The New India Assurance Company Limited
Registered & Head Office : New India Assurance, 87, M.G. Road, Fort, Mumbai - 400 001.
questionnaire and proposal for principal’s ( advance loss of profits insurance) following to Plant and machinery under erection no.
In addition to questionnaire for EAR material damage cover which forms integral part of this questionnaire
1.	Proposer (principal to be insured) _______________________________
			
      Name & Address of Proposer   __________________________________	________________________________________________________ 
           _______________________________                     	
	
Kind of Business      _______________________________________________

2.	Brief description of Construction/erection works to be carried out
                                       ____________________________________________
                                       ____________________________________________
any existing plant or surrounding property in proposer’s possession or care, custody or control on the above site(s) or adjacement to it (them). (Please attach site layout plan)
The project is     	  the extension of existing works	     a new venture

Any loss or damage to	      Yes	    No
adjacement plants and/or	If so, please specify
surrounding property,                ______________________________________
which was caused by the 	       ______________________________________
erection work, cause a delay    _____________________________________
in completion of the business   ___________________________________ to be insured ?		  

Any loss or damage to
adjacent plant and/or surrounding  __________________________________
by the erection was                            Yes		 No
caused by the erection work, lead  __________________________________
to any loss of profits there and is this
to be 	insured ?		If so, please fill in Loss of Profits Questionnaire(s)
					
the process or services, making special mention of bottlenecks. (Please attach flow sheet)	
____________________________________________________________________________________________________________________________
		
3.	Brief description of	_________________________________________
                                           _________________________________________

			 	Has the method of production or services been employed     		                      by the proposer previously ?   	Yes       No
				______________________________________________				If so, for how many years ?

4.	Intended normal working	per day	  hours	in shifts
	hours ?		                  ___ __________________________________
                                                     per week         hours 
	_____________________________________
                                           	per year          hours 
	_____________________________________

5. Anticipated gross profit
(annual turnover less cost   ________________________________________
of supplies of goods, raw  _________________________________________
material, electricity, water _________________________________________
gas,etc.)for first year of     _________________________________________
operation monthly figures _________________________________________

If indemnity period required  
longer than 12 months	 ________________________________________
	                                  indemnity period required  gross profit of required period
In the event  that a specific      is any one-off loss likely to arise ?Yes    no	
Date of completion is not     _______________________________________
meet					
				If so, please specify
			           _________________________________________                  
					
				Date				Amount
			_________________________________________
		                     
                                         Reasons
				_________________________________________	
Are there seasonal events likely	  Yes	 No	If so, please give details
to affect the gross profit ?						
			
____________________________________________________________________________________________________________________________

6.	Desired time excess (min one week per 6 months of
	construction erection period)

7.	Maximum indemnity period
	required to be insured
_____________________________________________________________					
			Question 8 is only in respect of power generation equipment at the plant to be insured supplying power to this plant and is only to be answered if electricity can,be drawn from the public power network in the event of damage to the power generation equipment at the plant to be insured.      ____________________________________________________

8. Is the additional 		              Yes		       	No
    expenditure caused
    by using external power  ____________________________________	 
    supply to be insured ?	Power requirements of the plant (kW,kWh p.a.)
				Percentage of the requirements met by the
				plant’s own power generation equipment ?
			costs of kWh of power     Own plant 	External plant
              ____________________________________________________
       To what extent (KW) may electricity be drawn from an external source ?
          ________________________________________________________
      What is the maximum demand charge per KW and within which period is it  
        due ?	(Please attach copy of contract)
         __________________________________________________________

9.	Time-related information	Annual maximum demand charges ?
	____________________________________
                                                    Date of inception of EAR cover
	____________________________________
                                                    Date of commencement of work
	____________________________________
                                                   Testing period               from             to
	____________________________________
				         Anticipated date of completion (handover  
	following testing/commissioning)
	____________________________________
	Scheduled date of commencement of insured 
	business
	____________________________________
				       At which date after completion of testing     
                                               commissioning is full production to be reached?   
       	____________________________________

                                          Is it possible to reduce that period ? Yes	   No
 	____________________________________
                                          If so, by which means ?
                                           _____________________________________
                                           _____________________________________
                                           _____________________________________
       
                                           What allowance exists for delays	due to accidents 
	                                   or otherwise
                                           _____________________________________
                                           _____________________________________
                                           _____________________________________

                                             Please, attach phase diagram of construction giving         the phasing of the work (date of arrival on site) erection, testing, commissioning handover) regarding all plant 	sections and  major items.

10. Details of any penalty
       agreements in connection        _________________________________
       with the contra cutwork                _______________________________
                                                         ________________________________
                                                        ________________________________
                                                        ________________________________
                                                        _________________________________

11. Remarks                       _____________________________________
                                           _____________________________________
                                           _____________________________________
                                           _____________________________________
                                           _____________________________________
                                           _____________________________________

We have by declare that the     hereby agree that this questionnaire  it is agree that the    The insurers underfate to
statements made by us in the   and proposal forms the business     insurers are liable     deal with tid information
questionnaire and proposal       and is part of any policy issued        in accordance with    in strict confidence
are to the best of our knowledge  in connection with the above         the terms of the policy
and belief complete and true      risk(s)	 and any other claims of 
and we 	whatever nature.

Executed at                             Date                             Signature

       	PROHIBITION OF REBATES
The following is the copy of Section 41 of the 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 live 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.