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Name
Full Name
*
Company/Business Name(If any)
*
Full Address
*
Contact no
*
Email
*
No.Of Years In Current Business
Please select
New venture
1
2
3
4
5
5+
Estimated Annual Turnover For The Business
*
Total Number Of Employees (Including Partners And Directors)
*
Current Insurer (If Any)
*
Details Of The Plant, Equipment, Machinery (Year, Make, Model)
*
Sum Insured (Value)
*
Is The Item Registered
*
Please select
Yes
No
Please Select Your Primary Business Activities/Occupation
*
Construction & Civil Engineering
Earthmoving & Excavation
Mining Activities
Agriculture/Farming/ Harvesting
Crane Operations
Drilling & Boring Operations
Logging & Forestry
Trenching/ Pipe Laying
Road Construction/Maintenance
Builders & Tradesmen
Demolition Work
Hire & Rental
Transport Operator
Others
Please Select The Coverage Section/S Required From The Following (Refer Combined Package Section For Details Of The Coverage Offered Under Each Section)
*
Material Damage - Comprehensive Cover For Plant, Equipment And Machinery
Public &Products (Broadform) Liability
Road Risk Liability – Third Party Property Damage Liability (For Registered Units)
Hired In Plant/Equipment Insurance - Owned By Third Party
Financial Protection/ Business Interruption (Consequential Loss)
Personal Accident & Sickness Insurance – For Plant Operators
Breakdown Cover
Have You (The Insured) Or Any Of Your Directors Ever Had Any Insurance Declined Or Cancelled By An Insurer Or Had Any Special Conditions Imposed?
Please Select
No
Yes
Have You (The Insured) Or Any Of Your Directors Ever Been Declared Bankrupt In Last 10 Years?
Please Select
No
Yes
Have You (The Insured) Or Any Of Your Directors Had Any Criminal Convictions In The Last 10 Years?
Please Select
No
Yes
Have You (The Insured) Suffered Losses Or Claims (Both Insured And Uninsured) In Relation To Contractor’s Plant, Mobile Machinery, Motor Machinery, Motor Vehicle, Public/Products Liability Insurance During The Last 5 Years?
Please Select
No
Yes
Are Any Of Your Machines Used Or Expected To Be Used For Dry Hire Activities (Hired Out Without Your Operator)?
Please Select
No
Yes
