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    This document provides contact information for two offices of AC and E Engineering Underwriting Managers and includes a plant all risk questionnaire for a business. The questionnaire collects information on the insured business name, plant items to be covered including descriptions and sums insured, whether SASRIA and third party liability coverage are needed, prior insurance details, and general comments. It requests additional details for plant items if more space is needed and signatures from the insured and date.

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    This document provides contact information for two offices of AC and E Engineering Underwriting Managers and includes a plant all risk questionnaire for a business. The questionnaire collects information on the insured business name, plant items to be covered including descriptions and sums insured, whether SASRIA and third party liability coverage are needed, prior insurance details, and general comments. It requests additional details for plant items if more space is needed and signatures from the insured and date.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    18 views3 pages

    PAR Questionnaire

    Uploaded by

    ejporter
    This document provides contact information for two offices of AC and E Engineering Underwriting Managers and includes a plant all risk questionnaire for a business. The questionnaire collects information on the insured business name, plant items to be covered including descriptions and sums insured, whether SASRIA and third party liability coverage are needed, prior insurance details, and general comments. It requests additional details for plant items if more space is needed and signatures from the insured and date.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    Johannesburg Office:

    th
    7 Floor Office Tower
    Bedford Centre
    Smith Street
    Bedford Gardens; 2047

    Durban Office:
    15 Imperial Office Park
    9/11 University Road
    Westville
    3630

    P.O Box 752189


    Gardenview
    2047

    P O Box 1968
    Westville
    3630

    Tel: 011 615 7529


    Fax: 011 615 9360

    Tel: 031 267 1124


    Fax: 031 267 1280

    AC and E Engineering Underwriting Managers (Pty) Ltd

    Website: www.engineeringace.co.za

    PLANT ALL RISK QUESTIONNAIRE


    BROKER DETAILS
    Brokerage Name:________________________________________________________
    Contact Person: _________________________________________________________
    Tel: _____________________________ Fax: _________________________________
    Email: _________________________________________________________________

    INSURED
    Business Name: _________________________________________________________
    Postal Address: _________________________________________________________
    _________________________________________________________
    VAT No:

    _________________________________________________________

    Company Registration: ___________________________________________________

    Director: Anne-Marie Fourie


    Reg. No: 2009/015923/07 VAT No: 4020257368
    A Registered Financial Services Provider: FSP 19015

    PLANT ITEMS

    Description

    Sum Insured

    NRV / MV*

    *NRV - New Replacement Value / MV - Market Value


    NB If the space is insufficient please provide a separate list of plant with the following
    information where possible:
    1.
    3.
    4.
    5.

    Age of equipment and when was last overhaul done.


    Is the plant local or imported, if imported are the agents local and who are they?
    Is there a planned maintenance program, if so please stipulate and is it done by the
    insured or outside contractor?
    Known defects to be insured at the time of taking out cover.

    SASRIA
    Cover required:

    YES ____________ NO ___________

    THIRD PARTY LIABILITY (On Site Only)


    Cover required:

    YES____________ NO ___________

    Limit of Indemnity:

    R _____________________________

    Director: Anne-Marie Fourie


    Reg. No: 2009/015923/07 VAT No: 4020257368
    A Registered Financial Services Provider: FSP 19015

    WINDSCREEN COVER
    Cover required:

    YES____________ NO ___________

    No of Items:

    ______________________________

    HIRED-IN PLANT
    Is Hire-in Plant Cover Required:

    YES____________ NO ___________

    If YES please state the estimated annual hire fees: _______________________


    Highest value of plant hired-in: _______________________________________
    PREVIOUS INSURANCE
    Name of Insurer: __________________________________________________
    Claims Experience / Details: _________________________________________
    ________________________________________________________________
    ________________________________________________________________
    ________________________________________________________________
    GENERAL COMMENTS
    ____________________________________________________________________________________
    ____________________________________________________________________________________
    ____________________________________________________________________________________
    ____________________________________________________________________________________

    ___________________________
    INSURED

    Director: Anne-Marie Fourie


    Reg. No: 2009/015923/07 VAT No: 4020257368
    A Registered Financial Services Provider: FSP 19015

    ___________________________
    DATE

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