Digital Forms Debit Form AuthorityAccount Holder's Name(Required) Bank(Required)First National BankEswatini BankStandard BankNedbankEswatini Building SocietyBranch and Code(Required) Account Number(Required) Type of Account(Required) Current (Cheque) Savings Transmission Other Travel Insurance Details 1Your Personal Details2Trip Details Tell us about yourselfName Dr.MissMr.Mrs.Ms.Prof.Rev. Title First Surname Date of Birth(Required) MM slash DD slash YYYY Email(Required) Contact Number(Required) ID Number(Required) Passport Number(Required) Tell us about your tripDestination(Required) Date of Departure(Required) MM slash DD slash YYYY Return Date(Required) MM slash DD slash YYYY Type of Trip(Required) Personal Business Please describe the purpose of your trip (optional) Business Insurance Proposal 1Tell us about yourself2Give us details on your insurance policy3Declare this proposal Your DetailsName of Insured(Required) First Surname Occupation(Required) Agent(Required) Email(Required) Physical Address(Required) Postal Address(Required) Period of insurance from(Required) DD slash MM slash YYYY Period of insurance until(Required) DD slash MM slash YYYY Policy OptionsStep 1: Download Policies Document on this link Step 2: Fill in the document and save Step 3: Reupload the filled, saved file in the field below (Policies Document)Policies Form Upload(Required)Accepted file types: pdf, Max. file size: 64 MB. DeclarationDeclaration(Required) Click here to accept declaration belowI declare that the answers in this proposal are full and true and that I have withheld no information whatever that may tend in any way to increase the Company’s risk or influence their decision regarding this proposal and i undertake to exercise all ordinary and reasonable precautions for the safety of the property proposed for insurance I agree that this proposal and declaration shall be the basis of the contract between me and Lidwala Insurance Company (private)Limited and I agree to accept a Policy subject to the usual conditions endorsed thereon. The insurance does not commence until acceptance has been confirmed by the Insurer.Date(Required) DD slash MM slash YYYY Contractors All Risks Policy Questionnaire & Proposal 1. Broker DetailsName of Broker(Required) Contact Person(Required) Contact Details (Tel)(Required) Fax No 2. Insured DetailsName of Insured(Required) Postal Address(Required)Contact Details (Tel)(Required) Fax No Principal/Employer Sub ContractorsPolicy OptionsPolicy Options(Required) Open Annual Contracts Policy Once Off/Specific Contracts Policy 3. Open Annual Contracts PolicyEstimated Annual Turnover(Required)Note: (The turnover must include the total cost of materials, labour, free issue materials, P & Gs and any other Contractual Income + VAT)Description of the type of contracts entered into(Required)(Erections, Alterations, Extenstions to Buildings/Dwellings etc)The Value of the largest contract to be worked/On/Awarded during the next 12months(Required)In which areas will the contracts take place?(Required)What work will be done by the Sub Contractors?(Required)Surrounding Property/Property under Custody Control (Not being Part of Contract Works) Limit of Indemnity Required(Required)Date(Required) MM slash DD slash YYYY Maintanance Period(Required) 3. Once Off/Specific Contracts PolicyContract Value(Required)Attach copy of Contract Cost Breakdown(Required) Drop files here or Select files Max. file size: 64 MB. Contract Title/Full Description of Contract(Required)What work will be done by the Sub Contractors?(Required)Site Location(Required)The Contract Site Details(Required)Select all that are appicable Level Slopping Rocky Sandy Clay Built Up Area Remote Area Select AllGive Details of Security Precautions(Required)Close Proximity to Rivers, dams, known water course(Required) Yes No Close Proximity to Highway, motorway airport etc(Required) Yes No Contract Start Date(Required) DD slash MM slash YYYY Contract End Date(Required) DD slash MM slash YYYY Surrounding Property/Property under Custody Control (Not being Part of Contract Works) Limit of Indemnity Required(Required)4. Contractors Public LiabilityLimit of Indemnity Required(Required)Use of Explosives?(Required) Yes No Adequate Fenced Off?(Required) Yes No Access Control to Site?(Required) Yes No Comment on density of pedestrian and vehicle traffic in the immediate vicinity of the site (e.g. Busy Mall or isolated area)(Required)Removal of support (Lateral Support) **If required please provide Engineers Report**(Required)Engineer's Report (if applicable) Drop files here or Select files Max. file size: 64 MB. Previous InsuranceDo you have any previous insurance? Yes No 5. Previous Insurance InformationName of Previous Insurer(Required) Claims Experience/Details(Required)Supporting Business(Required)Other InformationOther CommentsDeclarationDate(Required) DD slash MM slash YYYY Declaration(Required) I hereby declare the below statementWe hereby declare that the statements made by us in this Questionnaire and Proposal are, to the best of our knowledge and belief, complete and true, and we hereby agree that this forms the basis and is part of any policy issued in connection with the above risk. It is agreed that the Insurers are liable in accordance with the terms of the Policy only and that the insured will not lodge any other claims of whatever nature. The Insurers undertake to treat this information in strict confidence.PhoneThis field is for validation purposes and should be left unchanged. Save and Continue Later Deterioration of Stock Insurance Proposal Form Name of Proposer(Required) First Last Address of Proposer(Required)Address of Cold Stores(Required)Description of Stock kept under cold storage(Required)Taking into account the average temperature of the area and the type of stock - how long could the stocks be safely kept without deterioration following failure of the plant.(Required) Would it be possible to sell the stocks at short notice? If so at what price in terms of a percentage of the market price?(Required) What is the sum to be insured (i.e. cost price)?(Required) Please give a description of the plant and H.P. rating of electric motors in relation to each independent cold chamber(Required)Is there any standby plant ready for immediate use?(Required) Yes No Is there any any spare items of plant kept on the premises?(Required) Yes No In respect of each item of Plant Sale(Required)Use each text box below to add Plant details, click (+) to add more items to the listPlant item nameThe name and country of the manufacturerDate of manufacture Add RemoveIs there a manufacturers guarantee or warranty in force for the equipment?(Required) Yes No Is there a maintenance contract or service agreement in force?(Required) Yes No Is the plant regularly inspected by a qualified engineer(Required) Yes No At what intervals do the inspections take place?(Required) Is a competent engineering staff for maintenance purposes maintained at the premises?(Required) Yes No What type of refrigerant is used(Required) Ammonia Carbon dioxide Freon refrigerant Other Give details of any failures of plant occurred during the past 5 years?(Required)Have any items of plant previously been insured?(Required) Yes No Give details of items of plant previously insured(Required)Is the plant insured under an engineering (material damage) policy at the present time?(Required) Yes No Has an insurer in respect of this or any other insurance ever declined to renew your policy?(Required) Yes No Has an insurer in respect of this or any other insurance declined to insure you?(Required) Yes No What is the name of the power station from which electricity supply is obtained.(Required) How far is the power station (approximately) from the cold storage premises?(Required) Declaration(Required) I declare the statement below.By ticking this box, you consent to the sending of this form and all the contents that are entered are known to be true to you. Fidelity Guarantee Insurance Proposal Form 1Tell us about you2Give us details of the cover3Individual Cover4Floater Cover5Cover involving cash6Cover involving stock7Declare this proposal PROPOSER'S DETAILSName(Required) First Last Address(Required)Occupation Insurance Period of Insurance Start Date(Required) DD slash MM slash YYYY Insurance Period of Insurance End Date(Required) DD slash MM slash YYYY COVER DETAILSTick all appropriate parameters of the cover below(Required) Individual Cover Floater Cover Involves Cash Involves Stock DETAILS OF EMPLOYEE (S) TO BE INSUREDList of employees(Required)Add information into each column and press (+) to add another rowNameDutiesYear of EmploymentLimit Per OccurrenceAggregate/Annual Limit Add Remove FLOATER COVER DETAILSNumber of Employees to be covered(Required)Annual Turnover(Required)Limit of Liability/ Total amount to be insured(Required)Collusion Limit if anyIs there a system to obtain references from previous employer?(Required) Yes No Specify practice followed(Required)The maximum amount held by any employee at any one in time(Required)How long is this amount held? (In days)(Required) CASH & PAYMENT DETAILSHow often are the employees required to account for money? Do employees pay out money or draw cash from proposer’s account?(Required) Yes No If yes, are such payments/withdrawal authorized by a senior employee?(Required) Yes No How often is the cash book balanced, the entries checked with vouchers and other Bank’s documents?(Required) STOCK DETAILSWhat is the system followed for purchase, authorizing dispatch, ensuring dispatch and recording deliveries of goods?(Required) How often and by whom stock verification is done?(Required) What is the extent and frequency of audit?(Required) Details of losses suffered on account of infidelity of any employee in the last five years.(Required) Has any company decline, cancelled, refused or accepted you proposal on special terms and conditions?(Required) Yes No Claims ExperienceYearPremiumIncurred LossesLoss Ratio Add Remove DECLARATIONDate DD slash MM slash YYYY Declaration I hereby declare the below statementI/We to the best interest of my/our knowledge hereby confirm that the statements contained in this proposal form are true and correct and I/We have not concealed, misrepresented or misstated any material fact. I/We agree that the statements and declaration contained in this proposal form shall be the contract of insurance with the company and are deemed to be incorporated in the contract.