Insured:
e-mail:*
Address of the Insured Property:

Building, Site or Structure
When Built?
No. of floors?
Which floor are you on?
Main use of Site?	Factory Dwelling Office Villa Hotel
Products manufactured /applicable only if a factory/:
Type of Construction?	Solid Structure Semi-solid Frame
Size?
No. of Entrances?
How are Entrances secured?
Security measures:

1. 2. 3. 4. Basic Cover : Fire; Explosion and Implosion; Lighting; Aerials and other falling objects; Expenses for prevention from or diminishing the effect of insured events; Extended Cover : Storm, Tempest; Torrential rain, Hail; Flood resulting from Hail, Torrential rain and Snow; Landslide and Landscape; Tidal Waves; Damage caused by increased weight by accumulation of Snow deposits and creation of Ice; Average (damage) to water mains, heating and ventilation installation; Average (damage) to water mains, heating and ventilation as a result of freeze. Earthquake; Additional Cover:     a. Theft with forcible means or attempted theft;     b. Robbery;     c. Malicious acts (vandalism);     d. Malicious breakage of glass and windows;     e. Impact by external motor vehicle;     f. Public Liability;     g. Projected expenses and fees for engineers and architects;     h. Properties of persons with who the Insurer has relations based on contracts;     i. Property of insured that is situated temporarily out with the territory of the insured object;

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Type of property	М²	Value	Cover chosen from 1 to 4 above
1.Building
2.Extensions
3.Machinery and Equipment
4.Electronic Equipment
5.Furnishings and Fittings
6.Expenses for Acquisition of fixed tangible assets
7.Materials
8.Finished work
9.Work in progress
10.Cash
11.Jewellery and valuable metals
12.Works of Art, Historical pieces, Philately or Numismatic collections
13.Glass windows and signs
14.Public Liability
15.Others
Total: