Application Form - Forte Insurance
Application Form - Forte Insurance
Application Form - Forte Insurance
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C.A.R. & E.A.R. <strong>Insurance</strong> Work Sheet<br />
1. Insured Name : ---------------------------------------------------------------------------------------<br />
Title of Contract : ---------------------------------------------------------------------------------------<br />
Location of Site : ---------------------------------------------------------------------------------------<br />
Period : ---------------------------------------------------------------------------------------<br />
Maintenance (Testing) Period : ---------------------------------------------------------------------------------------<br />
2. Interest Contract Price : US$ ------------------------------------------------------<br />
Architect Fee : US$ ------------------------------------------------------<br />
Removal of Debris : US$ ------------------------------------------------------<br />
Material Supplies by the principle : US$ ------------------------------------------------------<br />
3. Description of Dimension :----------------------------------------------------------------------------------------<br />
Contract Work<br />
---------------------------------------------------------------------------------------<br />
Foundation Method : ---------------------------------------------------------------------------------------<br />
---------------------------------------------------------------------------------------<br />
Construction Material : ---------------------------------------------------------------------------------------<br />
: --------------------------------------------------------------------------------------<br />
---------------------------------------------------------------------------------------<br />
---------------------------------------------------------------------------------------<br />
4. Subsoil Condition Rock Gravel Sand Clay Filled Ground<br />
Other, please state : ---------------------------------------------------------------------------------------<br />
Do geological faults exist in vicinity Yes No<br />
5. Ground Water ----------------------------------------------------------------------------------------------------------------------------------------------<br />
Level<br />
6. Meteorological Rainy Season: From : ----------------------------- To: -------------------------------<br />
Condition<br />
Maximum Rainfall (mm) : -----------------------------<br />
Storm Hazard: Minor Medium High<br />
7. Nearest River, Name : ----------------------------------------------- Distance: ------------------------------------------------------------------<br />
Lake, Sea<br />
Level : -------------------------------------------------------------------------------------------------------------------------------<br />
8. Contractor (s) Name(s) :-------------------------------------------------------------------------------------------------------------------<br />
------------------------------------------------------------------------------------------------------------------<br />
Address(es) : ------------------------------------------------------------------------------------------------------------------<br />
----------------------------------------------------------------------------------------------------------------<br />
9. Sub-Contractor(s) Name(s) : ------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------<br />
------------------------------------------------------------------------------------------------------------------<br />
Address(es) : ------------------------------------------------------------------------------------------------------------------<br />
------------------------------------------------------------------------------------------------------------------<br />
------------------------------------------------------------------------------------------------------------------<br />
10. Consulting Name(s) : ------------------------------------------------------------------------------------------------------------------<br />
Engineer<br />
------------------------------------------------------------------------------------------------------------------<br />
Address(es) : -----------------------------------------------------------------------------------------------------------------<br />
11. Experience Is the contractor experienced in this type of word or construction methods yes No<br />
\<br />
If yes, please state: -------------------------------------------------------------------------------------------------------------------<br />
-------------------------------------------------------------------------------------------------------------------<br />
12. Third Party Is third party liability to be included Yes No<br />
If yes. please state the amount : --------------------------------------------------------------------------------------------------<br />
--------------------------------------------------------------------------------------------------<br />
13. Existing Property Detail of existing buildings or surrounding property possibly affected by the contract words<br />
(excavating, underpinning, pilling, vibrating, ect.) : ---------------------------------------------------------------------------<br />
----------------------------------------------------------------------------------------------------------------------------------------------<br />
----------------------------------------------------------------------------------------------------------------------------------------------<br />
----------------------------------------------------------------------------------------------------------------------------------------------<br />
Are existing building and/or structures on or adjacent to the site, owned by or held in care,<br />
custody or control of the contractor(s) or the principal to be insured against loss or damage<br />
arising out of or in connection with the contract works Yes No<br />
If yes, please state : ------------------------------------------------------------------------------------------------------------------<br />
---------------------------------------------------------------------------------------------------------------------------------------------<br />
----------------------------------------------------------------------------------------------------------------------------------------------<br />
----------------------------------------------------------------------------------------------------------------------------------------------<br />
For official use only<br />
Rate :--------------------------------Terms Condition -----------------------------------------------------------------------------------------------------------<br />
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------<br />
Remarks : -----------------------------------------------------------------------------------------------------------------------------------------------------------------<br />
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------<br />
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------<br />
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------<br />
Recorded by : --------------------------------------------------
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