1. Name of the insured
3. Risk Location Address
3.1 Communication Address
4. Pincode (click here to see the nearest fire satation)
5. Client Phone Number
6. Agent Name
7. Occupation (describe what does the company do)
8. Which year was the factory or the bulding made?
9. Raw material List (include all with commas)
10. Finished good name
11. Basement Exposure
12. If yes how many floors beneath
13. Nearest River/Canal
Type of Construction
15. Is Plastic Involved
15.1 If yes, Is the RM below 15000 Btu/lb or upto 15000?
Upto 15000 Btu/lb
Above 15000 Btu/lb
15.2 Flash point?
Below 32 degree C
Above 32 degree C
16. What fire safety measures are availble?
17. Security Detail
Security guard for limited time
23. Total Sum insured
Any Previous Insurer?
24.1 If yes who?
Pictures if availble (plastic occupancy compulsory they should show how the RM & FG are kept as well as where the fire safety equipment is. The electronic panel should also be visible well as where the fire safety equipment is.
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25. Is Burglary Needed?
27. Money on counter
Any Claim/Damage in the last 3 years?
30. Which year claim/damage was done?
31. Describe the case
32. What was done to prevent it from happening again?
Should be Empty:
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