SINGLE CONTRACT COMPREHENSIVE GENERAL LIABILITY INSURANCE PROPOSAL FORM
IMPORTANT :
I. PURSUANT TO SECTION 149(4) OF THE INSURANCE ACT 1996 – You are to disclose in this proposal form, fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder ma be void.
II. Signing of this Proposal does not bind the Company to offer or the Proposer to accept, Insurance, but it is agreed that this Proposal shall be the basis of any insurance issued.
III. If there is insufficient space to complete the Proposal, please attach additional sheets.

SIMON POON AGENCY & Associated Principal application
1. Name of Proposer *
(Nama Pencadang)
Your e-mail address (alamat e-mail kamu) *
2. Address *
(Alamat Surat Menyurat)
3. Is the Proposer the main contractor or subcontractor or both *
(Adakah Pencadang kontraktor utama ataupun sub-kontraktor)
4. Name of Principal (party for whom the Proposer has contracted to do the work) *
(Nama Prinsipal (pihak untuk siapa pencadang telah dikontrak untuk membuat kerja)
5. List additional parties to be mentioned in the policy as co-insured and their relationship contractually to the Proposer *
(5. Senarai parti tambahan yang akan dinyatakan dalam dasar sebagai co-diasuransikan dan hubungan mereka kontrak kepada pencadang)
6. General description of business of the Proposer *
6. Keterangan Umum usaha pencadang
7. Annual Turnover (RM) ( last financial year )
7. Penjualan/Pendapatan Tahunan (RM) (tahun kewangan berlalu)
7a.)Estimated Turnover RM ( current financial year’s projection )
7a.)(Anggaran Pendapatan RM (tahun kewangan terkini)
7b.)Estimated Turnover RM ( next financial year’s projection )
7b.)Anggaran Pendapatan RM (tahun kewangan hadapan)
8ai). Project Staff force : Technical
8ai). Daya Kakitangan Projek : Teknikal
8aii)Project Staff force : Non-Technical
8aii) Daya Kakitangan Projek : Bukan Teknikal
8bi. Annual Basis Staff Force: Technical
8bi. Daya Kakitangan Dasar Tahunan: Teknikal
8bii. Annual Basis Staff Force: Non-Technical
8bii. Daya Kakitangan Dasar Tahunan - Bukan Teknikal
9. a) Is the Proposer a subsidiary of another entity
9. a) Adakah Pencadang sebuah subsidiari untuk syarikat yang lain
9. b) Does the Proposer have any subsidiary
9. b) Adakah Pencadang memiliki sebuah subsidiari (Anak Syarikat)
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