Contractors All Risk

Personal Details

Risk Details

General Policy Details

Personal Details

Proposer Type

Intermediary

Select Intermediary branch

Binder

ID Type

Tax Pin Tax Pin

First Name

Middle Name

Last Name

Type of Business

Occupation

Date Of Birth

Gender

Male Female

If insured name or other name

Quotation Validity Period

Contact Details

Mobile No.

Telephone No.

Email Address

Postal Address

Postal Office

Town

County

Region

Earth Quake Zone

Physical Address

Branch

Cover type

Financier Interest

Period of Insurance

Insurance Start Date

Insurance End Date

Date of commencement of work

Duration of Contract (In Month)

Maintenance Period (in Month)

Date of completion of work

Title of contract

Site

Town/Location construction is being carried

Town

County

Earth Quake Zone

Flooding area

Prinicipal details:

Name

Postal address

Postal code

Telephone/Mobile no.

Email Id

Are there any Subcontractor?

Subcontractor details:

Type

Name

Postal address

Postal code

Telephone/Mobile no.

Email Id

Work to be carried out

Sub contracted work price

Description of Work to be carried out

Description of dimensions (in meters):

Length (metres)

Height (metres)

Depth (metres)

Spans (meters)

Number of floors

Number of basement levels

Type of foundation and deepest level of excavation

Construction method

Will you be constructing any Bridges, Tunnels or Overpasses?

Type of roads

Number of lanes / Tracks

Must traffic be maintained during construction of the road?

Will the new road be open to traffic before completion of wearing course?

Is the contractor experienced in this type of work or construction method?

How many years’ experience does the contractor have in this type of work?

Special risks:

Special risk

Is the design of the structure to be insured based on regulations for earthquake-resistant structures?

Is the design standard higher than that stipulated in the relevant regulations?

Details of subsoil

Rock

Gravel

Sand

Clay

Filled ground

Other

Provide details

Do geological faults exist in the vicinity?

Please provide the following information on the nearest lake, river or ocean:

Name

Distance from site(in Km)

Average water level(in mm)

Highest water level recorded(in mm)

Please select the usual start month of the longest rainy season

Please select the usual end month of the longest rainy season

What is the maximum rainfall recorded in the area(in mm)

Storm Hazard

Details of existing buildings or surrounding property possibly affected by the contract work

Construction machinery, plant and equipment

Description of item

Make

Model

Serial number

Replacement value

Are existing buildings and/or structures on or adjacent to the site, owned by or held in care, custody or control of the contractor(s) or the principal, to be insured against loss or damage arising as a direct or indirect consequence of the contract work?

Exact description of these buildings/structures

Please state the amounts you wish to insure and the limits of indemnity required for the following items

Contract price

Materials or items supplied by the principal(s)

Construction machinery, plant and equipment

Earthquake, volcanism, tsunami

Storm, cyclone, flood, inundation, landslide

Existing buildings or structures on or adjacent to site

Extra charges for Overtime

Clearance of debris

Designer’s risk

Works taken over or put into service

Vibration, Removal or Weakening of support

Is Third Party Liability (T.P.L) to be included?

This includes Third Party Bodily injury and Third Party Property damage Total Third Party Liability Limit sum insured

Has the Contractor concluded a separate policy for Third Party Liability?

what is the limit of liability?

General Policy Details

Are you now or have you ever been insured for this type of policy ?

Has any insurance company ever

Declined your proposal ?

Cancelled or refused to renew your policy?

Required an increased premium or imposed special conditions?

Declined your claim?

Insurance and Loss History

Please provide below information on any insurance claims you have reported in the last 5 years

Type of loss

Year of Incident

Claim Amount/ Value

Add Loss Claim History

DECLARATION AND CONSENT | Please Read Carefully *

I/ We do hereby declare that the above answers and statements are true and that I/ We have withheld no material information regarding this proposal. I/ We agree that this declaration and the answers given above as well as any proposal or declaration or statement made in writing by me/ us or anyone acting on my/ our behalf shall form the basis of the contract between me/ us and the Company. I/ We further agree to accept indemnity subject to the conditions in and endorsed on the Company’s policy.

I/We consent to Trident Insurance Company Ltd; (i) Collecting, using, disclosing and/or processing my/our personal data; and (ii) Transferring my/our personal data to their reinsurers and affiliated companies for the purposes of insurance as permitted by law.

CREDIT INFORMATION | Please Read Carefully *

I/we do hereby confirm that I/we have authorized Trident Insurance Limited to share my/our credit information and to access my/our credit profile from Credit Reference Bureau (C.R.B)

Contractors All Risk Proposal

Period of Insurance

Prinicipal details:

Subcontractor details:

Description of dimensions (in meters):

Special risks:

Details of subsoil

Please provide the following information on the nearest lake, river or ocean:

Please state the amounts you wish to insure and the limits of indemnity required for the following items

General Policy Details

Has any insurance company ever

Insurance and Loss History

DECLARATION AND CONSENT | Please Read Carefully *

CREDIT INFORMATION | Please Read Carefully *