Boiler pressure Plant

PROPOSAL AND QUESTIONNAIRE FOR BOILER AND PRESSURE PLANT INSURANCE -
(The liability of the Company does not commence until this proposal has been
accepted by the Company and the premium paid.)
1. Information given herein will be treated in strict Confidence.
2. Put a ( ) mark wherever applicable.
S. No. Details Answer
1. a) Name & Address of the Insured a)
b) Work Address (Site of the Property b)

to be Insured)
2. a) Period of Insurance -
b) From ___________ to __________
3. Total Sum Insured
A) BOILER AND PRESSURE PLANT -

4.
S. No. Location Description – Maker’s Registration Year of Sum

Name, Maker’s No., Number Make Insured
Capacity
B) SURROUNDING PROPERTY OF THE INSURED INCLUDING PROPERTY

HELD IN TRUST OR COMMISSION
C) LEGAL LIABILITIES TO THIRD PARTIES
a) Personal Injury Rs.
b) Property Damage Rs.

D) On payment of additional If Yes provide Limits of
Idemnity
premium do you wish to cover the
following?
a) Express freight (excluding No

airfreight), Overtime and Rs………
Holiday rates of wages.
b) Airfreight.
Rs………
c) Owner’s Surrounding Property. No

Rs………
No
d) Third Party Liability.
i) Any one Accident
ii) Any one Year Rs………

No
e) Additional Customs Duty.

Rs………
No
Rs………
No
5. a) In case of Boiler, state if it is a) Yes No

Water tube type?
b) If so, what is the evaporative b)

capacity per hour
6. State how Boiler is fired, e.g. Oil, Gas
Coal or Pulverized fuel.
a) Do you wish to include the main

steam piping?
7.
Yes No
b) If so, state whether cover required

within 20 meters or 100 meters
radius of the Boiler 20 m 100 m
8. a) Are all the items in good Yes No

condition?
b) Give particulars of any defects. b)
9. a) Which items of Plant are subject to a)

periodical inspection?
b) By whom are they inspected, and b)

at what intervals?
c) Date of last inspection, working c)

pressure approved, and period of
such approval (attach copy of
last report).
10. a) What is the maximum load on a)

safety valve per square inch?
b) What is the working pressure? b)
11. a) Are the Boiler Attendant solely Yes No

employed on the Boiler Plant?
b) What are their qualifications? b)
c) What proportion of their time is c)

given to other duties, if not solely
employed on the Boiler Plant?
12. a) Is the Boiler Plant now Insured? Yes No
b) If so, state name of Insurer, and b)

date policy expires.
13. a) Has the Boiler Plant at any time a) Yes No

been insured by you?
b) If so, state name of Insurer, and b)

date of policy expired?
14. In respect of Boiler Insurance, has any

Insurer -
a) permitted withdrawal of or
declined any proposal from you?
OR a) Yes No
b) cancelled or refused to renew

your policy?
b) Yes No
Note - Name of Insurer to be

stated.
15. a) Have you ever had an accident

to your Boiler Plant?
a) Yes No
b) If so, give full particulars on b)

separate sheet.
16. Have your any Boiler Plant in use

other than that specified in the
schedule? Yes No
17. a) Are any of the Boilers shown in the

proposal automatically
controlled? a) Yes No
b) If so, which ones? b)
18. a) Is any of the automatically

controlled Boilers not under
continuous supervision by person a) Yes No
competent to operate it?
b) If so which ones b)
19. Is Boiler under regular and frequent

supervision whilst working?
Yes No
I/We the undersigned hereby declare that the above statements and particulars are
true and complete and I/We declare and agree that this declaration and the answers
given above shall be held to be promissory and shall be the basis of the contract
between me/us and the Company.
Proposer's Signature
Place ___________________
Date ____________________
Note -
i) The term `Boiler' where used in the above schedule includes fittings, integral super
heaters and integral economisers but does not include steam or feed water piping,
separate super heaters, separate economisers, such items being covered by the
Policy only if specifically listed in the schedule.
ii) Value of the Boiler and/or Pressure Plant older than 20 years must be indicated
separately.
Section 41 of Insurance Act 1938

PROHIBITION OF REBATES -
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 lives or property in India, any rebate of the whole or part of the
commission payable or any rebate of the premium shown on the policy; nor shall
any person taking out or renewing or continuing a policy accept any rebate,
except such rebate as may be allowed in accordance with the published
prospectuses or tables 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.
*******

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PROPOSAL AND QUESTIONNAIRE FOR BOILER AND PRESSURE PLANT INSURANCE -

1. Information given herein will be treated in strict Confidence.

2. Put a ( ) mark wherever applicable.

S. No. Details Answer

1. a) Name & Address of the Insured a)

b) Work Address (Site of the Property b)

b) From ___________ to __________

3. Total Sum Insured

A) BOILER AND PRESSURE PLANT -

S. No. Location Description – Maker’s Registration Year of Sum

B) SURROUNDING PROPERTY OF THE INSURED INCLUDING PROPERTY

C) LEGAL LIABILITIES TO THIRD PARTIES

a) Personal Injury Rs.

b) Property Damage Rs.

a) Express freight (excluding No

c) Owner’s Surrounding Property. No

ii) Any one Year Rs………

e) Additional Customs Duty.

5. a) In case of Boiler, state if it is a) Yes No

b) If so, what is the evaporative b)

a) Do you wish to include the main

b) If so, state whether cover required

8. a) Are all the items in good Yes No

b) Give particulars of any defects. b)

9. a) Which items of Plant are subject to a)

b) By whom are they inspected, and b)

c) Date of last inspection, working c)

10. a) What is the maximum load on a)

11. a) Are the Boiler Attendant solely Yes No

b) What are their qualifications? b)

c) What proportion of their time is c)

12. a) Is the Boiler Plant now Insured? Yes No

b) If so, state name of Insurer, and b)

13. a) Has the Boiler Plant at any time a) Yes No

b) If so, state name of Insurer, and b)

14. In respect of Boiler Insurance, has any

b) cancelled or refused to renew

Note - Name of Insurer to be

15. a) Have you ever had an accident

b) If so, give full particulars on b)

16. Have your any Boiler Plant in use

17. a) Are any of the Boilers shown in the

b) If so, which ones? b)

18. a) Is any of the automatically

19. Is Boiler under regular and frequent

Section 41 of Insurance Act 1938

1. No person shall allow or offer to allow, either directly or indirectly as an inducement

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