UNITED INDIA INSURANCE COMPANY LIMITED
WEDDING BELLS POLICY
PROPOSAL FORM

IMPORTANT INFORMATION
PLEASE COMPLETE CLEARLY IN BLOCK LETTERS. SUM INSURED TO BE GIVEN IN INDIAN RUPEES ONLY.
1. Proposer’s Details
Proposer’s Full Name:
Telephone No:
Mobile No:
Occupation :
E-mail address:
2. Particulars of Bride/ Groom:
a) Name of the Bride
b) Age of the Bride
c) Daughter of
d) Name of the Groom
e) Age of the Groom
f) Son Of
g) Relationship of Insured to Bride/Groom
3. Address of the Marriage/Wedding Premises
a) Class of construction
b) Will the proposer be the sole occupant of the entre premises at the time of marriage
i.e., has the premises been taken for his exclusive use?
c) Any other similar function at the same time in the premises? (If the premises
contains a number of buildings/floors)
4. Details of the Marriage
a) Date and Time of Marriage
b) Date and time of starting the Activity/Function at the premises
c) Date and time of co0mpletion of the Function
5. Details of Expenses
a) Details of expenses- please give detailed list.
b) Indicate anticipated number of guests for main function, preliminaries & receptions
separately.
c) Details of property & valuables- (1) Owned by Insured (2) Taken on Rent
d) Has the property mentioned above been insured earlier under any other policy? If so
give details.
e) Has the buildings and other contents of the marriage premises been earlier insured
under any other policy? If so give details.
Date on which insurance is to commence: From
To
Section Sum Insured Rs.
I. Expenses Incurred
II. Property Damage
III. Legal Liability Third Party Liability- Rs. AOA :
Workmens Compensation as per WC Act
Extension 1
Extension 2 :
Extension 3:
Extension 4 :
TOTAL SUM INSURED
Signature(s)
Date
SECTION 41 OF THE INSURANCE ACT 1938
PROHIBITION OF REBATES
2. 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 or 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 continuing a
policy accept any rebate except such rebate as may be allowed in accordance with the prospectus or tables of the Insurer.
3. Any person making default in complying with the provisions of this Section shall be punishable with fine, which may extend
to Rs.500/-.