NATIONAL INSURANGE COMPANY LIMITED
(A Subsidiary of General Insurance Corporation of India)
Registered Office: 3, Middleton Street, Calcutta – 700 071

PROPOSAL 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 the premium paid. Information given herein will be treated in strict confidence.
Put a ( 4 ) mark wherever application
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
Full description of the Plant & Machinery
to be erected including Capacity.
(Please attach separate sheet if necessary)
4. (a ) Is this a contract/sub-contract forming part of
an over all erection project of value exceeding
Rs. 5 crores.
(b ) If yes, give name of the Project
(a ) Yes No
(b )
(2)
5. (a ) Have the Plans, Designs, and Materials been
already tested in any previous erection ?
(b ) Is the installation or part there of built for the
first time ?
(c ) Are you the manufacturer, importer, buyer or
contractor of the installation ?
(d ) Is the property brand new or is it second
hand and used one
(e ) If second hand or used, state age
(a ) Yes No
(b ) Yes No
(c ) Manufacturer Importer
(d ) Brand New Used one
(e )
6. (a ) Will the erection be carried out by your own
personnel ?
(b ) If not, by whom ?
(c ) Past experience of the erectors
(a ) Yes No
(b )
(c )
7. (a ) Will any sub-contractors be taking part in the
work of erection ?
(b ) If yes, what is their position as regards this
Insurance ?
(a ) Yes No
(b )
THE CONTRACT SITE
8. (a ) Location of site where the Plant is to be
erected.
(b ) Nearest Port and/or Railway Station and
distance.
(Note : A complete lay out of the Factory and
Site may be enclosed).
9. (a ) Are any special risks of floods, fire or
explosion involved ?
If yes, give details
(b ) Distance from nearest river or sea the names
and particulars to be given.
(c ) Elevation of Erection Site above normal river
or sea level.
(d ) Is there any record of the Erection Site ever
having been submerged during floods ?
(a )
(b )
(a ) Yes No
(b )
(c )
(d ) Yes No
(3)
10. (a ) Brief description of the arrangements made for
storage of equipments-whether in open or
closed premises ?
(b ) Will there be a watchmen on duty round the
clock ?
(c ) If not, what precautions will be taken against
theft, malicious damage etc.
(a )
(b )
(c )
THE INSURANCE
11. (a) Probable date of first shipment or despatch.
(b ) Expected date of first arrival at site.
(c ) Expected date of last arrival at site.
(d ) Probable date on commencement of erection
of Plant & Machinery.
(e ) Probable date on which erection of Plant
and Machinery is expected to be completed
finally.
(f ) Duration of Testing Period (Included in “g”
below).
(g ) Period of Insurance required including Test
run.
(a )
(b )
(c )
(d )
(e )
(f ) ……………..Months
(g ) ………….Months, From………To………
12. Sum Insured :
1. (a ) On landed cost of imported machinery as at
Factory Site, i.e.(a) Exchange rate (subdivided
as under)
(i ) Invoice Cost
(ii ) Freight, Insurance, Handling, Clearing
and Transportation charges upto Factory
Site.
(iii) Customs Duty
(b ) On Machinery fabricated or manufactured
in India (sub-divided as under )
(i ) Invoice Cost including Insurance,
Handling Clearing and Transporting
upto Factory Site.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
(4)
(ii ) Freight
(c ) One Cost of Erection, including salaries
of all Foreign and Indian Technicians and
Wages of all skilled and unskilled labour
Employed at Factory Site during erection.
(d ) On Building in which the above Plant and
Machinery is to be erected.
(i) Permanent Civil Engineering
Works
(ii) Temporary Works
Rs.
Rs.
Rs.
Rs.
Completely Erected Value Rs.
II. Clearance and Removal of Debris
III. Construction of Plant and Machinery to be
used at the Project Site.
IV. Insured’s own Surrounding Property
V. (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.
(b) On increased replacement value which
may have to be paid on replacement of
indigenous Plant and Machinery as per
item I-(b) above.
VI. Extra charges for Express Freight (excluding
Air Freight), Overtime, Sunday and Holiday
Rates of wages.
VII. Third Party Liability
(a) For any one accident
(b) For all accidents during the period.
Rs.
Rs.
Rs.
…………% Rs.
………….% Rs.
Rs.
Rs.
Rs.
________________
Total Sum Insured Rs.
(5 )
13. (a) Have you approached any other Insurance
Company for Insurance Cover in respect
of this Proposal ?
(b) If yes, please state name of the Insurance
14. Has any such proposal been
(a) declined ?
(b) withdrawn ?
(c) accepted subject to an increased rate or
special conditions ?
(d) If yes, please state name of the Insurance
(a) Yes No
(b)
(a) Yes No
(b) Yes No
(c) Yes No
(d) Yes No
The following questions are to be answered if Marine/Transit Insurance Cover is required
15. (a) Are there any fragile item like Refractory
Materials, Asbestos Cement Sheets, Procelain
materials, Glass equipments, Fire
Bricks, Graphite Electrode etc. ?
(b)If yes, please give their value, description
and mode of packing (whether packed in
cases or loose)
16. (a) Do you want cement to be covered /
(b)If yes, give its value and mode of packing
(whether packed in gunny bags or paper
bags)
17. Please give particulars of voyage for imports.
18. What is the limit required
(a) per any one shipment ?
(b) per any one despatch ?
(In case of indigenous materials)
19. Please state (for Inland Transit)
(a) How the goods will be transported to site
of erection ?
(a) Yes No
(b)
(a) Yes No
(b)
(a)
(b)
(a) By Rail By Steamer
By Lorry By Country-Craft
(6)
(b) How many Transshipments will be there ?
(c) Special hazards, if any, in transporting
goods from nearest Station/Port to
Erection site.
20. Do you require War & S.R.C.C. risk to be
covered during Overseas/Inland transit ?
(b)
(c)
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 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 …………………..
Dated …………………. Proposer’s Signature ……………………….
______________________________________________________________________________________
PROHIBITION OF REBATES
Section 41 of 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 lives or properly 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 or continuing a policy accept any rebate,
except such rebate as may be allowed in accordance with the published prospectuses or tables 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.