0% found this document useful (0 votes)
23 views4 pages

Laghu Udyam Proposal

The document is a proposal form for the National Bharat Laghu Udyam Suraksha Policy, which provides coverage for enterprises with insurable assets valued between ₹ 5 Crore and ₹ 50 Crore against Fire and Allied Perils. It outlines the necessary details required from the proposer, including business information, property details, fire protection measures, and premium information. The proposal must be accepted and premium paid for the coverage to be effective.

Uploaded by

dhanushero69
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
23 views4 pages

Laghu Udyam Proposal

The document is a proposal form for the National Bharat Laghu Udyam Suraksha Policy, which provides coverage for enterprises with insurable assets valued between ₹ 5 Crore and ₹ 50 Crore against Fire and Allied Perils. It outlines the necessary details required from the proposer, including business information, property details, fire protection measures, and premium information. The proposal must be accepted and premium paid for the coverage to be effective.

Uploaded by

dhanushero69
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 4

National Insurance Company Limited

CIN - U10200WB1906GOI001713 IRDAI Regn. No. – 58

National Bharat Laghu Udyam Suraksha Policy


(UIN: IRDAN058RP0007V01202021)
Proposal Form

Important:
1. This proposal is for covering an enterprise whose total value of insurable assets at a location exceeds
₹ 5 Crore but does not exceed ₹ 50 Crore, against Fire and Allied Perils.
2. Read the Prospectus/Key Features Document/Policy Wordings before filling up this proposal form to
understand the meaning of the terms used herein better.
3. The property proposed for insurance is not covered until the proposal is accepted and premium is
paid.

Policy Issuing Office Address & Code


Intermediary/Agent Name & Code (if any)

A. Details about Proposer and Policy Period:


1. Name of Proposer
2. Address of Proposer
3. Telephone No ( Landline)
4. Mobile No
5. Email
6. Contact person details, if not an individual
a. Name
b. Designation
7. Policy to be Issued in favour of (list out all the
parties who have insurable interest) including
the financial institutions
8. Period of Insurance From :

To :

B. Business and Location of Business:


9. Business of Proposer
10. Location of risk/business to be covered - full SL Address Pin Occupancy Age Floor*
postal address with Pin Code No. code of
unit
1.
2.
3.
4.
*Floor: Ground Floor (GF) / Mezzanine Floor (MF) /
Higher Floor

C. Details about business covered at the insured location


11. The Insured property is Please tick in the space below :
a. Offices, shops, hotels etc. Yes / No
b. Industrial / manufacturing risks Yes / No
c. Storage outside Industrial/ manufacturing risks Yes / No
d. Tanks / gas holders outside industrial/ Yes / No
manufacturing risks.

National Insurance Co. Ltd. National Bharat Laghu Udyam Suraksha Policy
Page 1 of 4
Regd. & Head Office: 3, Middleton Street, Kolkata 700071 (UIN: IRDAN058RP0007V01202021)
National Insurance Company Limited
CIN - U10200WB1906GOI001713 IRDAI Regn. No. – 58

National Bharat Laghu Udyam Suraksha Policy


(UIN: IRDAN058RP0007V01202021)

e. Utilities located outside Industrial/manufacturing Yes / No


risks.
f. Boundary wall Yes / No
g. Basement storage Yes / No

If, yes value stored SI: ₹….……….


h. Others ( please specify)
________________________________

12. If used as warehouse / godown (not located in a


manufacturing unit) please give the list of goods
stored.
13. If used as an Industrial Manufacturing unit give
products manufactured at the location
proposed(detailed block plan showing various
facilities to be enclosed wherever applicable)
14. If used as an Industrial Manufacturing unit, please
state whether the factory is working or silent?

15. Fire Protection devices installed Please Tick the correct answer in the box below.

Portable Extinguishers
Small bore hose reels
Trailer Pumps/Fire engines
Hydrant System
Sprinkler System
Fixed Water Spray System
Foam System
Fire Alarm System
Gas Flooding System
Others, please specify below.
_____________________________

16. Indicate whether AMC( Annual Maintenance


contract) for the Fire Protection Appliances is in Yes / No
force :
17. Construction Details
a. Please state material used Please tick the correct answer in the box
i.Walls Kutcha / Pucca
ii.Floor Kutcha / Pucca
iii.Roof Kutcha / Pucca
Note:
Kutcha: Building(s) having walls and/or roofs of wooden planks/thatched leaves and/or grass/hay of any
kind/bamboo/plastic cloth/asphalt/ canvas/tarpaulin and the like are treated as Kutcha Construction.
Pucca: Buildings other than Kutcha are treated as Pucca constructions.
b. Number of Floors
c. Age of the Building
Less than 5 years
5-10 years
10-20 years
Above 20 years

National Insurance Co. Ltd. National Bharat Laghu Udyam Suraksha Policy
Page 2 of 4
Regd. & Head Office: 3, Middleton Street, Kolkata 700071 (UIN: IRDAN058RP0007V01202021)
National Insurance Company Limited
CIN - U10200WB1906GOI001713 IRDAI Regn. No. – 58

National Bharat Laghu Udyam Suraksha Policy


(UIN: IRDAN058RP0007V01202021)

18. Distance between the risk to be covered and nearest


Fire Brigade
19. Whether You have insured the same property with
any other Insurance Company with the same type of
coverage. (Give details)
20. Whether Insurance was declined by any other
Company (Give details)
21. Premium / Claim details for the past 36 months Year Premium Claim
excluding the expiring policy period ₹ ₹
₹ ₹
₹ ₹
₹ ₹
₹ ₹
TOTAL ₹ ₹

D. Sum Insured and Other details of Insured Property


(Indicate Sum Insured on the following basis:
 For Building, Plant and Machinery, Furniture, Fixture and Fittings and other contents: Reinstatement Value;
 For raw material: Landed Cost;
 For stock in process: Input cost;
 For finished stock: Manufacturing cost of the finished stock or the Contract Price* of goods sold but not
delivered, as applicable.

* Contract Price is in respect only of goods sold but not delivered, for which You are responsible and with regard
to which under the conditions of the sale, the sale contract is cancelled by reason of any Damage insured under
this Policy either wholly or to the extent of the Damage. The Company’s liability shall be based on the Contract
Price).
22. Description Building Plant & Furniture Raw Stock in Finished Other Total
of Block inc l u d ing Machinery & Material Process Stock Contents
plinth, Fixtures, ( Please
Basement Fittings specify)
and and other
additional equipment
structures


E. Standard add-ons
I. Do You want to opt for Floater Cover?: Yes/No (strike off what is not applicable). If yes, give details
below:

23. Floater Cover (for stocks at various Location (Postal Address Sum Insured (in ₹)
locations) with Pin Code )

i) Maximum value at any one location: ₹……….

National Insurance Co. Ltd. National Bharat Laghu Udyam Suraksha Policy
Page 3 of 4
Regd. & Head Office: 3, Middleton Street, Kolkata 700071 (UIN: IRDAN058RP0007V01202021)
National Insurance Company Limited
CIN - U10200WB1906GOI001713 IRDAI Regn. No. – 58

National Bharat Laghu Udyam Suraksha Policy


(UIN: IRDAN058RP0007V01202021)

ii) Whether stocks stored in open: Yes / No

II. Do You want to opt for Declaration Policy?: Yes/No (strike off what is not applicable). If yes, give
details below :
24.
Stocks which fluctuate in value to be covered on (monthly) declaration basis:

Amount (₹):

F. Premium Details
Mode of Payment
25. Payment Details
Amount

G. Declaration by Insured
I/ We hereby declare that the value insurable assets is more than ₹ 5 Crore but less than ₹ 50 Crore and the
statements made by me / Us in this Proposal Form are true to the best of my / our knowledge and belief and I /
We hereby agree that this declaration shall form the basis of the contract between me/Us and the National
Insurance Co. Ltd.

If any additions or alterations are carried out in the risk proposed after the submission of this proposal form then
the same should be conveyed to the insurers immediately.

Date:
Place: Signature of the Proposer

INSURANCE ACT 1938 SECTION 41- Prohibition of Rebates

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 the premium shown on the policy, nor shall any
person taking out or renewing a policy accept any rebate, except such rebate as may be allowed in accordance
with the 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 EXTEND TO TEN LAKHS RUPEES.

National Insurance Co. Ltd. National Bharat Laghu Udyam Suraksha Policy
Page 4 of 4
Regd. & Head Office: 3, Middleton Street, Kolkata 700071 (UIN: IRDAN058RP0007V01202021)

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy