NATIONAL INSURANCE COMPANY LIMITED
(Subsidiary of General Insurance Corporation of India)
Regd. Office : 3, Middleton Street, Calcutta – 700 071

POLICY ISSUING OFFICE
____________________________________________________________________________________________________________
For Office use only :
Agency Code : Policy No. : Premium :
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
PROPOSAL – CUM – POLICY SCHEDULE FOR OFFICE PACKAGE POLICY
___________________________________________________________________________________________________________
a) Proposer’s Name : Phone :
b) Proposer’s Address : Fax :
c) Proposer’s Business :
d) Office Premises Address :
Is the proposer a Government owned office : Yes / No
If yes please state paid up capital : Rs.
e) Period of Insurance : From AM/PM To 12.00 midnight
1) Please note that sections 1A, 1B and 2 are compulsory for owner of building and sections 1B and 2 for tenants
of the building.
2) The proposer has to opt a minimum of 3 sections other than minimum compulsory sections prescribed above.
3) The Sum Insured under Sec. 1B & 2 should be more or less indentical. Should there be any difference in the
Sum Insured reasons thereof be specified.
________________________________________________________________________________________________________
SECTION DESCRIPTION OF PROPERTY SUM INSURED RATE EXCESS PREMIUM
CONTIN- (RS.) (% 0) (RS.) (RS.)
GENCIES (Col. 1) (Col. 2) (Col. 3) (Col. 4)
________________________________________________________________________________________________________
FIRE AND i) Building : 0.75
ALLIED ii) Land lord’s fixtures & fittings :
1A iii) Boundary Walls, Gates & Fences :
iv) Other Property :
v) Sanitary Fitings :
vi) Canteen :
________________________________________________________________________________________________________
_________________________________________________________________________________________________________
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
_________________________________________________________________________________________________________
1B Contents : 0.75
i) Furniture, Furnishing Safes, Fixtures,
Fitting Stationary :
ii) Documents such as Manuscripts,
Drawings, Designs etc. :
iii) Telephone, Gas & Electric meters :
iv) Interior decorations :
v) Electronics Equipments :
vi) Office appliances :
vii) Clothings and personal effects
(excepts for property otherwise
insured and jewellery, money & Fur.)
(Limit Rs. 5,000/- per person) :
viii) Any other property (please specify) :
ix) Canteen Contents :
x) Office Appliance :
xi) Lift :
_________________________________________________________________________________________________________
1C. Fire Loss of Profit : 0.75
i) Gross Income :
ii) Additional Expenditure :
iii) Accountant charges / fee :
__________________________________________________________________________________________________________
1D. Additional Expenses of Rent for
an alternative accomodation : 0.75
__________________________________________________________________________________________________________
1E. Loss of Rent : 0.75
__________________________________________________________________________________________________________
BURGLARY Contents ( as stated as above ) : 0.75
HOUSE
BREAKING
THEFT
2
___________________________________________________________________________________________________________
DAMAGE/ Plate Glass : 10.00
BREAKAGE a) Description
3 b) DIMENSION
_________________________________________________________________________________________________________
DAMAGE Neon / Glow Sign : 10.00
BREAKAGE a) Description
4 b) Year of Manufacturing
________________________________________________________________________________________________________
MECHANICAL Office Appliances / Lift : 15.00
BREAKDOWN i) Item No.
5 ii) Description of items
iii) Mfg. Year
_______________________________________________________________________________________________________
DAMAGE Electronic Items (installed) : 8.05
BREAKAGE i) Item No.
6A ii) Description of items
iii) Mfg. Year 16.10 / 12.10
(without maintenance
agreement)
______________________________________________________________________________________________________
6B Portable Computers etc. : 8.05
i) Item No.
ii) Description of Item
iii) Mfg. Year
iv) Value 16.10 / 12.10
(without maintenance
agreement)
______________________________________________________________________________________________________
________________________________________________________________________________________________________
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
________________________________________________________________________________________________________
LOSS OF i) Wages and Salary whilst : 2.00
MONEY In transit from Bank to the
7 Office
ii) Money other than wages &
Salary whilst in direct
Transit between bank and
Office premises :
iii) Cash in counter during
Business hours :
iv) Money in Office in Locked
Safe outside business hours :
_______________________________________________________________________________________________________
LOSS/DAMAGE Pedal Cycle : 20.05
8 i) Mfg. Year ii) Type, make and model iii) Sum Insured
______________________________________________________________________________________________________
ALL RISK Baggages : 7.50
9 i) Limit for Any one Accident
ii) Limit for Any one Year
______________________________________________________________________________________________________
PERSONAL Employees : As per guide lines
ACCIDENT A list should be submitted
10 Mentioning details as under
i) Name of the Person
ii) Age
iii) Monthly income
iv) Details of existing
Deformity/disability
v) Occupation / Designation
vi) Capital Sum Insured
______________________________________________________________________________________________________
MEDICLAIM / Employee : As per Scheme
HOSPITALI- Details hould be provided as
SATION per seperate proposal attached :
11
_______________________________________________________________________________________________________
INFIDELITY / Direct Pecuniary loss caused by : Rs.5/-
DISHONESTY insured’s permanent employees
12 i) Fidelity Guarrantee cover is
required for total no. of
employees.
ii) Maximum Guarrantee is
Required for any one employee
______________________________________________________________________________________________________
FIRE & Cost of Reinstatement of
ALLIED PERILS Data / Programme : 10.05
13 i) Cost of Reinstatement of data
ii) Cost of Reinstatement of
Programme, please specify details
a) Description of Programme
b) Name of Developing Agency
c) Year of Development
d) Value
_____________________________________________________________________________________________________
FIRE / ALLIED Tenant’s Legal Liability : 0.75
PERILS (owner/co-tenants)
14 i) Legal liability towards owner
ii) Legal liability towards co-owner
______________________________________________________________________________________________________
LEGAL i) Third Party liability Limit AOA AOP As per Market agreement
LIABILITY
15A
______________________________________________________________________________________________________
______________________________________________________________________________________________________
LEGAL i) Name of the employee ii) Nature of Work/Designation iii) Monthly earning
LIABILITY (W.C.)
15B
______________________________________________________________________________________________________
Total Rs. _____________________________
Less : % Discount Rs. _____________________________
Add : 5% S. Tax Rs. _____________________________
Net Premium payable Rs. _____________________________
Declaration
I/We hereby declare that the particulars contained herein are true and correct and that no material fact has been withheld, misstated or
misrepresented and also that this Proposal-cum-Schedule forming part of the Company’s standard Policy shall be the basis of contract
between me/us and the Comapny. I/We further declare that the Sum Insured herein represent the full value of the property described
herein.
Place :
Date : Signature of the Proposer
---------------------------------------------------------------------------------------------------------------------------------------------------------------
( To be completed by the Policy Issuing Office )
The Insurance cover herein applies to Section Nos................................................ above and subject to printed Policy wording attached.
Note : The attached Policy and this Proposal-cum-Policy Schedule shall be read together as one contract and any word or
expression to which a specific meaning has been attached in any part of this Policy or of the Schedule shall bear such
meaning wherever if may appear.
Signed at ................................. on the ..................................... day of .................................. 200 .......................................
For and on behalf of
National Insurance Co. Ltd.
Authorised Signatory
Skd./ office package policy