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

HOME 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 purpose of entering into this contract.

A specimen policy is available on request.

Please write in block capitals or tick the boxes as appropriate.

DATE INSURANCE IS TO BEGIN
(Which cannot be before the
proposal is accepted by the Insurers)
DD / MM / YY
EXPIRY DATE DD / MM / YY

Proposer's Name:
Postal Address:
Occupation:
Telephone:
(Home)
(Business)
 
Email:  
Currency required:B$/US$:
Full Address of Property to be Insured:
Distance Of Nearest Building From the Sea: Height Above the Sea:
Cover requried : Inculding Hurricane etc Excluding Hurricane etc.
Your Home Please complete in all instances

1. Is your home

a. Occupied only by you? (By “you” we mean you, your spouse, children, parents and other relatives who normally reside with you)
YES
 
NO
IF no,how many tenants?
Do you live on the premises?
b. Used for any business or professional purposes?
c. A weekend or holiday home?
d. Left unoccupied for more than 2 months in a year?
e. Protected by hurricane shutters?
(If "Yes", please describe)
f. Protected by a burglar alarm which includes at
least one external bell?
g.Protected by keyed mortice deadlocks on all
external doors and can all external windows be
secured from within?
h. Protected by security grilles, bars or screens on all windows?
i. Built of brick, stone or concrete walls?
j. Roofed with
(i). Concrete or cement tiles or slates?
(ii).Asphalt or wood shingle or sheet metal?
(iii).Any other material?

k. In a good state of repair and will be so maintained
at all times?
YES
NO
l. On a site which has been free from flooding during
the last ten years?
2. With regard to the sections of cover you are selecting, have you or any person normally residing with you, at your present address or elsewhere
a. Sustained any loss, damage or liability during
the last five years, whether insured or not?
b. Had any insurer decline or cancel insurance, impose special conditions or not invite renewal?
3. Have you or any member of your family residing with you, or directors where the proposer is a limited company, ever been convicted of any offence other than driving offences?
4. Is the property
(i). One-storey?
(ii). Two-storey?
(iii). Split level?
(iv). A duplex?
(v). A triplex?
(vi). A condominium?
If you have ticked any of the shaded boxes please give further details here:

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Copyright 2009 Insurance Management (Bahamas) Ltd.