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Proposer Info:

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Property Info:

Property Location

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Approximate Value of the Buiding (IQD)

Approximate Value of Conetnts (IQD)

Did any claim occur during the last 3 years?
Yes No

If yes, please specify nature, date and estimated amount in the Details box below

Policy Effective Date

Policy Expiry Date

I/we, the undersigned, declare herewith that all the information provided, to the best of my/our knowledge, are complete and correct and that this proposal forms the basis and will be part of the policy to be issued in connection with the above risk(s), and that there are no current damages to the premises to be insured

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