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PROPOSAL FORM FOR CASH IN TRANSIT

INSURANCE COVER

Name of Proposer

Business/Occupation

Address

Premises where safe is kept
Current Address:
Contact Phone
Email Address
Address

Describe fully Money in transit to be Insured

(a)

Money for payment of wages in direct transit from Bank be Insured/Authorised Empoyee(s)until delivered at Permises and whilst there secured in locked safe and vice-versa

	Maximum amount in transit any one being limit of liability any one loss	Rs.
.	Estimated Annual Amount in Transit.	Rs.
	Maximum distance involved in transit

(b)	Money other than(a) above in transit from premises to Bank or other places (please specify) and vice versa
	Maximum amount in transit any one being limit of liability any one loss	Rs.
	Estimated Annual Amount in Transit.	Rs.
	Maximum distance involved in transit

(c)	Others (please describe fully such transit)
	Maximum amount in transit any one being limit of liability any one loss	Rs.
	Estimated Annual Amount in Transit.	Rs.
	Maximum distance involved in transit

(d)	Other money secured in locked safe on Permises against Burglary Risks only Cheques to be included in transit in estimated amount
	Maximum amount in transit any one being limit of liability any one loss	Rs.
	Estimated Annual Amount in Transit.	Rs.
	Maximum distance involved in transit

Are employee(s) engaged in carrying cash covered under Fidelity Guarantee Policy. If so give details, if not do you wish to extend this Insurance to include this cover.

(a)

How is money carried ?

(b)

What means of transportation is used ?

(c)

How often journeys made ?

(d)

Are journeys made only during business hours ?

(e)

If armed guards do not accompany, what precautions are provided ?

Give makers' name and size of safe in which money will be kept, also how many keys and with whom and where kept ?

Do u keep regular Books of Accounts and

(a)

record of all such Cash in Transit ?

(b)

Give other information material to risk

(a)

Is proposer at present or had insured Money in transit now proposed ?

(b)

Has proposer ever sustained loss on Money transit ?

(c)

Has proposer made any Claim under Cash in Transit Policy ?

(d)

Has any Insurance Company declined Proposal, Cancelled Policy/required special terms for renewal ? If so, give details

Period of Insurance

From

I/We Declare that foregoing statement are true to best of my/our knowledge and belief:

Place

Date

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