Proposal Form
Erection All Risks Insurance
This proposal is to be completed by the Proposer or an Authorized Representative of the proposer. As the answers will
form the basis of any insured issued, they should be complete and accurate. Attention is also drawn to Proposer’s
obligations by law, to disclose all material facts which would affect the issuance of the proposed insurance. If there is
insufficient space to complete the proposal, please attach additional sheets.
Details of Proposer
Name
Mailing Address PO Box: City: Emirates:
Contact Number Mobile: Tel: Fax:
Business of the Insured
Contract Details
Please clearly indicate in the list below, the “Proposer” of the insurance, and those to be declared as “Insured” in the Policy.
Title of Contract
Principal Name:
Proposer Insured Address:
Main Contractor (s) Name:
Proposer Insured Address:
Sub Contractor (s) Name:
Proposer Insured Address:
Manufacturers of main items Name:
Proposer Insured Address:
Firm supervising erection Name:
Proposer Insured Address:
Consulting Engineer Name:
Proposer Insured Address:
Site Details
Location/s to be insured Plot No.: Area:
Town: City/Emirates:
Geo Coordinates Longitude: Latitude:
Oman Insurance Company / Erection All Risk Proposal Form 1
Erection Details
Exact description of the property to
be erected (if second hand items are to be
erected, please state) In case of machines:
manufacturer’s name, number, type, size,
capacity, weight, pressure, temperature,
revolutions; year of construction of major
units. In case of complete factories: general
drawing of plant, nature of civil engineering
work (if any)
Period of Insurance Commencement of Insurance
Duration of pre-storage Months
Commencement of erection work
Duration of erection / construction Months
Duration if testing Weeks
If maintenance coverage is required Duration of Maintenance Months
Type of coverage required
Termination of Insurance
Have plans, designs
Previous Constructions Yes* No
and materials of the
kind used in this project Previous Constructions by the
been used and / or Yes* No
contractor
tested in – *Please give details of similar projects carried out by the Contractor(s)
Is this an extension of an existing
Yes No
plant?
If yes, will operation of the existing
plant continue during the erection Yes No
period? (Enclose plans where available).
Have the building and civil
engineering works already been Yes No
completed?
Please list the work to be carried out by subcontractors
Oman Insurance Company / Erection All Risk Proposal Form 2
Site Information
Is there any aggravated risk of Fire Yes* No
Explosion Yes* No
If so, give details
Ground Water level
Nearest river, lake, sea, etc. levels of Name Distance from site
such river, lake, sea, etc.
Low water Mean water Highest level recorded
Mean level of site
Meteorological Information Monsoon from To
Max. rainfall (mm) Per hour Per day
Max. wind
Storm frequency LOW MED HIGH
velocity
Has the site experienced any natural disasters like
History of Natural Disasters Yes No
volcanoes or tsunamis, for example?
Have any earthquakes been observed in the area? Yes No
If yes, please state the intensity and magnitude
Is the design of the structure to be insured based on
Yes No
regulations regarding earthquake resistant structures?
Do geological faults exist in the vicinity? Yes No
Subsoil conditions Rock Gravel Sand Clay Filled site
Estimate, if possible, the probable a) due to earthquake b) due to fire
maximum loss, expressed as a
percentage of the sum insured, in a c) due to other cause (please specify)
single occurrence
Oman Insurance Company / Erection All Risk Proposal Form 3
Insurance Covers
Is coverage of Construction / Yes. Please give brief description and state value under Sum Insured Section I, point 3
Erection equipment (scaffolding,
huts, tools, etc.) required?
No
Is coverage of Construction / Yes (Please attach list of major machines showing individual new replacement values
Erection machinery (excavators, and state total value under Material Damage Sum Insured Section I, point 4.)
cranes, etc.) required?
No
Are existing buildings and / or Yes* (Please state the limit under Material Damage Sum Insured Section I, point 6)
structures on or adjacent to the
site, owned by or held in care,
custody or control of the
Contractor(s) or the Principal, to be
insured against loss or damage
arising out of or in connection with
the contract works?
No
Is Third Party Liability to be Yes (Give brief description of surrounding and existing buildings and / or structures not
included? belonging to the Principal or Contractors (enclose maps, if possible) State limits under Limits
of Indemnity, Section II TPL)
No
Do you wish to cover to include express freight, overtime, night work,
Yes No
extra charges (in case of loss) for: work on public holidays
air freight Yes No
Give details of any special extension of cover required:
Oman Insurance Company / Erection All Risk Proposal Form 4
Sum Insured & Limits of Indemnity - Section 1 Material Damage
Please state hereunder the amounts you wish to insure or where applicable, the limits of indemnity that are
required
Items to be insured Sum Insured
(Please state the amount for each
item separately).
Currency:
1. Erection works, split up as follows:
1.1. Item to be erected
1.2. Freight
1.3. Customer Duties and Dues
1.4. Cost of Erection
2. Civil Engineering Works
3. Construction Erection Equipment/Machinery
4. Temporary Facilities
5. Clearance of Debris (Limit of Indemnity)
6. Property located on the Principal’s Premises or on the
site, belonging to the Principal or held in care custody or
control (Limit of indemnity - see Memo 4 of Policy)
Total sum to be insured under Section 1
Please indicate limits of indemnity required for the following perils:
Risk Limits of Indemnity1
1. Earthquake, Volcanism, Tsunami
2. Storm, Cyclone, Flood, Inundation, Landslide
1
Limit of Indemnity in respect of each and every loss or damage and / or series or losses or damage arising out of any one event.
Limits of Indemnity - Section 2 Third Party Liability
Items to be insured Limits of Indemnity2
Currency
1. Bodily Injury – any one person
2. Bodily Injury – total
3. Property Damage
Or alternatively, Combined Single Limit
2
Limit of Indemnity in respect of any one accident or series of accidents arising out of one event.
Declaration
I/we declare the above particulars to be true and correct and shall form the basis of contract between Oman Insurance
Company P.S.C (hereafter called company) and me/us.
The Insured undertakes to inform the insurer of any material alteration whereby the risk is increased, and the insurers
reserve the right to modify any quotation made in the light of such alteration.
I/we agree that any information collected or held by the company (whether contained in application or obtained otherwise)
may be used or disclosed by the company to its associate individuals/companies or any independent third parties (within
or outside UAE) for any matters related to this application, any policy issued and to provide advice information concerning
products and services, which the company believes may be of interests to the proposer and to communicate with the
proposer for any purposes.
Proposers Signature Company Stamp
Date
Oman Insurance Company (P.S.C.), Paid up Capital 461,872,125, [Link]. 41952, Insurance Authority No. 9 dated 24/12/1984
Head Office: [Link] 5209, Dubai, United Arab Emirates. Tel: +971 4 233 7777, Fax: +971 4 233 7775, [Link]
Oman Insurance Company / Erection All Risk Proposal Form 5