FIRE INSURANCE PROPOSAL FORM

BML INSURANCE cm Of Ed ea cS wa cs cn er wa x
u cn ia r wy wf

Proposal no. Policy no.

Individual Company National ID Card

     

Occupation: Nature of Business: Work Permit Passport

      

ID No.
       

Date of Birth: Male Female Reg No.

  D D M M Y Y Y Y    

Permanent Address (as in ID card): Contact Name:

       

Current Address: Nationality:

‫މހރ އޅ އޑރސ‬ 

House/Building name: Contact No:

     

Road: District: Email:

  
Postal Code: Atoll,Isand: Fax:
    

Mortgagee:      

Risk name:       

Location of risk:

Nature of Business:   

Period of Insurance:     

Total Sum Insured:     

DecIaration: I/We desire to effect with the Company an insurance, in the terms of the Policy used for this class of business and I/We warrant that
the above statements and particulars are correct and complete. I/We agree that this proposal shall be the basis of the contract and part of the
insurance between myself/ourselves and the Company.
                
                 
    

Signature: Date:

Documents required with the Proposal: Stock details

      

Copy of permit for selling important goods (if applicable) ID. Card/ Company’s registration copy If mortgaged, Copy of loan agreement
            

Bank use only Rate: Premium: Agent’s Name:

Rate Options: Option 1: Options 2: Options 3:

THIS INSURANCE WILL NOT BE IN FORCE UNTIL THE PROPOSAL HAS BEEN ACCEPTED BY THE COMPANY
      

Allied Insurance Company of the Maldives Pvt. Ltd. (C-43/84), Fen Building, 3rd floor, Ameenee Magu, Male’, 20375, Maldives 1-2
+960 330 0033 +960 332 5035 info@allied.mv youtube.com/alliedmv facebook.com/alliedmv twitter.com/alliedmv
allied.mv
Note : Where two or more separate buildings or internally communicating ranges of buildings and/ or their contents are to be insured separate
amounts must be given for each.
If the information concerning the premises or property to be insured differs between buildings full details should be given on a separate sheet.

Sum Insured
Item Property Building 1 Building 2 Building 3 Building 4
(MVR/USD) (MVR/USD) (MVR/USD) (MVR/USD)

1 Building(s) including Permanent Fixtures

and Fittings
2 __Months’ Rent thereof

3 Furniture
4 Stock and Materials in Trade
5 Plant and Machinery
6 Household Goods and Personal effects

7 Architects and Surveyors Fees

8 Removal of Debris

Others ( Please specify )

Total Sum to be Insured

Questionnaire

Please tick the

appropriate If yes, give full details
box
Is there any other Insurance on the same property in force with us or any Yes No
other company?

Yes No
Has any company or insurer ever declined to insure you or your property,
imposed special terms or cancelled or refused to renew your insurance?

Yes No
Are there any other occupants of the premises?

Are the premises attached to or near any other premises? Yes No If yes, Please describe below in detail the nearby premises
to the right, left and back ( e.g. distance, residents and the
materials in which external wall, roofs, etc. are made of)

Are any hazardous goods, including petrol, kerosene, rubber, copra, Yes No
matches or joss sticks, used or stored?

Of what material are the following constructed? External Walls:

Roof:
Floors:

How are the premises lighted?

How long have you conducted business at the premises?

Signature: Date:

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