The New India Assurance Company Limited
Head Office: 87, M G Road, Fort, Mumbai-400001

PROPOSAL FORM FOR HUT INSURANCE

1. Name of Proposer:
2. ADDRESS:

3. Occupation
4. Name of the financier if any:
5. Period of Insurance
6. Location of the Hut/s to be Insured:
Plot No. Survey No.
Village Taluka
District State
7. Description of the hut/s:
Roof made of:
Wall made of:
Area of Hut:
8. Sum Insured proposed: 1. Hut : Rs. ____________________
2. Contents: Rs. ____________________
Total : Rs. ____________________
_________________________________________________________________________
I/We propose to insure the above mentioned hut/s and their contents owned by me/us with .The New India Assurance Co. Ltd. Subject to the terms, conditions and exclusions of the Companies Policy. I/We warrant that the answers to the above queries are true and that there is no other Insurance Policy in existence at present. I/We agree that this proposal shall be the basis of the contract between me/us and the Company.
Agency Code No
Inspector Code No SIGNATURE OF PROPOSER.
Branch Code No.
Policy NO.

1. No person shall allow, or offer to allow; either directly or indirectly, as an inducement to any kind of risk relating to lives or property in Indian, any rebate, or the whole or part of the commission payable or any rebate, or the premium shown on the Policy, nor shall any person taking it or renewing or continuing a Policy accept any rebate as may be allowed in accordance with the published prospectuses or tables of the Insured.
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.