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

PROPOSAL FOR CONTRACTOR’S PLANT & MACHINERY INSURANCE
(The Liability of the Company does not commence until this Proposal has been accepted by the Company and premium paid)
(Information given herein will be treated in strict confidence)

PUT A TICK Mark wherever applicable

(a) Proposer’s Name ____________________________________________
(b)Proposer’s Trade or Business ___________________________________
(c)Proposer’sPostalAddress _______________________________________
_____________________________________________________________
(d) Location of Operation (site of property to insured)____________________
(e) Nearest Railway Station and Distance ___________________

1. Do the items listed represent the entire machinery used by you
at the above location

2. (a) Are you at present Insured : (a) Yes / No
(b) If so, with whom ? (b)

3. Has any Company
(a) Declined to insure any of the machinery now proposed ? (a) Yes / No
(b) Required an increased premium or imposed special conditions? (b)Yes / No
(c) Requested for repairs or made other special stipulations for
risk improvement ? (c)Yes / No

4. (a) Are you aware of any defects/damage existing in
the machinery. (a)Yes / No
(b) If so, give details there of (b)

5. Do you own or use any equipment other than that described
above working on the same site ?
6. Is any of the equipment now proposed
(a) Licensed for road use ? If so, give details (a)________
(b) Covered by any other insurance ? If so give details (b)________
_________________________________________________________________
7. (a) Are you the owner of the proposal equipment ? If yes
will you be hiring out ?

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(b) If the equipment is hired ;
(i) is insurance you responsibility ?
(ii) is maintenance and operation your responsibility ?

8.Are the premises where the equipment operates well guarded ?
_________________________________________________________________
9. (a) What is the site condition where the equipment will be utilised ?
(b) Are the equipment likely to operate on reclaimed or soft ground ?
(c) Are ground conditions such that equipment are exposed to
the risk of toppling over ? If so, give details ?
(d) Is the site susceptible to flood, sea damage, storm, cyclone
or other natural calamities ? If so, give details and safety
precautions taken.
_________________________________________________________________
10. Will equipment belonging to other contractors operate on the
same site ?

11. Do you have trained and qualified operators ? Are there any
statutory rules governing the appointment ?

12. Which of the equipments are required to inspected and certified
for operation by statutory rules ?

13. (a)Has your machinery sustained any damage from break down
or other cause during last 3 year ? (a) Yes / No
(b)If so give details of damage/s and Repairing cost (b)

14. (a) Are regular periodical inspections of the machinery carried (a)Yes / No
out ?
(b) If so,by whom and at what intervals?

15.On payment of additional premium do you wish to cover :- (If yes, provide limits
of indemnity)
(a) Express freight (excluding Airfreight), overtime and Holiday
rates of wages (a) Rs....... No

(b) Owners surrounding property. (b)Yes Rs....... / No
(c) Clearance & Removal of Debris (c)Yes Rs....... / No
(d) Third Party Liability :
(i) For any one accidents (d)Yes (i) Rs........./No....
(ii)For all accidents during the period (ii) Rs............
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________________________________________________________________
16. Period of Insurance From To

SCHEDULE OF MACHINERY TO BE INSURED

GUIDE NOTES :
I. Each Machinery should be entered separately with necessary specifications as mentioned in Schedule Column No. 3
II. The Sum Insured must be calculated on the present day new replacement value of the Machinery to be insured including provision for packing, freight and also value of foundations, erection cost customs duty, etc. to afford full protection under this Policy.
III. If any of the Machines is a ‘Stand By’ this fact should be mentioned.
IV. All portable Machines must be so designated. All items in the open must be so described separately.

Sr.No. Quantity Description Type,Model,Capacity of Machine/Serial No.HP/KVA Volts,AMPS,RPM Maker’s Name and Country of Origin Year of Make Sum Insured
1 2 3 4 5 6

I/We the undersigned hereby declare that the above statements and particulars are true and complete and I/We declare and agree this declaration and the

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answers given above shall be held to be promissory and shall be the basis of the contract between me/us and the Company.

Place : _______________
Dated : ______________ Proposer’s Signature ___________

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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