::.Welcome to Goldlink Insurance.::

We Have added the following new products:
  *School Safety policy.
  *Travel & Tours Insurance.
* Hospitality Plus Insurance.
  *A re-branded auto Insurance
more

FIRE INSURANCE :::

FIRE INSURANCE FORM FOR PRIVATE/BUSINESS PREMISES

Name Of Proposal(In Full)
Telephone
Business or Occupation
Email Address
Postal Address
Period of Insurance: From: To:
PROPERTY TO BE INSURED Please supply the following information in respect of each building proposed for insurance.
DESCRIPTION	BUILDING
1. Full address(s) of premises proposed for insurance
2. Construction of (a) walls: stone brick or concrete blocks

(b) roofs: Tiles, Slates, Asbestos, corrugated iron sheets or hard decked roof
(c) Floors: Mables, Earth, tiles, ceramics, concrete or terrazo

3. Number of storeys (note that a bungalow is regarded as a storey building)
4.Age and condition of the building(s)
OCCUPATION OF PREMISES
(a)Method of lighting (and heating, if any)
(b) Is the whole building used for business purposes or private dwelling?
(c) Is any retail trade carried on? if yes, give details
(d) What manufacturing processes or repair work (if any) are carried on within the premises?
(e) What power is used? Electricity, Gas or any other source.
(f) What other trade or business is carried on by other occupants (if any) of the premises?
(g) Are there any hazardous goods located outside the building(s) and within 10 metres thereof? Please give details
6.DESCRIPTION OF ADJOINING OR ADJACENT BUILDING (IF ANY)
(a) Construction of:
(i) Walls: stone, brick or concrete blocks
(ii) Roofs: tiles, slates, asbestos, corrugated iron sheets or hard decked roof
(iii) Floors:Mables, Earth, tiles, ceramics, concrete or terrazo
(b) How are the buildings occupied
(c) What is the distance between adjacent buildings and the premises to be insured?
(d) Are adjoining buildings cut off by bricks stone or concrete walls at least 225mm (9ins) thick, without openings, going up to and through the roof?	YES NO If not, give details of the separation.
7. FIRE FIGHTING EQUIPMENT:
(a) What fire fighting equipment is available on the premises?
(b) Are the fire fighting equipment in good efficient working order and serviced regularly?	YES NO
(c) Are occupants or employees trained to use the appliances?	YES NO
(d) What is the distance from the nearest Fire Brigade Station?
(e) Water Supplies are available at all times?	YES NO
NOTE: THE SUMS INSURED BELOW ARE SUBJECT TO AVERAGE. THIS MEANS THAT SHOULD THESE PROVE TO BE INADEQUATE AT THE TIME OF LOSS, YOU WILL BE RESPONSIBLE FOR A PROPORTIONATE SHARE OF THE LOSS. IT IS THEREFORE IMPORTANT IN YOUR OWN INTERESTS THAT YOU INSURE FOR FULL VALUE.
8. SCHEDULE OF PROPERTY TO BE INSURED
DESCRIPTION	AMOUNT
(a) On the building
(b) Boundary and Compound with walls, gates and fences
(c) On Office furniture and equipment, trade fixtures and fitting
(d) Household goods and personal effect of all description
(e) On machinery and plant therein
(f) On stock and materials in trade therein
(g) On months rent
(h) On items not specified above
TOTAL

9. GENERAL INFORMATION: If there is any fire insurance in force on the same property, state:
(a) Name of Insurer(s)
(b) Amount of Insurance (s)
(c) Are there other parties who have financial interest (interests) in any of the property to insured? Please give details
(d) Have you ever had a proposal or renewal of insurance declined, or a policy cancelled or renewal invited at an increased rate? If so state name of insurer and full details in each case.
(e) Have you ever suffered loss by fire or other perils? If so give details
(f) Do you:
(i) Take stock monthly, quarterly, half yearly, annually?	YES NO
(ii) Keep a proper set of account books?	YES NO
(iii) Keep such books in a fire-proof safe or remove such books to another building when the above premises are closed?	YES NO
(g) Is smoking or naked light/flame or cooking allowed in the premises? If so give details
(h) (i) Are all wastes and othre refuse swept up and removed daily from the premises? Please give details
(ii) Are all oily and greasy wipes and rags placed in metal containers and removed from the premises daily at close of work? Give details
10. Do you wish to include any of the following perils? If so, indicate which one(s) you require. THE FOLLOWING EXTRANEOUS PERILS MAY BE INCLUDED IN THE POLICY SUBJECT TO AN ADDITIONAL PREMIUM AND PROVIDED THE RISKS ARE NORMAL. LOSS OR DAMAGE DIRECTLY CAUSED BY:
AIRCRAFT EXPLOSION EARTHQUAKE RIOT AND STRIKE MALICIOUS DAMAGE Note: That Malicious Damage cannot be insured without Riot and Strike cover.
BUSH FIRE TORNADO FLOOD BURST PIPES Please tick box for extra perils required. If a block plan of the premises is available, please attach a copy for our perusal and return if necessary.

DECLARATION: I/We desire to effect and insurance in the terms of the usual Policy for Fire Insurance and declare that the above statements and particulars are true. I/We further declare that this proposal shall be the basis of the Contract between me/us and the Company and that the amounts to be insured represent to the best of my/knowledge and belief the full market value of the property stated.

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