PROPOSAL FOR FIRE INSURANCE
(For risk located in United Arab Emirates)
Name of Proposer
A
ddress
T
elephone
F
ax
E-Mail
Bank Interest, if any
T
ype of Risk:
Private
None
Residence
Commercial
None
Factory
Warehouse
Other, please specify
Location
Address
Type of Construction
Superior
I Class
II Class
Inferior
Fire Protection System
Sprinklers
Handheld Fire Extinguishers
Smoke Detectors
Others. Please specify
If warehouse, type of goods stored
If factory, type of manufacturing process
Type of Cover
Fire and Lightning/Fire
Lightning and other Allied
Perils / Fire
Lightning
Allied Perils and Burglary
Value of Property (with break-up) in Dirhams
Building
Furniture, Fixtures
and Fittings
Plant & Machinery
Stocks
============
Total
I
/We certify that the above information is true to the best of my/our knowledge and belief.
D
ate
P
lace
...
