PROPOSAL FORM FOR INSURANCE OF FIDELITY INSURANCE COVER Name of Proposer Business/Occupation Address Current Address:   Contact Phone Email Address Address   Since when established   2. Employee/s to be covered: Name Duties Since when employed Place employed           Total salary Rs. Amount of Guarantee Rs. Other security taken   3. Give maximum amount held by these person(s) at any one Time and Period       4. (a) Have you obtained reference for all such person(s) before employment and such replies absolutely satisfactory?   YES NO (b) Has there been any occasion to question honesty/conduct of such person(s) ?   YES NO     5. How often :     (a) Such person(s) are required to account money held by them and how these are verified with supporting documents.   (b) Supervising officer verify all receipts/ payments and entries in register.   (c) Books of acount balanced for money   (d) Independent internal audit made       6. In case of stocks give system followed for receipts of goods, entries in books, recording deliveries and independent stock position verified.       7. (a) IS proposer at present or had taken F/G Insurance on such person(s).   YES NO (b) Has proposer ever sustained financial loss by infidelity by employee.   YES NO (c) Has proposer made any claim under F/G policy   YES NO (d) Has any Insurance Company declined proposal, cancelled Policy/required special terms for renewal. If so give details indicating steps taken to prevent recurrence.       8. Period of Insurance:   From To   WE HEREBY DECLARE AND WARRANT that above statements are true and complete. We desire to efect insurance as described herein with the company and We agree that this proposal and declaration shall be basis of contract between us and the Company and We agree to accept Policy subject to conditions prescribed by the Company. Place Date         | Fire | Burglary/House beraking | Motorcycle | Private vehicle | Commercial Vehicle | | Personal Accident | Marine(Cargo) | Contractor's all risks | Workmen compensation | Overseas mediclaim | Hospitalization mediclaim | Fidelity guarantee | Cash in Transit | Comprehensive Household | Public liability | Loss of profit |   Site designed and maintained by: INFOCOM Pvt. Ltd.