MONEY INSURANCE PROPOSAL FORM
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Premises where safe is kept ? |
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2. |
Money In transit: |
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Describe fully Money in transit to be Insured |
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The
expression “MONEY” means Cash, Bank Notes, Cheques,
Money Orders, Postal Orders, Bills of Exchange and
Postage and other Stamps having a monetary value. |
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(a) |
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Bank to Premises |
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Money for payment of wages in direct transit from
Bank to Insured / Authorized Employee (s) until
delivered at Premises |
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Limit of Liability Maximum amount carried
any one Time |
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Estimated Annual Carrying |
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Maximum distance involved in transit
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Maximum Amount Retained In Locked Safe (if none, state "NIL") |
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If wages and salaries are not paid away on
the day drawn from the Bank,state maximum
amount of such moneys held in locked safe or
strong room out of business hours
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maximum
amount Retained in locked safe |
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maximum
period
kept in locked safe |
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(b) |
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Premises to Bank |
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Money other than (a) above in transit from
premises to Bank or other places and vice versa,
(please specify) |
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Limit of Liability
Maximum amount carried any one Time
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Estimated Annual Carrying
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(c) |
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Travelers and Collectors |
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Money (other than A and B above) collected by
employees for delivery to Proposer's Premises or
Bank subject to delivery being made on the same
day as received |
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Limit of Liability Maximum amount carried
any one Time |
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Estimated Annual Carrying |
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(d) |
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Others:
(if none, state "NIL") |
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(please describe fully such transit)
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Limit of Liability Maximum amount carried
any one Time |
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Estimated Annual Carrying |
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Maximum distance involved in transit
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please give details of security arrangements in
force to protect money |
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i- |
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How will the money be
conveyed? |
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ii- |
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iii- |
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How often journeys made ? |
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iv- |
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Are journeys made only during business hours ? |
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v- |
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Number of employees engaged in carrying cash ? |
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vi- |
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Are employee (s) engaged in carrying cash
covered under Fidelity Guarantee Policy. |
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vii- |
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Do you
wish to extend Insurance to include this cover? |
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This
insurance covers losses arising from fraud or
dishonesty of employees engaged in carrying cash. |
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viii- |
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Will such employees
be armed or
accompanied by armed guard
? |
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If armed guards do not accompany,
what precautions are provided ? |
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3. |
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Money on the Premises
(other than under A) |
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State whether you wish to insure against loss of
money by housebreaking or burglary from locked safe
or strongroom
or by hold-up while on the premises
including damage to any safe or strongroom.
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Please give particulars of safe and strong rooms in
which money is contained out of business hours.
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(if not Required, state "NIL")
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i) |
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ii) |
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How many
keys, with whom & where kept ?
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4. |
Do u keep regular Books of Accounts and
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(a) |
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record of all such Cash in Transit ? |
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(b) |
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record of all such Cash in Safe ? |
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(c) |
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Give other information material to risk. |
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5. |
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(A) |
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Have you ever
proposed for similar insurance? |
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If so, state
name of Insurer. |
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(B) |
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Have
you ever sustained the loss of any money?
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If so, please
give details. |
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(C) |
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Has an Insurance Company declined
Proposal, Cancelled Policy/
required special terms for renewal ? |
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6. |
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Period of Insurance |
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I/We
Declare that foregoing statement are true to best of
my/our knowledge and belief:
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