Bussiness-Interruption-Insurance-Proposal (2)

PlroFo iINSURANCT] LIMITDD.

No. PS 3754)
lpala rllawotha,

],

2206406 Fax: (0ll) 2206399

I.ION INSURANCE

2. Postal Address

3. Business : ,...,..,.... Telephon No.:

4. How long have you carried on present business?

5. Situation of all the premises to be included in the in urance:

6. ,..Perlod,of Insurance: Fron: ...,,.. To :

7. Indernnityperiodrequired: ........ rnonl l$.

8. Sumo to be insured :

l. On Gross profit Rs

2. On wages (100% for . , . .weeks and . . . .% Rs
for remainder of Indomnity period) Rs
Rs
3. On Auditors Charges Rs.
4. On...
5. On...

A. Name and address of your Auditors:

10. Has any Insurer declined to aceept to oontinue any ir turance in respeet ofthe perll n0w
proposodl? If so, give details:

LI Are you :inswed against the material loss caused bv re or other extra perils requirr 1? Ifso,
...state Policy Nos. :
,.. ... ,..

f12, Have you ever sustained loss or darnage by any of th perils now proposed or loss profits

resulting thorefore? YESNO
If YES, g;ive details:

13. ADDITIIONAL PERILS (Other than fue and lightn rg) which may be included ir the

insurance':

(Pleasae )dellEetextpholsoe snoiot rnequired) (e) Natural perils
b) lR.iot and Strike
c) lVlelicious Damago (er) Cyclone, Sto m, Tempest
b)('as extension to (ez) Floocl
d) A,irpraft Damage (er) Eanhquake
(t) Eseape of wst, r from tanks, apparetus or pi1
(g) Impact by roa I vehioles excluding the Frop 6

own vehicles.

Notel No Insurance is in force until the proposal has n accepted and eovor conllrmsd.

[gelsfafion
o I/We wish l;o insure
felass of insrffanee.
rvith people's Insurance Limited. ( )ompany) in the usual form : this

I/We agree that immediate notice will be given to the C )mpany of any alteration in tl

eireunrstEnoea doscribed hprein.

I/We declare that to the best of mylour knowledge and rclief the inforruation given is tue in
ofanother Berson, he / she ae rdasmy/
every respeet and if such statements are in the witing

our agent fcrr such pupose.

VWe agree that this proposal and declaration shall be th I basis of the contract betwee me/us and
the cornpany.

I/We understand and agree that the proposal will be efft ctive only if the Company ha accepted
lt.

I / We underrstand and agree that the policy is subject to the Premium Warranty Claus

Proposer's Sig lature:

Designation : .........

Eusln6$s Channcl

plSerence Methrod Annual A lount
Ij
SaIe .iless discount received)
Add Rs.
Dedr tock Rs.

(Letohsos reduced tumover)

bl)) 100%o of'purchases (less discountreceived) Rs. ...
o)
d) 100% of'packing matelial Rs. ...,
$)
Rs,.,.,

Rs""'

Rs.....

Annua Gross Profit

Addition Methoct

Net P'rofit - befor,e the deduction of any taxation chargeable c orofits.

fNote: exclude any income not rlsmg
d, e.g., transfer fees, rent

plus standing Charges

Annual Gross Profit

Jfotal annual wage roll of all employees whose remunerations ; not treated as salaries in th
(ineluding bonuses, holiday pay and other payments pertaininl to wages).

'f'he above total annual wage roll should be adjusted as necess :y to be adequate for the fuh Where the
fndemnity period e,xceeds 12 months the amount should be inc eased proportionately

pover Required (a) All wages for a period of......... Sum rsured

..... weeks/months.
(b) ... .. . . . . ...yo of the total wage roll for the ralance of the maximum ind
period.