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

PROPOSAL AND QUESTIONNAIRE FOR ERECTION ALL RISKS/MARINE-CUM- ERECTION 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

1.(a) Name and Address of the Principal Trade of Business_______________
________________ ________________

(b) Name and Address of the Contractor Trade or Business ______________
_______________
_______________

(c)Name & Address of the Sub Contractor if any, Trade Business____________
______________
______________

THE INSURED INTERESTS
2. Whose interests are to be insured ? Principal Contractor Sub-contractor
THE CONTRACT WORK
3. Full description of the Plant & Machinery to be erected.
Including Capacity.
(Please attach separate sheet if necessary)
4. (i) Is this a contract/Sub-Contract forming part of an over all
erection project of value exceeding Rs. 5 crores ? (i) Yes / No
(ii) If yes give name of the Project (ii)
5. (a) Have the Plans, Designs and Materials been already tested Yes / No
in any previous erection ?
(b) Is the installations or part there of built for the fist time ? Yes / No
(c) Are you the manufacturer, importer, buyer
or contractor of the installation Manufacturer / Importer/ Buyer/ Contractor

(d)Is the property brand new or is it
second hand and used one Brand New/ Second-hand
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(e) If second hand or used,State Age?

6. (a) Will the erection be carried out by your own personnel ?(a) Yes / No
(b) If not by whom ? (b)
(c) Past experience of the erectors ? (c)
_________________________________________________________________
7. (a) Will any sub-contractors be taking part in the work of (a) Yes / No
erection ?
(b) If yes, what is their position as regards insurance ? (b)
THE CONTRACT SITE
8. (a) Location of site where the Plant is to be erected ? (a) (b) Nearest Post &/or Railway station and distance ? (b)
Note : A complete lay out of the Factory and Site may be enclosed

9. (a) (i) Are any special risk of flood, fire or explosion Involved ? (a) (i) Yes No
(ii) If yes, give details. (ii)
(b) Distance from nearest river or sea-the names and (b)
particulars to be given
(c) Elevation of Erection Site above normal river or sea level (c)
(d) Is there any record of the Erection site ever having been (d) Yes / No
submerged during floods ?
THE INSURANCE
11. (a) Probable date of first shipment or despatch. (a) (b) Expected date of first arrival at site. (b)
(c) Expected date of last arrival at site (c)
(d) Probable date of commencement of erection of Plant
& machinery (d)
(e) Probable date on which erection of Plant & Machinery is (e)
expected to be completed finally.
(f) Duration of Testing Period (including in ‘g’ below) (f) ...........Month
(g) Period of insurance required including Test run
(g)......Months From............ To .............

Items to be Insured Sum Insured
12. A SECTION I Material Damage
1. (a) On landed cost of imported machinery, as at Factory Site
i.e. @ Exchange rate (Sub divided as under)
(i) Invoice cost : Rs
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(ii) Freight Insurance Handling Clearing and forwarding
charges upto Factory Site Rs.
(iii) Customs duty at % Rs.
(b) On Machinery fabricated or manufactured in India
(sub divided as under)
(i) Invoice Cost including insurance, handling for transporting upto factory site. Rs.
(ii) Freight Rs.
(c) On cost of Erection, including salaries all Foreign and
Indian Technicians and Wages of all skilled and unskilled
labour employed at Factory Site during erection. Rs.
(d) On Building in which the above Plant and Machinery is
to be erected
(i) Permanent Civil Engineering Works Rs.
(ii) Temporary Works Rs.
2. Clearance and Removal of Debris. Completely Erected Value Rs.
3. Value of Surrounding Property to be Covered. Rs.
4. Extra charges for Express Freight (excluding Air Freight)
Over time, Sunday and Holiday rates of wages. Rs.
5. Construction Plant and Machinery to be used at the Project
Site Details( as per attached list) Rs.
6. Do you wish Air freight to be covered, if so, amount &
indemnity. Rs.
7. (a) On Increased replacement value (including duty on such
additional replacement value) which may have to be paid on
replacement of imported Plant and Machinery as per
Item I-(a) above Rs.
(b) On increased replacement value which may have to be
paid on replacement of indigenous Plant and Machinery as
per item I-(b) above. Rs.
2. B SECTION II-Third Party Liability
(a) for any one accident. Rs.
(b) For all accidents during the period Rs.
13. (a) Have you approached any other Insurance Co. for (a) Yes / No
insurance Cover in respect of this proposal ?
(b) If yes, please state name of the Insurance Co.
14. Has any such proposal been
(a) declined ? (a) Yes No
(b) withdrawn ? (b) Yes No
(c) accepted subject to an increase or special condition ? (c) Yes No

The following questions are to be answered if Marine/Transit Insurance Cover is required
15. (a) Are there any fragile items like Refractory materials, (a) Yes / No
Asbestos cement sheets, Porcelain materials, Glass
equipments Fire Bricks, Graphite Electrodes etc.
(b) If yes, please give their value, description and mode of
packing (where packed in cases or loose)
16. (a) Do you want cement to be covered ? (a) Yes / No
(b) If yes, give its value and mode of packing (whether
packed in gunny bags or paper bags) (b)

17. Please give particulars of voyage for imports/ transports.
18. What is the limit required
(a) per any one shipment ? (In case of imports) (a)
(b) per any one despatch ? (In case of indigenous materials) (b)
19. Please state (for Inland Transit)
(a) how the goods will be transported to site of erection ?
(a) By Rail By Steamer By Lorry By Country Craft
(b) How many Transhipments will be there ? (b)
(c) Special hazards, if any, in transporting goods from (c)
nearest Station/port to erection site
20. Do you require war & S.R.C.C. risk to be covered during Yes No
Overseas Inland transits.

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.

Date :_______________
Place :_______________
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.
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