THE OREINTAL INSURANCE COMPANY LIMITED
SWEET HOME POLICY
PROPOSAL FORM

* Floater P.A. either insured or his/her spouse is insured PROVIDED their age is less than 70 years, in case the age of insured is more than 70 years then only his/her spouse is covered provided his/her age is less than 70 years, in case both are more than 70 years age then the PA section would be deleted from the scope of the policy. In the event of death claim for one (insured or his/her spouse), the other one will be the assignee for getting the benefits. In the event of death of both insured and spouse the law of the land shall be applicable.
** Electrical/Electronic items having value less than Rs. 1,000/- cannot be covered. The details of specifications of household machinery along with its estimated value is required to be mentioned in the proposal form.
· The maximum limit of coverage per household item/pair or set of items is 10% of the total sum declared and insured in the
respective section.
(To be filled in DUPLICATE)
1. NAME OF PROPOSER _______________________________
2. ADDRESS OF PROPOSER _______________________________
3. PERIOD FOR WHICH INSURANCE IS REQUIRED : from______to_____________
4. VALUE OF THE PROPERTY : (A) Building Rs.4 lacs/Rs.6lacs/Rs.8lacs
(B)Contents: Re.1 /Rs.2lacs/Rs.3lacs
5. ANYOTHER INSURANCE ON THE SAME
PROPERTY, IF YES: (a)POLICY NO.___________________
(b)Name and address:_______________
of the insurer ________________
6. NAME OF THE SPOUSE FOR THE PURPOSE OF Shri/Smt.__________________________
Machinery
Items(Electrical/Electronic)
Name of
insured
Age Location/
Address
where
property is
situated
Plan
(Mention)
A/B/C/
(excluding
jwellery)
Name of
Spouse/
Assignee
Age/
Date
Of
Birth
Item Make Year
of
mfg.
Sum
Insured
Tick the %
of total value
of the
property
sought for
under first
loss basis
Upto 25%
Upto 50%
Upto 65%
Upto 75%
Beyond
75%
*strike out whichever is not opted.
DECLARATION CLAUSE : I hereby declare that particulars contained herein are true and correct and that no material fact has been withheld,
misstated or misrepresented and also that this proposal forming part of the company’s standard policy shall be the basis of the contract between me
and the insurance company.
I further declare that myself/ my spouse will be the assignee for each other for Personal Accident Insurance Cover and in the event of my death of,
either of us the receipt given by assignee shall be sufficient discharge to the Company.
SIGNATURES OF INSURED/ PROPOSER&SPOUSE
Date:___________ Place____________
PROHIBITION OF REBATES (Section 41 of Insurance Act 1939) No person shall allow, or offer to allow, either directly or indirectly as an inducement to any person to
take out 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 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 published prospectus or tables of the insurer.
Any person making default in complying with the provisions of this section shall be punishable with fine which may be extended to five hundred
rupees.