usual terms and conditions of your Policies against Loss of Net Profit and standing charges as stated above arising through reduction in Turnover and increase in Cost of Working caused by fire in the premises herein referred to, the Indemnity to be for a period of______months, after each fire.

I/We agree that this proposal shall be the basis of the contract between THE NEW INDIA ASSURANCE COMPANY LIMITED and myself/ourselves.

Date________________this______________________________day of_____________________

Signature of Proposer_________________
Note : The liability of the Company does not commence until this proposal has been accepted and the premium in Consideration has been paid or debited to a valid BG/CD, A/c.

PROHIBITION OF REBATES
The following is the copy of Section 41 of the Insurance Act 1938.
1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an Insurance in respect of any kind of risk relating to live or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown in the policy; nor shall any person taking out or renewing continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses of rebates of the Insurer.
2. Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five hundred rupees.