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Department
PL
CORP
Branch
POS
SDO
TGO
Policy number
Policy no. (old)
Last updated by
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Client data
Cert —
Certificate
Client number
Client name
Mailing address
Address 1
Address 2
Address 3
Address 4
Country
Risk location
Building name/no
Street
City
Country
Contact
Home
Work
Mobile
Email
Occupation
Coverages data
Eff / Exp date
Section 1 · Buildings
Building
Out building
Retaining walls
Swimming pool
Jetty
AC units
Section 2 · Contents
General contents
Tools
Paintings
Section 3 · All-risks
Jewellery
Section 4 · Electronics
Computer equip
Laptop
Camera
Cellphone
Elec equip
Plan & premium
Group / plan
Class
A
B
C
Total sum insured
Age over 60
Exempt from 6% insurance tax
Affinity premium
Existing premium
Manual calculation
Override the computed premium
Gross premium
6% Ins tax
Net premium
Risk data
Status
Invoice no.
Invoice date
Month
Brokerage
Year built
Construction
No. of stories
Walls
Roof
Floors
Occupancy
Risk type
Mortgagees
1st mortgagee
1st address
2nd mortgagee
2nd address
Notes
Audit
Date processed
Date modified
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