UNITED INDIA INSURANCE COMPANY LIMITED
PROPOSAL FORM
UNITED INDIA INSURANCE COMPANY LIMITED

PROPOSAL AND QUESTIONNAIRE FOR ERECTION ALL RISKS/
STORAGE-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 (Ö ) mark wherever applicable.
S. No. 3 Details 3 Answer
1. a) Name & Address of the Principal Trade or
business
a)
b) Name & Address of the Contractor Trade or
business
b)
c) Name & Address of the Sub Cont- ractor, if
any,
Trade or Business
c)
a. 2 THE INSURED INTERESTS -
Whose Interests are to be Insured?
3.
Principal Contractor Subcontractor
a) Type of main plant
b) 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 overall erection project.
Yes No
b) If yes, give name of the project.
c) Whether to be commissioned independently
or with the main plant.
independ
ently
With
Main
Plant
5. a) Have the Plans, Designs and Materials
been already tested in any previous
erection?
Yes No
b) Is the installation or part thereof built for the
first time
Yes No
c) Are you the manufacturer, importer, buyer
or contractor of the installation?
d) Is the property brand new or is it
second hand or used one?
e) If second hand or used, state age
6. a) Will the erection be carried out by your own
personnel?
Yes No
b) If not, by whom?
c) Past experience of the Erector
7. a) Will any sub-contractors be taking part in
the work of erection?
Yes No
b) If yes, what is their position as regards this
insurance?
8. THE CONTRACT SITE -
a) Location of site where the Plant is to be
erected?
b) Nearest Port &/or Railway Station and
distance.
Brand New Second Hand Used
Manufa
cturer Importer Buyer
Contra
ctor
Note - A complete lay out of the Factory and Site may be enclosed.
9. a) i) Are any special risks of floods, fire or
explosion involved?
Yes No
ii) 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?
Yes No
e) Do you wish to cover earthquake (fire &
shock) for risks in Earthquake Zones I & II
Yes No
10. STORAGE ARRANGEMENTS -
a) Brief description of the arrangements made
for storage of equipments –
whether in open or closed premises.
b) i) Will there be a watchman on duty
round the clock?
ii) If not, what precautions will be
taken against theft, malicious damage
etc.?
11. THE INSURANCE PERIOD -
a) Probable date of first shipment or dispatch
b) Expected date of first arrival at site.
c) Expected date of last arrival at site.
d) Probable date of commencement of
erection of Plant & machinery
e) Probable date on which erection of Plant
& Machinery is expected to be
completed finally.
f) Duration of testing period included in (g)
below.
_______
_
months
g) Period of Insurance required including
test run _________ months
from ______ to ______
a. 12. SUM INSURED –
12.1 a) On landed cost of imported machinery
as at Factory Site -
i.e. @ Exchange rate ______
(sub divided as under)
Rs.
___
i) Invoice Cost Rs.
___
ii) Freight, Insurance, Handling,
Clearing and Transportation
charges upto Factory Site.
Rs.
___
iii) Customs Duty Rs.
___
12.1 b) On machinery fabricated or manufactured
in India
(sub divided as under)
i) Invoice Cost including insurance,
handling and clearing and
transporting upto factory Site.
Rs.
___
ii) Freight Rs.
___
12.1 c) Cost of Foundation relating to (a) &
(b) above
Rs.
___
12.1 d) On 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.
Rs.
___
12.1 e) On Civil Works
i) Permanent Civil Engineering Works
Rs.
___
ii) Temporary works Rs.
___
Completely Erected value Rs.
___
12.2 Clearance and Removal of Debris Rs.
___
12.3 Construction Plant and Machinery to be
used at the Project Site. (To provide
Details as attachment)
Rs.
___
12.4 Insured’s own Surrounding Property Rs.
___
12.5 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 12.1
(a) above.
Rs.
___
b) On increased replacement value which may
have to be paid on replacement of
indigenous Plant and Machinery as per item
12.1 (b) above.
Rs.
___
c) Escalation on 12.I (d) -
- On increased replacement value Rs.
___
- On reconstruction of -
- Permanent Civil Works Rs.
___
- Temporary Works Rs.
___
12.6 Extra charges for Express Freight
(excluding Air Freight) Overtime, Sunday
and Holiday rates of wages viz., Expediting
cost
Rs.
___
12.7 Additional Customs Duty Rs.
___
12.8 Air Freight Rs.
___
12.9 A). Third Party Liability -
a) For any one accident Rs.
___
b) For all accidents during the period
Rs.
___
TOTAL SUM INSURED . . . . Rs.
___
B). Cross Liability, if required Yes No
13.
What deductibe Do you wish to opt
14. a) Have you approached any other
Insurance Co. for Insurance Cover in
respect of this Proposal?
Yes No
b) If yes, please state the name of the
Insurance Co.
15. Has any such proposal been -
a) declined? Yes No
b) withdrawn? Yes No
c) accepted subject to an increased rate or
special conditions? Yes No
16. Do you require MARINE/TRANSIT Insurance
cover Yes No
If yes, the following questions are to be
answered -
a) Are there any fragile items like Refractory
materials, Asbestos Cement Sheets,
Porcelain materials, Glass equipments, Fire
Bricks, Graphite Electrode etc.
Yes No
If yes, please give their value, description
and mode of packing (whether packed in
cases or loose)
17. a) Do you want cement to be covered? Yes No
b) If yes, give its value and mode of
packing(whether packed in gunny
bags or paper bags)
18. Please give particulars of voyage for imports.
19. What is the limit required -
a) Per any one shipment? (In case of imports)
b) Per any one dispatch? (In case of
indigenous materials)
20. Please state (for Inland Transit) -
a) How the goods will be transported to site of
erection?
b) How many Transhipments will be there?
c) Special hazards, if any, in transporting
goods from nearest Station/Port to erection
site.
21. Do you require War & S.R.C.C. Risk to be
covered during Overseas/inland transits? Yes No
22. Do you wish to opt for excess under
marine/transit losses 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___________
By Rail By Steamer By Lorry By Country
Craft