New India Building, 87, M.G. Road, Fort, Mumbai - 400 001
PROPOSAL FORM FOR BANKER'S INDEMNITY INSURANCE

1. (a) Name of Bank_______________________________
(b) Address (I) Regd. Office________________________ (b) (i)
(II) Regd./Central Office__________________ (ii)
2. (a) State the total number of At the
beginning of
the previous
(i) Employees (Officers, Clerks and sub-staff) Financial
year whether permanent or temporary whole-time (i)
or part time, on contract or otherwise including
Apprentices.
(ii) Appraisers Janata Agents, Chhoti Bachat (ii)
Yojana Agents, Pygmie Collectors and other
Persons performing duties of a like nature
(b) State the total no. of branches in India and Total India Abroad
abroad existing at present.

3. (a) Are you at present insured under a Bankers Indemnity (a)
Policy ? If so, Please state the name of the
Company and the amount and period of insurance ?
(b) Have you made a proposal for insurance of this (b)
nature to any insurance company ?
If so, with what result ?
(c) Has any proposal for insurance of this nature (c)
been declined by any company in the past ?

(d) Has any Policy been cancelled or renewal thereof (d)
refused ? If so, give details.

4. Have you ever sustained a loss or losses or money/
securities :
(i) Whilst lying at the premises (i)
(ii) Due to dishonest act by employees and/or agents (ii)
(iii) Misappropriation of Hypothecated goods (iii)
(iv) Whilst in transit (iv)
(v) Whilst in postal transit (v)
(vi) Arising out of false valuation by Appraiser (vi)
If so, please give details in respect of the past
five years giving date of occurrence, date of
discovery, amount of loss and brief particulars.

5. (a) What is the amount for which cover is required (a)
(i.e. basic sum Insured)
(b) What additional sum insured, if any, you require (b)
in respect of money and/or Securities whilst
(i) On Premises ? (i)
(ii) In transit ? (ii)
(Please note that cover under (b) is for amount in
addition to basic sum insured)
6. Period of insurance : FROM...................................To.............................
We the undersigned, do hereby warrant and declare the truth of all the above statements and that we have not with held any material information and we agree that this declaration and proposal shall be the basis of the contract as mutually and finally agreed between us and the New India Assurance Company Limited.

Place :________________
Date :_________________
Signature of the proposer

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.
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