Application for Business Buddy Insurance -

Applicant Information
*Applicant Name: *Type:
Business Registration No.:Issued Date:Issued By:
*Correspondence Address:
*Insured Location:
*Telephone:Fax:
*Email Address:Website:
Period of Insurance:From: To:
*Nature of Business:Tax Code:
*Business Type:
THE FOLLOWING QUESTIONS MUST BE ANSWERED BY THE APPLICANT:
  1. Is your insured premises protected with any of the following fire fighting facilities?
    If all NO, please refer to the Company
  2. Is your insured premises protected with any of the following security measures?
    If all NO, please refer to the Company
  3. Is your insured premises constructed of brick/tile/concrete?
  4. Does any insured proprietor/employee to be insured suffer from any physical defect or infirmity?
  5. In respect of the risk to be insured, has any previous insurer refused to give cover, renew or imposed any special terms?
  6. Did you suffer any losses in the past 3 years?
Declaration

I/We declare that the above particulars to be true and correct, and agree that they shall be the basis of the contract between Forte Insurance and me/us.

Date:

NOTE1: Statement Pursuant to the Law on Insurance or Any Amendments Thereof: You are to disclose in the proposal, fully and faithfully, all the facts which you know or ought to know, otherwise the policy issued may be void and you may receive nothing from the policy

NOTE2: No insurance is in force until this application is accepted by the Company in accordance to policy terms, conditions and exclusions.

NOTE3: If your proposal is accepted, it is a condition precedent to our liability under the Policy that the premium must be paid to and received by us within 30 working days from the inception of the insurance, failing which the Policy shall deem to be automatically terminated and a pro‐rata premium will be charged for the period that the Company is on risk.

Go to Business Buddy Insurancee page for more information.