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BARD HOUSE, 69 SAMORA MACHEL AVENUE, P O BOX 2469, HARARE Tele : 705221-7 727294-9
Fax : 705228/727299
E-Mail:insure@heritage.co.zw
Full Name
Postal
Address
Suburb Town
(b) by others as :
Are premises occupied after business hours by the Proposer or his Manager? Yes No
If not, state whether a Watchman or Caretaker is employed and what special precautions are adopted for
protecting the premises :
Do you keep a complete set of books and are such books locked in a fireproof safe or removed from the
premises after business hours? Yes No
BCP-Pro 12/2000
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Is there any other insurance effected upon this property? Yes No
Have you at any time in respect of any of the risks to which this Proposal refers (whether at the above premises
or elsewhere) :
Have you or any firm of which you were a Partner or Director ever been bankrupt, insolvent, made an assignment
or compromised with Creditors? Yes No
Has any Insurer at any time in respect either of yourself or of a firm of which you were a Partner or Director :
SUM INSURED
1. GROSS PROFIT
(i) the sum of the Turnover and the amounts of the closing stock and work in progress shall
exceed.
(ii) the sum of the amounts of the opening stock and work in progress and the amount of the
uninsured working expenses.
2. Discounts allowed
4. Carriage
5. Packaging
6. Consumable stores
NOTE : The amounts of the opening and closing stocks and work in progress shall be arrived at in
accordance with the Insured’s normal accountancy methods due provision being made for
depreciation.
Being LOSS OF OUTSTANDING BOOK DEBTS through loss or damage to accounts records.
N.B : The amount of debts outstanding at the end of each month must be declared to the Company within
30 days, as this figure will form the basis of any claim which may arise.
SECTION 4 - BURGLARY
Sum Insured $
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SECTION 5 - MONEY
DEFINITION OF MONEY : Cash, Bank and Currency Notes, Uncrossed Cheques, Postal Orders or Money
Orders, Postage Stamps and Revenue Stamps, the property of the Proposer.
Situation
Make
Date of Manufacture
Dimensions
Weight of Safe
SECTION 6 - GLASS
(a) External $
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SECTION 8 - ALL RISKS
Articles Insured
1. $
2. $
3. $
Apart from deliveries do you undertake any work away from the premises? Yes No
State make and carrying capacity of any lifts, hoists and other lifting machinery.
Indemnity against legal liability at Law to Employees for death or bodily injury caused by an accident arising out of
and in the course of their employment.
(2) Others $
NOTE : The Cover provided is limited to $20 000 000,00 any one claim any one year of insurance.
1. EARNINGS BASIS
i) NAMED EMPLOYEES
A. Death occurring within twelve calendar months from the A. A capital sum equal to times
happening of the accident. the Average Weekly Earnings.
B. Permanent Disablement resulting within twelve calendar B. Percentage of Compensation A as detailed
months from the happening of the accident. in the Table of Compensation.
C. Total and absolute incapacity from following usual C. A sum equal to 75 percent of the Average
employment for a longer period than one week. Weekly Earnings for each week of such
incapacity.
D. Medical, Surgical or Hospital treatment incurred as the D. Not exceeding $
result of the injury within twelve calendar months from
the happening of the accident.
A. Death occurring within twelve calendar months from the A. The Capital Sum.
happening of the accident.
B. Permanent Disablement resulting within twelve calendar B. Percentage of Compensation A as detailed
months from the happening of the accident. in the Table of Compensation.
C. Total and absolute incapacity from following usual C. $ per week.
employment for a longer period than one week.
D. Medical, Surgical or Hospital treatment incurred as the D. Not exceeding $
result of the injury within twelve calendar months from
the happening of the accident.
i) ever been declined or had special terms imposed for Life or Accident Insurance, or has any Company
ever cancelled or refused to renew his / her Policy?
ii) ever suffered from any affection of the Heart, Lungs, Brain, Urinary or Genital Organs, or has any
physical defect or infirmity of any kind?
DECLARATION :
I / WE DECLARE THAT :
2. If the premiums for any Policy issued have been calculated on estimates furnished by
me/us, I/we agree to render at the end of each period of insurance a statement as required by the
Company and should such estimates be exceeded, to pay the additional premium due.
3. During the currency of the Policies I/we will maintain the property in good repair and all
reasonable precautions will be observed for the prevention or minimisation of any loss
or damage.
4. This Proposal and Declaration shall be the basis of the contract or contracts between
me/us and the Company and I/we will accept the Company’s Policies subject to the
terms and conditions contained therein.