NEW PROVIDENCE
PO Box SS-6283
Rosetta Steet East,
Palmdale, Nassau
Tel: (242) 394-5555
Fax: (242) 323-6520
Email: info.nassau@imbbah.com

GRAND BAHAMA
PO Box F-42541,
1 Pioneers Way,
Freeport
Tel: (242) 350-3500
Fax: (242) 350-3510
Email: info.freeport@imbbah.com

ABACO
PO Box AB-20666
Queen Elizabeth Drive,
Marsh Harbour
Tel: (242) 367-4204
Fax: (242) 367-4206
Email: info.abaco@imbbah.com

ELEUTHERA
PO Box EL-25190
Queen's Highway,
Govemor's Harbour
Tel: (242) 332-2862
Fax: (242) 332-2863
Email: info.eleuthera@imbbah.com

EXUMA
Queen's Highway,
George Town,
Tel: (242) 336-2304
Fax: (242) 336-2305
Email: info.exuma@imbbah.com

FIRE INSURANCE PROPOSAL FORM

Unless all material facts are disclosed, this insurance could be invalidated. Material Facts are those facts an Insurer would regard as likely to influence the acceptance and/or assessment of the Proposal. If you are in any doubt about whether facts are material, you should disclose them. A copy of the completed Proposal Form will be supplied on request but you should keep a record (including copies of letters) of all information supplied to us for the purposes of entering into this contract.

A specimen Policy is available on request.

This Policy is Subject to Average which means you may not receive the full amount of any claim that is payable in the event of under-insurance. This is explained in more detail in a separate notice issued with this Proposal Form.

Commencement Date of Insurance:	DD / MM / YY	Expiry Date of Insurance:	DD / MM / YY

(Which cannot be before the acceptance of the Proposal by the Insurers)

Note: Unless otherwise agreed this Policy will commence and expire at 4:00pm in the afternoon on the dates mentioned above.

Proposer's Name:
Postal Address:

Telephone:

(Home)

(Work)

(Cell)

E-mail:

Currency B$ or US$ :

Occupation of Proposer:

1. GENERAL QUESTIONS (Please answer all of the following)		Yes	No
1	Are any hazardous processes carried on at the premises, or are any flammable liquids or other hazardous goods stored?
2	Are there any other insurances on the property proposed for this insurance?
3	Has the Proposer previously been insured against Fire and/or Additional Perils?
4	Has the Proposer been refused insurance cover in respect of this or any Proposal?
5	Have you or any director where the Proposer is a limited company, ever been convicted of any offence other than driving offences?