1. You must tell us (Netherlands Insurance Limited) in this Proposal fully and faithfully all facts which you know, or ought to know.
  2. Our liability in respect of this proposal does not commence until acceptance has been communicated by us to you.
  3. You must answer all the questions in this Proposal Form. Any questions not answered will be taken as answered in the negative.

Insured Particulars

Details of Property

Additional Information

Has any insurer ever, In respect of Public Liability Insurance :

Details of Expiring Insurance (If Any)

Please provide the following information:

Limit of Indemnity:

Claims Experience

Please give particulars of claims that have been made against you (or are pending) during the last 5 years:


- For the purpose of this proposal, the undersigned being the proposer or an authorised representative of the proposer and any other parties to be icluded for this insurance declare that the statements herein are true, accurate and complete; otherwise the Policy issued may be void. NETHERLANDS INSURANCE Limited is authorised to make any inquiry in connection with this proposal. Neither the acceptance of this proposal nor the making of any further inquiry will bind NETHERLANDS INSURANCE Limited to complete the insurance.

- The information contained in and submitted with this proposal is on file with NETHERLANDS INSURANCE Limited and along with the proposal is considered physically attached to the Policy and will become part of it. NETHERLANDS INSURANCE Limited has relied upon this proposal and attachments in issuing this Policy. The undersigned and/or authorised representative proposed for this insurance agrees that the information contained in and submitted with this proposal is deemed material to the risk assumed by NETHERLANDS INSURANCE Limited.

- If the information in this proposal materially changes between the date this proposal is signed and prior to the inception date of the Policy, the proposer will notify NETHERLANDS INSURANCE Limited, who may modify or withdraw the quotation.