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

Proposal and questionnaire for contractor’s
ALL RISKS INSURANCE
(The liability of the Company does not commence until this proposal has been
accepted by the Company and the premium paid)
Information given herein will be treated in strict Confidence. Put a ( ) mark wherever applicable

1. (a) Name & Address of the Principal (a) ______________________________
Trade or Business __________________________

(b) Name & Address of the Contractor (b) ____________________________
Trade or Business __________________

(c) Name & Address of the Sub-Contractor, (c) _______________________
if any. ___________________________________________
Trade or Business

THE INSURED INTERESTS

2. Whose interests are to be Insured ? Principal Contractor Sub-Contractor

3. THE CONTRACT WORKS

(a) Full description of the Contract

(b) Please give details :

(i) Building (type of construction,
number of storeys etc.)
(ii) Blasting operation
(iii) Excavation work
(iv) Pile riving
(v) Tunnelling
(vi) Dam Construction or diversion
of water
(vii) Others (Specify)

Note : A site plan of contract work may be enclosed.

4. (i) Is this a contract/Sub-contract forming part
of an over all construction project of value (i) Yes No.
exceeding Rs. 5 crores.

(ii) If yes give the name of the Project (ii)

5. (a) Will the Construction be carried out by
your own personal ? (a) Yes No.

(b) If not, by whom ? (b)

(c) Past experience of the contactor (c)

6. (a) Will any sub-contractors be taking part (a)
in the work of construction ? Yes No.

(b) If yes, what is their position as regards (b)
this insurance ?

THE CONTRACT SITE

7. (a) Location of Contract site (a)

(b) Nearest Port and/or Railway Station and (b)
distance

(Note : A complete lay out of the site may be enclosed)

8. (a) Are any Special Risks of one or more of (a)
the following involved ?

(i) Earthquake-Fire & Shock
(ii) Landslide/Rockslide/Subsidence
(iii) Flood/Inundation
(iv)Storm/Tempest/Hurricane/Typhoon/
Cyclone
(v) Collapse
(vi) Water Damage for ‘Wet’ risk i.e.
contract involving construction in
rivers, canals, lakes or sea.

(b) Distance from nearest river, lake, reservoir (b)
or sea the names and particulars to be given.

(c) Elevation of construction Site above normal (c)
river, lake reservoir or sea level.

(d) Is there any record of the construction site (d)
ever having been effected by any of the
major perils specified in (a) above.

9. Give full details regarding geological
condition including subsoil.

10. (a) Brief description of the arrangements made
for storage of construction materials and
equipments-whether in open or closed
premises.

(b) (i) Will there be a watch and ward round (i)
clock

(ii) If not, what precautions will be taken
against theft malicious damage etc. (ii)

11. THE INSURANCE
(a) Estimated construction period excluding (a).......................months
maintenance period (cover to commence
from the date of first arrival of consignment From...............to..............
materials at site, or, commencement of work
whichever is earlier).
(b) Cover required during maintenance period, (b).......................months
if any From................to................ (c)Probable date on which construction is c)
expected to be completed.

(d)Period of Insurance required (d).........................months

From.................to...............

12. (a) Have you approached any other Insurance (a) Yes No
Co. for Insurance Cover in respect of this
Proposal ?

(b) If yes, please state name of the Insurance Co. (b)

13. Has any such proposal been (a) Yes No

(a) Declined ?

(b) withdrawn ? (b) Yes No

(c) accepted subject to an increased rate or (c) Yes No
special conditions ?

14. SUM INSURED :

I. Contract Works
(Permanent & Temporary works including
all materials to incorporated therein)

(a) Contract Price Rs.

(b)Materials or Items supplied by the Principal Rs.

(c)Any additional items not including in (a) & Rs.
(b) above

(d) Landed cost of imported items as at
construction site [Please specify where
included in [a] and/or (b) above]
@ Exchange Rate..... Rs.________
Total Value of contract works. Rs.________

II. Construction Plant & Machinery to be used
at the construction site (Details as per
attached sheet)

III. Clearance & Removal of Debris Rs.

IV. Insured’s own surrounding property. Rs

V. Extra charges for Express Freight (excluding) Rs.
Air Freight) overtime Sunday & Holiday
rates of wages, if required

VI. On Increased Replacement value for Item Rs. (.......%)
I (a) (b) & (d) above, if required

VII. Third Party Liability

(a) For any one accident Rs.

(b) For all Accidents during the period Rs.

15. Do you wish to opt for higher amount Yes No.
of Deductible Excess ?

If yes, whether (i) 2 times
(ii) 5 times
(iii) 10 times

I/ We the undersigned hereby declare that the above statements and particulars are true and complete and I/We declare and agree that this declaration and the answers given above shall be held to be promissory and shall be the basis of the contract between me/us and the Company.

Place.........................

Date.......................... SIGNATURE OF 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.