Fire Insurance Proposal Form

    1. Personal

    2. Details of Construction of Building

    3. Are there any adjoining buildings? If so

    4. Is the risk detached from all other buildings? If so

    5. Do you keep any oil within the premises, if so

    6. Are you at present insured in this to any other office? If so, state

    7. Has any Company or insurer in respect of the insurance proposed

    EarthquakeAircraftRiot and StrikeTornadoImpactExplosionFlood