top of page

Office - All Risks Form

All questions marked with * require an answer

Do you have any other insurance with us?
Yes
No
Have you had any insurance refused or subjected to special terms?
Yes
No
Have you had any losses during the past 3 years?
Yes
No

Business

Building Construction

Are buildings equipped with (choose all that apply)
Do you occupy the entire premises?
Yes
No
Coverage required FROM
Coverage required TO
Type of Perils (select one)
Full (including hurricane)
Restricted

Sums Insured (estimated amounts)

I/we declare that the sums insured listed above represent full replacement costs of the items covered. I/we further declare that we have been advised that should the sums insured not represent full replacement costs at the time of loss, any claim will be settled using sum insured to value.

bottom of page