Telephone: 242-394-5555
P.O. Box SS 6283
Rosetta Street
Nassau, Bahamas
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?
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Copyright 2009 Insurance Management (Bahamas) Ltd.