Number of Storeys
Type of Construction Material Used (e.g. concrete,
concrete hollow blocks, timber, light material, etc.)
2nd Floor up
Type of Roofing (e.g. hard roof, tile roof, galvanized
Is there any profession, business, or trade carried
on in the dwelling or in any portion of which the dwelling
forms a part?
For how long (whether consecutive or not) is the dwelling
likely to be left without an occupant during one year?
State the longest continuous period in one year during
which the dwelling is likely to be left without an occupant?
Please state distance of your residence from boundaries.
If your residence is bounded by another building, please state
construction and occupancy. If your residence is bounded by
a road or street, please state the name of road/street.
to be Insured Against
Fire and Lightning
Extended Cover (damage due to Smoke, Failing Aircraft, Vehicle
Broad Water Damage
Riot, Strikes and Malicious Damage
Burglary (please provide listing of items to be covered with
corresponding brands, serial numbers, and values)
to be Covered
coverage against fire and lightning and other perils except
For coverage against burglary
note that cash, jewelry and curiosities or works of art
such as paintings, sculptures, etc. are not included in
the above insurance coverage.
Duty of Disclosure
is important that you advise us, your insurance broker,
of any material alteration to the description & occupancy
of your property as it will have a bearing on the adequacy
of your insurance program. The insurers will assess and
accept your risk on the basis of information you will provide
them. Any variation of these details could lead to an uninsured
loss if they are not disclosed to us.
to 80%-20% loss clause