Laghu Udyam Proposal
Laghu Udyam Proposal
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.
To :
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
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.
_____________________________
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
* 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 )
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
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
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)