Download The New India Assurance Company Limited

The New India Assurance Company Limited
Head Office: 87, M G Road, Fort, Mumbai-400001
PROPOSAL FORM FOR MACHINERY LOSS OF PROFITS INSURANCE
Name of the Proposer: __________________________________________
Postal Address: _______________________________________Tel. No.________
Works Address: ____________________________________Tel No.___________
Trade of Business: ____________________________________________
1. Do you wish to cover the risk of Loss of profit arising from.
a. Machinery breakdown in your premises, If so complete Schedule A.
b. Boiler and Pressure Plant explosion in your premises, if so complete Schedule B.
c. Accidental Failure of Public supply of electricity water (in case you require this to
be covered a supplementary from has to be filled in)
2. a. Do the lists of the machinery in the Schedule A and B represent the whole or only a
part of the machinery in the premises.
b. Any circumstances which render the risk more hazardous?
c. Are all or any of your machines subject to periodical inspection? If so state by whom
and at what intervals inspections are carried out? Supply details of your
maintenance Schedule.
3. Which machines proposed under this insurance are the machines for which the spare
parts would need to be imported.
4. Give a description of the manufacturing process and details of utility supplies such as
power, steam air and water etc. required for production.
5. Please attach process flow diagram showing the connected machinery and indicate
bottlenecks buffer stocks if any.
6. Please attach separate line diagram for utility supplies such as power steam, air and
water showing interconnected machinery.
7. In the event of stoppage of any of the machines proposed:
a. Can machines which remain in operation carry the load originally borne by the
machines which has failed?
b. Are there any alternative means of maintaining production?
i.
The work being done at other premises and to what extent?
ii.
By suitable replacement machines hired temporarily.
8. a. What machines are available as stand by in your works.
b. Which machines are available for immediate use and to what extent they could
maintain the production of the items. Which they replace (% of usefulness to be
mentioned in the schedule separately)
9. a. What repair facilities are there in your premises?
b. What are the local repair facilities?
10. Is there any possibility of spoilage of material in process in the event of a breakdown of
failure of utility supplies? If so, state how this interruption may subsequently affect
after resumption of normal production.
11. Give brief details of your past experience and the number of years with this type of
industry.
12. a. What are your normal working hours? Are there regular night shifts?
b. How many shifts per day?
c. Working days per year?
d. Can extra shifts be worked to make up production loss?
13. If business is “seasonal” indicate the period of high and low output or turnover and
indicate the degree of fluctuation. State if there is a tendency of fluctuations due to
demands.
14. State what terms are required for Loss of Profits Insurance with regard to
a. Indemnity period (max 12 months)
Note: The Indemnity period should be selected based on an estimate of the
maximum time which would be required to resume work after a serious accident.
b. The time Exclusion (Min. 7 days)
Note: The period immediately following a breakdown and/ or explosion and for
which claims are not payable in terms as time exclusion.
15. INSURED STANDING CHARGES: - Please Indicate Expenses to be insured- delete or
supplement as appropriate
Interest on debenture mortgage
Motor Unkeep and licenses:
Lighting Heating, Power and Water
Loans and Bank overdraft
Charges:
Director’s fees and remunerations
Office Expenses:
Taxes (other than chargeable of profits)
Salaries including National Insurance
Contribution:
Insurance premium
Contributions to pension fund
Telephone Rentals
Miscellaneous Charges (not
Exceeding 5% of the total amount of
the aforesaid Standing Charges)
Travelling Expenses
Advertising Cost
Auditors and legal fees
Trade and Charitable Subscriptions
Repairs and Renewals chargeable to revenue
accounts
Miscellaneous charges
Depreciation of Building Machinery
Plant and Motor Vehicle
16. State the Sum Insured on Gross Profit under the Loss of Profit Policy ( This Gross Profit
for the current financial year to be computed from the annual balance sheet with
adjustment for upward or downward trend of business for the period of Insurance)
N.B. Gross Profit in Rs. ______________
17. Are your books regularly audited:
a. If so, give names and address of your auditors: _________________________
_______________________________________________________________
b. When does your financial year end: ____________________________________
c. Date on which insurance be renewable:________________________________
N.B. Date & month after the end of the financial year is recommended.
18. Is the machinery specified in the Schedule insured under the Machinery breakdown
and/or Boiler Explosion Policy. If so, give the name of the Company and Policy No.
19. Are you Insured or have you made a proposal in respect of Loss of Profit following
Machinery Breakdown and/or Boiler Explosion and/or Failure of Public Electric supply
and/or water supply. If so, give name of the Company concerned and state whether
any such proposal or renewal has been (a) declined (b) subjected to increased rates or
special conditions.
20. Have you ever suffered loss of profit following machinery breakdown and or Boiler
Explosion and/or Failure of Public Supply of Electricity and/or Water?
Give details of the cause duration and cost of each stoppage during the past 3 years.
21. Are you insured against Loss of Profit following fire and if so, state the sum insured and
the name of the Company and Policy No.
SCHEDULE
Period of Insurance will be from the agreed time of commencement date till midnight of the
date of expiry.
I/We HEREBY DECLARE AND WARRANT that the above statements are true and
complete and that I/We have withheld on information whatsoever which is material for
the acceptance of this proposal. I/ We agree that declaration and the answers given
above shall be the basis of the contract between me/us and the Company and shall be
deemed to be incorporated in such contract. And that if any untrue statement he
contained therein the said contract shall be absolutely null and void. I/We undertake to
exercise all reasonable precautions for the safety of machinery and I/We agree to
accept the policy in the form issued by the Company subject to the terms, exceptions
and conditions prescribed or endorsed on the policy.
Place: _____________
Date: ______________
Signature: ________________
The liability of the Company does not commence until this proposal has been accepted by
the Company and the premium paid.
N.B. If insufficient space above for any answer please continue on separate sheet and attach
hereto. Please answer in a separate sheet incase the space provided against each question is
insufficient.
Explanatory Note:
Standard Machinery Loss of Profit Policy cover Loss of Gross Profit arising from
breakdown or explosion of insured machinery or boilers and pressure vessels. It does not cover
Loss of Profit arising from damage to Owner’s Surrounding Property (including machinery
insured under machinery policy) caused by explosion.
PROHIBITION OF REBATES:
The following is an extract of Section 41 of Insurance Act 1938
1. No person shall allow or offer to allow, either directly or indirectly, as an inducement
to any person to take out or renew or continue an Insurance in respect of any kind of
risk relating to lives or property in India, any rebate of the whole or part of the
commission payable or any rebate of the premium shown in the policy; nor shall any
person taking out or renewing continuing a policy accept any rebate, except such
rebate as may be allowed in accordance with the published prospectuses of rebates of
the Insurer.
2. Any person making default in complying with the provisions of this section
shall be punishable with fine which may extend to five hundred rupees.
SCHEDULE OF ITEMS TO BE INCLUDED IN THE MACHINERY LOSS OF PROFIT
INSURANCE PROPOSAL
(1)
(2)
(3)
(4)
Particulars of
Function (i.e. Relative
Country of
Machine and/or nature of work Importance Manufacturer
Vessel. (Refer) performed)
see Note (D) Name of the
(5)
(6)
It is under
Are you aware
manufacture of defect in the
Guarantee
machinery (If
Note[a]
Manufacturer
See Note (C)
If so upto
what date
so please state
details)
SCHEDULE ‘A’ (Machinery insured under Machinery Insurance Policy)
SCHEDULE ‘B’ (Boilers and Pressure Plant insured under Explosion Policy)
Notes: a. The particulars of the machine should be as informative as possible including
description year of manufacture type, performance speed number of cylinders, transmission
ratio of gearings, voltage, pressure, and temperature heating surfaces etc. Auxiliary equipment
such as gearing drivings units and switchgears etc. should be listed separately.
b. Spare machine should be marked and their sphere of utility indicated.
c. Any machine of foreign manufacture should be noted, unless their importance from the point
of view of production is negligible.
d. Relative importance is the maximum percentage effect which breakdown of particular
machine will have on the total Gross Profit disregarding any loss of minimization measures.
e. In the event of a breakdown state whether production can be maintained and to what extent
by
i.
additional load on other machines
ii.
working in other premises.
iii.
Use of hired machinery.
f. State whether machine is prototype or of latest design. Date of last inspection and any
defects noted should be mentioned.
Also state whether any special operating media is used.
(7)
Did the Machinery suffer any damage
or breakdown in the last 3 years. If
so, state the nature of breakdown,
time taken for repairs and who carried
out the repairs
(8)
(9)
(10)
What spare parts
State alternative
of stand by do your
means of working Remarks
hold for the
in the event of
see note[f]
machinery see Note (b)breakdown (see
note [e] )
Imported Indigenous