PROPOSAL FOR BURGLARY INSURANCE
(For risk located in United Arab Emirates)

Name of Proposer
Address
Telephone
Fax
E-Mail
       
Bank Interest, if any
          
Type of Risk:
Private         
Commercial
Other, please specify 
        
Location
Address
       
Type of Construction
               
Security Procedure
Burglary Alarm
Alarm connected to Police Station
Security Watchman -
       Night    1 2 More
       Day       1 2 More
Safes for
       Cash        Valuables
       Fixed        Movable      
       Make  
        
If warehouse, type of goods stored
           
If factory, type of manufacturing process
              
Value of Property (with break-up) in Dirhams      
Building
Furniture, Fixtures
and Fittings
Plant & Machinery
Stocks
============
Total
     
Previous Claims Experience (Last five years)
I/We certify that the above information is true to the best of my/our knowledge and belief.
         
Date
Place

 


 


 ...