Money Insurance Proposal Form – Vanguard Assurance

Motor Insurance Proposal Form

Please note that for the purposes of this insurance, MONEY means cash, bank notes, currency notes, cheques, money order
or postal order in the personal custody of the insured’s authorized employees.

A. DETAILS OF THE PROPOSER

Full Name Of Proposer

Postal Address

Occupation/Profession

Telephone

Email Address

Fax

B. LOCATION ADDRESS AND DESCRIPTION OF THE RISK

1. Location of the insured premises

2. State approximately the distance between the bank and the proposer’s office or place where cash is to be paid

3. How is the money conveyed, and how many employees have charge of it?

4. From the bank, would you normally stop at any site or branch? If so, give details

5. Are employees insured under Fidelity Guarantee Policy? If so, for what sum, and with which company

6. Will wages be paid out the same day as received from the bank?YesNo

(a) Will the money be deposited in a safe and if so for how long?

(b) Please state maximum amount in safe

Manufacturer's Name/Model No and Year of Make, Size and Dimension, Material Used, Built into Wall / Fixed Floor, Who has possesion of keys

7. Do you want cover for hold-up? If so, state amount required

8. (a) Have you ever sustained a loss in respect of any of the risks to which this proposal applies?YesNo

(b) If yes, describe the nature of the loss

9. Has any previous request for insurance by you beenDeclinedCancelledHad special terms imposed?

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Motor Insurance Proposal Form

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