HORTICULTURALISTS’ POLICY: PROPOSAL FORM

(Please use capital letters)

  1. NAME OF PROPSER ______

FULL POSTAL ADDRESS: -

______

______

______

______

TELEPHONE NUMBER

(OFFICE) ______(Res. ______

  1. GENERAL Questionnaire

a)Has any insurer declined, cancelled or refused to renew insurance on any of the risks described in Section 3 of this proposal? If so, please state name of insurer and date of such action ______

b)Have you ever claimed on any of the risks described in Section 3? If so, please give name of insurer and particulars of claim, including the amount ______

______

c)Are any of these risks currently insured? If so, please give name of insurer and details of the present cover ______

______

  1. DETAILS OF NSUREANCE REQUIRED

SECTION 1: GREEN HOUSE STRUCTURES

Dimensions / How constructed steel/wood, details of bracing, supports, foundations and how protected (galvanized, painted, wood preservative used, etc) / Constructed by / Sum Insured
1.
2.
3.
Total Sum Insured Section 1

(Please continue on separate sheet if necessary)

Section 2: PLASTIC CLADDING ON ABOVE GREENHOUSES (This Section may

only be taken if Section 1 is also taken)

Gauge of plastic in microns ______Age of Plastic ______

(Please produce invoice)

Is plastic treated against the effects of Ultra violet light? ______

How is plastic fitted to structure: (Details of Profiles, material used and protective strips, if any ______

Details of sums insured for Plastic Cladding on each of the above Greenhouse (Please use same sequence as in Section 1).

Green house No. Sum Insured : Plastic Cladding

  1. ______
  2. ______
  3. ______

Total Sum Insured: Section 2 ______

______

SECTION 3: CROP IN GREENHOUSES

(Please detail as per Greenhouse in Section 1)

CROP SUM INSURED

Rose 1. ______

  1. ______
  2. ______

Total:Rose ______

Chrysanthemums: 1. ______

  1. ______
  2. ______

Total : Chrysanthemums ______

Asters : 1. ______

  1. ______
  2. ______

Total : Asters ______

Other Crops : (Please state 1. ______

  1. ______
  2. ______

Total : Other ______

Total Sum Insured ______

Section 4: MACHINERY BREAKDOWN INSURANCE: COLD ROOMS AND PRECOOLERS

(Please give a full and exact description of all plant and machinery to be insured)

Item No / Type of equipment and year of manufacture / Make and Horse power / Replacement value
COLD ROOMS
1.
2.
3.
4.
PRE-COLD
1.
2.
3.
4.
Total Replacement value= Sum Insured In Section 4

Section 5 : DETERIAORATION OF STOCK IN COLD ROOM/PRE-COOLER

In arriving at the sum to be insured under this Section, please calculate the maximum number of boxes of produce that may be stored in each facility and multiply by the value of produce per box. Please use the sequence appearing in Section 4.

This Section may only be taken if Section 4 is also taken

Item No / Type of produce Stored / Maximum Quantity / Sum Insured
COLD ROOMS
1.
2.
3.
4.
PRE-COLD
1.
2.
3.
4.
Total Sum Insured : Section 5
  1. DECLARATION AND WARANTY

I/we declare that the foregoing statements and particulars are true to the best of my/our belief and agree that this Proposal and the Declaration therein contained shall be the basis of the contract between me/us and the Insured. It is warranted that, at the date of this proposal, all building, plant machinery and crops are in a sound condition and free from defects.

Date ______Signed ______

Witness ______Name ______

Name ______