United India Insurance Co. Ltd
Registered & Head Office : No.24, Whites Road, Chennai- 600014

INDUSTRIAL ALL RISK POLICY
PROPOSAL FORM

NAME OF THE COMPANY
LOCATION OF THE RISK
PIN CODE
Sr No. Block No. Decsription of the
risk
Class of
construction
Sum Insured in Rs.
Main Communica
ting if any
Bldg Machinery Furniture,
fixture &
fittings
etc
Piping Cabling Stock &
Stock- in
- process
Stock in
godown
Materials
in
open/gas
holders/
tank
farms
Total
Sum
Insured
Also state the Block Nos. communicating with the block described
Also state storey/basement/attic/loft