Contractor / Erection All Risk Proposal Form
Provides protection against loss or damage in respect of the contract works at contract site and third party claims arising in connection with the construction of a project.
Name of Proposer (In Block Letters) *
Principal, Consultants, Main Contractor, Sub-Cons, Financiers. Example:CAN TRUST CONSTRUCTION AS MAIN CONTRACTOR, JASA DEVELOPMENT BERHAD AS PRINCIPAL, LEE & LEE CONSULTANT AS CONSULTANT, PBB BANK AS FINANCIER, AND ALL NOMINATED SUB-CONTRACTOR OF CAN TRUST CONSTRUCTION FTRRI
Company Registration No. *
business registration no
Postal Address *
Correspondence Address
TeL No: *
E-Mail address *
Business,Trade or Occupation of Proposer *
Mortgagee / Chargee if any
DETAILS OF PROJECT / RISK TO BE INSURED
1. Title of Contract *
2.Sites of Risk Tempat/Lokasi Risiko *
Situation of Risk- County, State, District, City, Town, Village(Tempat Risiko-Negara, Negeri, Mukim, Bandaraya, Bandar, Kampung) EXAMPLE:ON THE PROPOSED SUPPLY AND INSTALLATION OF PPR PIPE REPLACEMENT OF HOT WATER DROPPER PIPES AT PARKROYAL KL (7 th FLOOR TO ROOF TOP) AS PER DESCRIPTION IN PURCHASED ORDER :PARKROYAL KUALA LUMPUR (PO0201001-02586)DATED: 28/01/2010 AND BILL OF QUANTITY REF: GRTE2350/20001DATED:22/01/2010 AND LETTER OF AWARD REF: ASG34349590/2010
3. Name(s,) address(es) of Principal(s)
Nama, Alamat Prinsipal
4. Insured (Pihak Diinsurankan)
Please states the parties to be declared as insured in the policy. (Sila kemuka pihak yang disahkan sebagai Insured dalam polisi ini) Example:CAN TRUST CONSTRUCTION AS MAIN CONTRACTOR, JASA DEVELOPMENT BERHAD AS PRINCIPAL, LEE & LEE CONSULTANT AS CONSULTANT, PBB BANK AS FINANCIER, AND ALL NOMINATED SUB-CONTRACTOR OF CAN TRUST CONSTRUCTION FTRRI
5. Types of foundation and level of deepest excavation (Jenis tapak pembinaan dan tahap pengorekan tanah)
Construction Methods (Cara Pembinaan)
6. Is the contractor experience in this type of work or construction method? Adakah bahawa kontraktor fasih atau biasa dengan kerja dan cara pembinaan sedemikian? *
7 i) Period of Insurance (Tempoh Diinsurankan)
Commencement of Work (Tarikh permulaan Kerja)
7 ii) Duration of Construction ( Jangkamasa pembinaan)
Month(s) (Bulan)
7 iii) Date of Completion (Tarikh kelepkapan)
00/00/0000
7iv)Maintenance Period ( Tempoh Penyelenggaran penjagaan)
Month(s) (Bulan)
Next
Never submit passwords through Google Forms.
This form was created inside of SIMON POON AGENCY. Report Abuse