UNITED INDIA INSURANCE COMPANY LIMITED
REGD & HEAD OFFICE NO 24 WHITES ROAD CHENNAI – 600 014
PROPOSAL FORM FOR HOARDINGS INSURANCE

Please, give specific reply to each Question:
1. (a) Name and Address of proposer in full:
(b) Business:
2. Location where Hoardings are installed:
3. (a) Dimensions of Hoardings:
(b) Materials used for fabrication:
(c) How are the Hoardings mounted and at what
Height?
(d) Are any Hoardings installed on terrace or
Roof tops?
(e) Are they in good condition?
a) Length :
Breadth :
Width :
4. Are the Hoardings situated
(a) Along busy thoroughfares.
(b) At corners of street / roads
(c) In close proximity to auditoria, cenema houses, markets,
shopping centers, buildings, housing commercial
enterprises, educational institutions, hospitals, railway
stations, bus stations or airports or residential buildings?
(give details)
5. Has the Hoarding suffered any damage previously? If so,
how?
6. Give details of previous insurance if any.
7. Has any Company refused to accept the renewal in respect of
the Hoarding or cancelled the Policy or increased the
premium?
8. Schedule of Property to be Insured. (Description and separate
values must be given):
Sl.
No
.
Location
(Within India)
Date of
Installation
Sum
Insured
Rs.
9. Give details of losses sustained, if any during the past three
years.
10. Details of claims paid by and / or outstanding with any
Insurance Company
I / We hereby declare that foregoing particulars are true and correct in every respect and that no
material fact has been withheld, misrepresented and mis-stated and I / we agree that this proposal and
declaration shall be the basis of the contract between me / us and . . . . . . . . . . . . . . . .INSURANCE
COMPANY LTD., where standard policy for the insurance is acceptable to me / us.
Signature of the Proposer
Place:
Date:
___________________________________________________________________________________
PROHIBITION OF REBATES
Section 41 of Insurance Act, 1938 as amended provides that:
1. No person shall allow, or offer to allow, either directly or indirectly as an inducement to any person
to take cut or renew or continue an insurance in respect of any kind of 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 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,.