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    GSIS TEMPLATE Fire Insurance Application Form (TRAD)

    Uploaded by

    Ronan Maquidato
    This document is an application for property insurance submitted to the Government Service Insurance System (GSIS). It includes details about the property to be insured such as the building, contents, and location. It also lists various types of insurance coverage being applied for including fire, earthquake, typhoon, flood, theft, and others. The applicant declares the information provided is true and agrees it will form the basis of an insurance contract with GSIS. An inventory of properties and equipment is also attached to provide additional details.

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    © All Rights Reserved
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    GSIS TEMPLATE Fire Insurance Application Form (TRAD)

    Uploaded by

    Ronan Maquidato
    124 views3 pages
    This document is an application for property insurance submitted to the Government Service Insurance System (GSIS). It includes details about the property to be insured such as the building, contents, and location. It also lists various types of insurance coverage being applied for including fire, earthquake, typhoon, flood, theft, and others. The applicant declares the information provided is true and agrees it will form the basis of an insurance contract with GSIS. An inventory of properties and equipment is also attached to provide additional details.

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    This document is an application for property insurance submitted to the Government Service Insurance System (GSIS). It includes details about the property to be insured such as the building, contents, and location. It also lists various types of insurance coverage being applied for including fire, earthquake, typhoon, flood, theft, and others. The applicant declares the information provided is true and agrees it will form the basis of an insurance contract with GSIS. An inventory of properties and equipment is also attached to provide additional details.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    124 views3 pages

    GSIS TEMPLATE Fire Insurance Application Form (TRAD)

    Uploaded by

    Ronan Maquidato
    This document is an application for property insurance submitted to the Government Service Insurance System (GSIS). It includes details about the property to be insured such as the building, contents, and location. It also lists various types of insurance coverage being applied for including fire, earthquake, typhoon, flood, theft, and others. The applicant declares the information provided is true and agrees it will form the basis of an insurance contract with GSIS. An inventory of properties and equipment is also attached to provide additional details.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
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    Underwriting Form No.

    2004/01
    (Revised 04/2004)

    PROPERTY INSURANCE APPLICATION


    Name of Assured

    Address

    Date

    GOVERNMENT SERVICE INSURANCE SYSTEM


    Cagayan de Oro Branch Office

    Attention: Special Business Unit

    Gentlemen:

    In accordance with Section 5 of Republic Act No. 656, I have the honor to apply for Insurance of the
    following property:

    1 Property: a. Building 2. Value: a)

    b. Contents (furniture, fixtures, and equipment) b)

    Total

    3 Location Block No. Street

    Town/City Province

    4 A sketch of the building to be insured and its premises to be drawn at the back hereof.

    5 Insurance will be against (please check)

    (1) Fire and/or Lightning (5) Theft and/or Robbery


    (2) Earthquake-Fire & Shock (5) Unauthorized Dismantling
    (3) Typhoon (6) Landslide
    (4) Flood (7) Others

    It is further certified that we shall effect payment of the above-mentioned Insurance


    policies/bills on a "CASH and CARRY" basis, or within the prescribed sixty(60) days from the
    Inception or from the date of receipt of the bill, whichever is later. As embodied under Section 77,
    Insurance Code, "no policy or contract of insurance issued by an insurance company is valid and
    binding unless and until the premium has been paid." Therefore, non-payment of the premium
    within the prescribed period will cause the GSIS to cancel the policy without prior notice.

    I hereby declare that the above particulars are complete and true to the best of my
    knowledge and belief, and I agree that this Property Insurance Application and Certification of
    Availability of Funds shall be the basis of a contract between me and the Government Service
    Insurance System, Insurance Group.

    Done t_________day of___________ 20____, ______________, Philippines.

    Authorized Signatory

    Office / Designation

    Address / Telephone No.


    Note: Please submit Inventory for Office Furniture, Fixtures, Equipment, Machines, Appliances, etc.
    INVENTORY OF PROPERTIES

    NAME OF OFFICE: Date Prepared:


    OFFICE ADDRESS: Zip Code:________
    VALUE OF
    DESCRIPTION OF PROPERTY OCCUPANCY OF BUILDING CONTENTS*
    (Indicate whether 1-Storey / (Office/ School/ Hospital / VALUE OF BUILDING (Attach Itemized
    ITEM 2-Storey, 3-Storey or more) Residential / Commercial) LOCATION OF BUILDING (Sound Value) Inventory per Bldg)

    Building 1

    Building 2

    Building 3

    Building 4

    Building 5

    Building 6

    Building 7

    Building 8

    Building 9

    Building 10

    *total amount of all Office Furniture, Fixtures, Equipment, Machines, Appliances, etc. TOTAL:
    which are kept / stowed / used in the corresponding building / property / structure

    Prepared By: Certified Correct: Noted:

    <SIGNATURE OVER PRINTED NAME> <SIGNATURE OVER PRINTED NAME> <SIGNATURE OVER PRINTED NAME>
    <Designation> <Designation> <Designation>
    Republic of the Philippines
    GOVERNMENT SERVICE INSURANCE SYSTEM
    Carmen, Cagayan de Oro City

    FIRE INSURANCE APPLICATION Date Prepared:

    INVENTORY OF EQUIPMENTS AND MATERIALS

    EQUIPMENT/MATERIAL QUANTITY UNIT UNIT VALUE TOTAL VALUE

    Prepared by: Certified Correct:

    <SIGNATURE OVER PRINTED NAME> <SIGNATURE OVER PRINTED NAME>

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