PROPOSAL FOR MATERIAL DAMAGE

No risk attaches until the proposal has been accepted by the company and premium is paid or agreed to be paid

Your Details
Business name :*
Business's physical address :*
Type of business :
Contact details :
Postal Address :
Telephone:
Work :
Home :
Mobile :
E mail :
YOUR DUTY OF DISCLOSURE
You must tell us everything you know (or could be reasonably expected to know) that a prudent insurer would want to take into account in deciding:
  • Whether to accept your proposal, and
  • If so, on what terms.
Examples of what you must tell us include:
  • Anything that increases the risk of a claim
  • Any criminal offending or convictions
  • Any previous insurance claims
  • Any refusal by another insurer to insure you on standard terms, or continue to insure you on standard terms.
You must also tell us this every time this policy renews, and when you make any changes to it.
If you fail to do this, we may avoid the policy back to when it started as if you were never insured at all.
When in doubt, disclose. We treat all information confidentially.
YOUR PRIVACY
We collect and receive your personal information in this proposal to decide whether to insure you. We hold it in our records. You have rights to access it, and correct it under the Privacy Act 1993.

You must supply your personal information to us if it comes within your duty of disclosure (see Your Duty of Disclosure above). If you fail to do so, we may decline your proposal or avoid your insurance retrospectively.

We obtain your authority below to transfer some or all of it to other members of the insurance industry, financially interested parties noted on your policy and Insurance Claims Register Limited.

YOUR PREVIOUS HISTORY The following questions must be answered in relation to the business, and in relation to every director and manager of the business.
If yes, please list each offence or prosecution, and each sentence your business has received.
If you have answered yes to any of the above questions, please write full details below
OPTIONAL EXTENSIONS
If Yes :
Section a Cover ($)
Section B Cover ($)
CONSTRUCTION DETAILS
Walls (state materials used eg. Concrete or bricks or iron sheets or timber etc)
Roof (state materials used)
Floors (state materials used)
OCCUPATION OF THE BUILDING
Whether used for office, store, warehouse or factory
If used for shops or warehouse, state nature of goods stored
If used for factory, give particulars of processes carried out
Is night work carried out in the factory
Is the building detached? If so, give distances from nearest buildings. If not, give construction and occupation particulars of adjoining buildings
State all other circumstances material to the risk
SUM INSURED:
Buildings -Indemnity$
Buildings & Replacement$
Demolition costs and professional fees estimate$
Contents$
Stock$
Additional property$
Optional extension$
AVERAGE CONDITION:

The Average condition will apply to all items of insured property insured for reinstatement, if the sum insured for them is below 90% of the reinstatement cost.

    Where this applies, the following will apply:
  • If you suffer a total loss, the condition has no effect.
  • If you suffer a partial loss, the maximum amount you may recover will bear the same proportion to your actual loss as the amount for which the property insured bears to the value of the property
  • Whatever your loss, in no case will you be entitled to recover more than the amount for which the property is insured.
    For example :
      1. New replacement cost $20,000.
      2. Your sum insured $10,000.
      3. You suffer a loss of $5,000.
      4. If your policy is subject to Average, the maximum amount you may recover is $2,500.
YOUR DECLARATION
    I declare that I:
      1 Have answered all questions truthfully.
      2 Have, in addition, disclosed all material facts to New India (please see Your Duty of Disclosure above)
      3 Agree to the policy terms and conditions.
      4 Authorize:
        4.1 New India to advise me of its other services from time to time.
        4.2 The disclosure of my personal information held by New India to :
          4.2.1 Other members of the insurance industry, and
          4.2.2 Financially interested parties noted on the policy, and
          4.2.3 Insurance Claims Register Limited.
        4.3 The disclosure of my personal information held by:
        4.3.1 Other members of the insurance industry, and
        4.3.2 Insurance Claims Register Limited to New India for the purpose of considering this proposal and administering the policy.
      5 Am authorized to complete this proposal on behalf of anyone else to be insured under the policy, and agree that they give the same declarations. Signature of Proposer