marine cargo by lnwh62f

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									                                        Reliance
                           General Insurance Company Limited
                  (Registered Office: 3rd Floor, Maker Chambers IV, 222, Nariman Point, Mumbai 400021)




                                       MARINE CARGO PROPOSAL

 1. PERSONAL DETAILS:

 i.        Proposer’s Name &
           Address

                                                                                         Pincode:
 ii.       Customer ID, if any.
 iii.      Contact Person, if
           any.
 iv.       Telephone and E-
           mail ID:

 2. CARGO DETAILS:

In addition to questions i to ix, you are also required to answer questions x and xi only in case of specific policy and
questions xii, xiii and xiv only in case of policies other than specific policy.
 i.        Goods proposed for
           insurance
 ii.       Specify whether
           New or Secondhand
 iii.      Packing used
 iv.       Conveyance(s)
 v.        Containerization
           details
 vi.       Terms of Sale
 vii.      RR/GR/BL/AWB
           No. and date, if any.
 viii.     Details of the
           carrying
           vessel/vehicle such
           as name/no. and
           name of the
           transporter
 ix.       Basis of valuation
 x.        Value of Cargo




 RGIC—Proposal form-Marine Cargo Proposal
xi.     Sum proposed for
        Insurance
xii.    Annual turnover
xiii.   Limit per sending
xiv.    Limit per location

3. COVER DETAILS:
i. Type of Policy                1. Specific Policy/Open Policy
     required(Please tick        2. Others(Please specify):
     whichever is
     applicable)
ii. Voyage details               From __________________ To _____________________
iii. Distance less than 100      YES / NO.
     kms.
iv. Policy period                From _____________________ To _____________________
v. Multi transit involved        YES / NO.

vi. Is Storage extension
      required?
vii. Periodicity of              Monthly /Quarterly/ Others
      Declaration( other than
      specific policy)
viii. Type of Cover (Please
      specify)
ix. Do you wish to bear a        YES / NO    If YES, please specify the % of loss :
      portion of each and
      every loss (voluntary
      excess):

4. CLAIMS EXPERIENCE:(For last Three years excluding current year)

Department         Year       Cover         Premium                  Claims (Rs.)
                                            (Rs.)
                                                          Paid               Outstanding
MARINE


           Total
OTHER THAN
MARINE

           Total




RGIC—Proposal form-Marine Cargo Proposal
5.   OTHERS:

Has any other insurer refused to accept
this insurance or imposed conditions to
accept the same. If YES, give details.
Rate of premium charged by previous
Insurer, if any.

Duty of disclosure: The policy shall be void and all premium paid shall be forfeited to the
Company in the event of misrepresentation, mis-description or non disclosure of any
material fact.

I/We declare that the answers given by me/us are true and correct and that I/We have
not withheld any information, which might influence acceptance of this proposal. I/We
agree that this declaration and the answers given by me/us shall be the basis of the
insurance contract between me/us and Reliance General Insurance Company Limited
and shall deemed to be incorporated in the policy.

I/We agree and undertake to convey to Reliance General Insurance Company Limited
any additions/alterations carried out in the risk proposed for insurance after submission
of this proposal form.

I/We agree to accept the policy subject to the terms, conditions, exceptions and
warranties prescribed by the Company.



                                                                SIGNATURE OF THE PROPOSER
                                                                   (WITH OFFICE SEAL, IF ANY)
Place:
Date:


For Office Use only:
Recommendations:
Premium Rate:
Accepted by:
Authorised by:




RGIC—Proposal form-Marine Cargo Proposal

								
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