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Householder and Houseowner Proposal

  • Policy NoPremiumRate
  • CellHomeWork
  • 2. (a) Of what materials is the dwelling constructed?
  • External WallsInternal WallsRoof
  • CeilingFloorType of WindowsFence
  • 4. Are there any outbuildings and, if so, how are they constructed?
  • WallsRoofs
  • 5. If the buildings or outbuildings are within 50 feet of any other building:-
  • (i) State the distance:
  • Building 1Building 2Building 3
  • (ii) Type of construction:
  • Building 1Building 2Building 3
  • (iii) Use of such building:
  • Building 1Building 2Building 3
  • Note: Attention is drawn to a provision in the Policy that cover against Theft will be suspended for any period or periods in excess of 40 days during which the dwelling is left without an inhabitant therein unless specially agreed to by the Company
  • 11. Has any Company or Insurer, in respect of any of the perils to which the proposal applies:-
  • THE PROPERTY TO BE INSURED
    Note: The SUM TO BE INSURED must represent the FULL VALUE of the property, the Proposer being required to sign a declaration to the effect below. The insurance will be subject to average, which means that if at the time of loss or damage the sum insured is less than the full value of the property insured, the amount payable is proportionately reduced.
  • THE BUILDINGS
    The buildings of the Private Dwelling House or Private Flat and all the Domestic Offices, Stables, Garages and Outbuildings used solely in connection therewith and on the same premises including Landlord’s, Fixtures therein and the Walls, Gates and Fences around and pertaining thereto.
  • All the buildings are built of brick, stone, concrete, wood or polymer and roofed with concrete, slate, tile, metal, asbestos or a composition of asbestos and other incombustible mineral ingredients, except as stated in question 2 and 4.
  • Specify here any such articles of greater value from 5 per cent of the Total Sum to be insured on the said Contents.
  • Note 2. The amount of Insurance on Platinum, Gold, Silver Articles, Jewellery and Furs is limited to one-fifth of the Total Sum Insured on contents unless the value thereof is stated and additional premium paid. If the said value exceeds the proportion mentioned please state the total value of such property.
  • Note 3. The insurance on Contents does not cover any part of the structure or ceilings of the Buildings, wallpapers and the like, external television, radio antennas, aerials, aerial satellite dishes, fittings, masts and towers nor any property to be insured under Buildings, nor does it cover property more specifically insured under another policy or, unless specially mentioned, Deeds, Bonds, Bills of Exchange, Promissory Notes, Cheques, Travellers Cheques, Securities for Money, Stamps Documents of any kind, Cash, Currency Notes, Manuscripts, Medals, Coins, Pedal Cycles, Motor Vehicles and Accessories or Livestock.
  • Period of Insurance (both dates inclusive)
  • FromTo
  • DECLARATION, I do hereby declare that the above answers are true and that I have withheld no material information regarding this proposal. I agree that this declaration and the answers given above as well as any further Proposal or Declaration or statement made in writing by me or anyone acting on my behalf shall form the basis of the contract between me and General Insurance Company, and I further agree to accept indemnity subject to the conditions in and endorsed on the company’s Policy.
    I also declare that THE TOTAL SUMS INSURED REPRESENT NOT LESS THAN THE FULL VALUE OF THE PROPERTY, as above mentioned.
  • Date Format: MM slash DD slash YYYY