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Business Insurance Quotation

Important Notice
1) To get accurate quotes, please kindly provide detail and accurate information as the accuracy of premium depend on the accuracy of information given.

2) All data or information given will be kept confidential and only use for our company data usage and quotation.

Insured Details

Business/Proposer's Name : *
Office / Handphone : *		Fax No :
Email Address :		Contact Person : *
Description of Business/Trade :
	Others, please Specify:
Location of Risk (Address) :
Correspondence / Billing Address :
Period of Insurance :	From To

All Risk Insurance

Sum insured for Machinery/Equipment :	$
Sum insured for Renovation / Furniture / Fixures&Fitting / Office Equipment & All other contents pertaining to Insured's business :	$
Sum insured for Material in Trade :	$ Please Specify Item:

Fire Insurance

Sum insured for Building Only :	$
Sum insured for Machinery/Equipment :	$
Sum insured for Renovation / Furniture / Fixures&Fitting / Office Equipment & All other contents pertaining to Insured's business :	$
Sum insured for Material in Trade :	$ Please Specify Item:

Burglary Insurance

Sum insured for Machinery/Equipment :	$
Sum insured for Renovation / Furniture / Fixures&Fitting / Office Equipment & All other contents pertaining to Insured's business :	$
Sum insured for Material in Trade :	$ Please Specify Item:

.......................................................................................................................................................................................

For All Risk/Fire/Burglary Insurance, provide the following information:
1) Insured premise constructed of Brick/Tile/Conrete?	If No, please specify :
2) Insured premise solely occupied by insured?	If No, please specify :
3) Any hazardous goods stored in the premise?	If Yes, please specify :

4) Insured premise protected with
Fire Alarm		Sprinkler
Fire Extinguisher		Hosereel
5) Insured premise protected with
Burlgary Alarm		24-hr Security guard
Solid Door/Glass Door/Gate/Shutter		CCTV

Workmen Compensation

No. of Employees	Annual Salary / Other Earning (12 Months)	Occupation / Nature of Work
	$
	$
	$
	$
Please combine the number of employee and their total salary/earning for employees that have the same occupation category or nature of work (E.g. No of employee - 3, Total earning $150,000 ($50,000x3), Occupation - Sales Engineers)
1) Are your workers involved in height >30 feet above ground?
2) Are your workers involved in chemical/flammable/excavation works, construction/erection/demolition of buildings/manholes
3) Do you want to insure employee for Travelling to and from work? Meal Hour
4) Are your workers involved in testing/installation/fabrication work outside office/factory premises (i.e at third party's premises)?

Public Liability

Sum insured for Any One Occurrence $100K $250K $500K $1million Other Limit:$

Fidelity Guarantee

Sum insured $

No. of employee to be insured :

Money

Sum insured in Premise during office hr $ After office hr $ Outside premise during office hr (in Transit) $

Plate Glass

Sum insured $

Claim History and Current Insurer

Any Claim History in 3 years?	(Claim History for any of the insurance classes)
If Yes, please provide detail :

Currently under any insurance :	If Yes, Current Insurer :

How You get to know about us :
Your friend/Relative/Associate Name :