National Insurance Company limited
(Subsidiary of General Insurance Corporation of India)
Regd. Office : 3, Middleton Street, Calcutta – 700 071

PROPOSAL AND QUESTIONNAIRE FOR CONTRACTOR’S ALL RISK 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 whichever applicable.

1. a) Name & Address of the Principal
Trade or Business
b) Name & Address of the Contractor
Trade or Business
c) Name & Address of the
Sub-Contractor, if any
Trade or Business
a)
b)
c)
2. THE INSURED INTERESTS
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 driving.
v) Tunnelling.
vi) Dam construction or diversion
of water.
vii) Others (Specify)
Note : A site plan of contract works may be
enclosed.
4. i) Is this a Contract/Sub-Contract
Forming part of an overall
Construction project of value
Exceeding Rs. 5 crores ?
ii) If so, give name of the project
i) Yes No
ii) Yes No
5. a) Will the Construction be carried out
by your own personnel ?
b) If not, by whom ?
c) Past experience of the Contractor.
a) Yes No
b)
c)
6. a) Will any Sub-Contractors be taken
part in the work of construction ?
b) If yes, what is their position as
regards this Insurance
a) Yes No
b)
7. a) Location of Contract site.
b) Nearest Port and/or Railway
Station and distance.
(Note : A complete lay out of the site may
be enclosed)
a)
b)
8. a) Are any Special Risks of one or
More of 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 or sea – the names and
particulars to be given
c) Elevation of Construction Site
above normal river, lake,
reservoir or sea level.
d) Is there any record of the
construction site ever having
been effected by any of the
major perils specified in (a)
above ?
a)
b)
c)
d) Yes No
9. Give full details regarding geological
condition including sub-soil
10. a) Brief description of the
arrangements made for storage of
construction materials & equipments –
whether in open or closed premises.
b) i) Will there be watch and ward
round the clock ?
ii) If not , what precautions will be
taken against theft, malicious
damage etc. ?
a)
b) i)
ii)
taken against theft, malicious
damage etc. ?
11. THE INSURANCE
a) Estimated construction period
excluding maintenance period
(cover to commence from the date
of first arrival of consignment of
materials at site, or commence of
work whichever is earlier.)
b) Cover required during
maintenance period, if any.
c) Probable date on which
construction is expected to be
completed.
d) Period of Insurance required.
a) ______________________ months
from ________________ to __________
b) ______________________ months
from ________________ to __________
c)
d) ______________________ months
from ________________ to __________
12. a) have you approached any other
Insurance Company for Insurance
Cover in respect of the Proposal.
b) If yes, please state name of the
Insurance Company.
a) Yes No
b)
13. Has any such proposal been
a) declined ?
b) withdrawn ?
c) accepted subject to an increased
rate or special conditions ?
a) Yes No
b) Yes No
c) Yes No
14. SUM INSURED :
i) Contract Works
Note : Please attach Schedule of
Quantities and rates and/or values.
(Permanent & Temporary works
including all materials to be
incorporated therein)
a) Contract price
b) Materials or Items supplied by the
Principal.
c) Any additional items not included
in (a) & (b) above.
d) Landed cost of imported items as at
construction site. (Please specify
whether it is included in (a) and/or
(b) above
@ Exchange Rate ……………..
ii) Construction Plant & Machinery
to be used at the construction site
(Details as per attached sheet.)
Rs.
Rs.
Rs.
Total Value of Construction Rs.________
Rs.
iii) Clearance & Removal Debris.
iv) Insured’s own surrounding
property.
v) Extra charges for Express Freight
(Excluding Air Freight) Overtime
Sunday & Holiday rates of wages,
If required.
vi) On Increased Replacement value
for Items I (a), (b) & (d) above,
if required.
vii) Third Party Liability
a) For any one Accident
b) For all accidents during the period
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
15. Do you wish to opt for higher amounts
of deductible excess ?
If yes, whether
i) 2 times
ii) 5 times
iii) 10 times
Yes No
I/We the undersigned hereby declare that the above statements and particulars are true
and complete and I/we declare and agree that the 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…………………….
Dated…………………… Proposer’s Signature ……………………….
PROHIBITION OF REBATES
Section 41 of Insurance Act, 1938 :
1. No persons 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 or
risk relating to lives or property in India any rebate of the whole or part of the
commission payable or any rebate of the premium shown on the policy nor shall any
person taking out or renewing or continuing a policy accept any rebate except such
rebate as may be allowed in accordance with the published prospectuses or tables of
the Insurers.
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.
NATIONAL INSURANCE COMPANY LIMITED
Additional Questionnaire for Contractor’s
All Risk Insurance Proposal
1) In case of construction of Auditoriums
and Cinema Halls please specify :
a) Height in mts.
b) Span in mts.
a)
b)
2. In case of construction of Factory
Sheds, Warehouse, Cold Storage and
Hangars please specify type of
construction.
RCC Construction Other than RCC Const.
3. In case of construction of Chimneys.
Soils and Cooling Towers 9other than
hyperbolic or natural draught type)
please specify :
a) Height in mts.
b) Diameter in mts.
a)
b)
4. In case of construction of Flyovers on
Land please specify span in mts.
5. In case of construction of Subways on
Land please span in mts.
6. In case of construction of
Reservoirs/Tanks please specify ;
a) Material used
b) Location of construction
a) Steel Other than Steel
b) Surface Underground Overhead
7. In case of construction of Road please
specify
a)
b) Whether the contract involves const.
of any Culverts, Road, Bridges and
Tunnels, if so please specify the value
in percentage in relation with the total
contract value.
a) In Township only
b) In Plain Area
c) In Hilly Ghat Areas
8. In case of Road Bridge const. please
specify material to be used for such
construction.
Steel RCC or Other materials
Pressed Concrete