HOME INSURANCE PROPOSAL FORM

Unless all material facts are disclosed, this insurance could be invalidated. Material Facts are those facts an Insurer would regard as likely to influence the acceptance and/or assessment of the Proposal. If you are in any doubt about whether facts are material, you should disclose them. A copy of the completed Proposal Form will be supplied on request but you should keep a record (including copies of letters) of all information supplied to us for the purposes of entering into this contract. A specimen Policy is available on request.

DATE INSURANCE IS TO BEGIN (which cannot be before the proposal is accepted by the Insurers)

EXPIRY DATE

Name of Proposer:

DL/NIB#:

Occupation:

Policy Currency (B$ / US$):

Postal Address:

E-mail:

Telephone:

Home:

Mobile:

Office:

Full Address of Property to be Insured:

Distance of Nearest Building from the Sea:

Height Above Sea Level:

GPS Coordinates:

Lat:

Long:

Do you require cover for *Catastrophe Perils?

Yes

If 'YES', choose a Deductible from the following options:

10%

*Catastrophe Perils are Hurricane, Tropical Storm, Cyclone, Tornado, Earth-quake, Volcanic Eruption or Tidal Wave including Flood following these perils.

SECTION 1 - BUILDINGS

Do you require this cover?

Yes

1.

What is the full rebuilding cost of your home?

The home plus landlord's fixtures and fittings

Patios, footpaths, walls (but not seawalls), gates, fences and driveways

Swimming pools and tennis courts

Docks, jetties, piers, seawalls or similar water-side structures (these structures are not covered unless specifically mentioned and insured)

Other (please provide details)

2.

Loss of Rent/Alternative Accommodations

Cover is included up to a limit of 10% of your Building Sum Insured, in respect of all perils except Catastrophe Perils. Do you wish to increase this limit? If so, please specify Sum Insured.

Sum Insured

You may also increase cover to include Catastrophe Perils (provided your Building is covered on this basis).

Do you wish to do so?

Yes

3.

What is the approximate area of your home in square feet?

4.

Mortgage or Other Interest

Name

Address

SECTION 2 - CONTENTS WHILST IN THE HOME

Do you require this cover?

Yes

If you require Contents cover, please answer the questions below (do not include items you wish to cover under Section 3 - “All Risks”).

1.

a. What is the replacement cost of your High Risk Items, i.e.:

TV, personal computer, audio and video equipment

Jewellery and watches

Photographic equipment

Total High Risk Items

b. Total other Contents

c. Total a. plus b.

d.

If the replacement cost of High Risk Item exceeds $5,000 list the item(s) and value(s) below:

Item

Value $

If the replacement cost of all High Risk Items exceeds 35% of the total Sum Insured for Contents, an additional premium may apply.

SECTION 3 - "ALL RISKS"

1. Unspecified Items:

This provides cover for unspecified valuables, personal effects and clothing providing no one item exceeds $500 in value. Items in excess of $500 should be insured separately as a Specified Item. In addition, cover is provided for Loss of Personal Money up to $500 and Financial Loss resulting from stolen credit cards up to $500. A deductible of $50 applies to all claims.

Do you require this cover?

Yes

Sum Insured required

(minimum $1,500)

2.' Specified Items:

Items exceeding $500 in value. A valuation or appraisal is required for each item (excluding electronic goods) of $1,000 or more in value. Please list below or on a separate sheet of paper.

Description

Sum Insured

Add Item

Delete Item

SECTION 4 - LIABILITIES

Provided Section 1 and/or Section 2 of this Policy is taken, the following cover is automatically included without extra charge:

Personal Liability (does not apply if Policy is not issued in the name of a private individual(s)).
Property Owners Liability
Occupiers Liability
Employers Liability in respect of domestic staff (Maximum 3)

The Limit of Indemnity is $500,000 per occurrence and in the aggregate. This may be increased at an Additional Premium.

Do you wish to increase the Limit of Indemnity for:

Personal, Property Owners and Occupiers Liability?

To $1,000,000

Yes

Employers Liability?

To $1,000,000

Yes

Number of Employees

If you are a tenant of the home, liability as a Tenant of the Property is also included free of charge up to the Sum Insured on Contents or $20,000, whichever is the lesser. A $50 deductible applies to each and every claim.

SECTION 5-PERSONAL ACCIDENT BENEFITS PAYABLE IN CONSEQUENCE OF A CRIMINAL ASSAULT OR MOTOR VEHICLE ACCIDENT

The following Benefits are payable to any of the Insured who are between 18 and 65 years of age and not in full time education, in the event they are subject to a Criminal Assault or in a Motor Vehicle Accident anywhere in the Commonwealth of The Bahamas.

Please note there are a number of Exclusions. A representative of Insurance Management (Bahamas) Limited will be pleased to discuss these with you.

Death or Total Disablement from gainful employment of any kind

$25,000

Medical Expenses (excluding the first $250)

$10,000

Hospital Confinement (excluding the first two days)

$50 per day up to 60 days

The maximum amount payable is $38,000 in respect of any one Insured and $76,000 in respect of all Insureds.

Do you require this cover? An additional premium is required.

Yes

DECLARATION, DATA PROTECTION ACT NOTICE & CONDITION OF AVERAGE NOTICE

Please note that in accordance with the Data Protection Act 2003, the information supplied when arranging this insurance policy may be shared for insurance purposes and services with other companies and organisations. For full details please refer to the Data Protection Act Statement available from Insurance Management (Bahamas) Ltd.

Please note that your Policy is subject to a Condition of Average. This means that if the Sum Insured is less than it should be (known as underinsurance) you will not receive reimbursement for the full amount of any loss the Policy responds to. In the event your property is underinsured then the Condition of Average will operate to reduce the net amount you will receive from a valid claim, in direct proportion to the amount of underinsurance. For example, if you have a Sum Insured that is only 50% of what it should be you will only receive 50% of any valid claim. Similarly, if you insure for 75% of the correct amount you will receive only 75% of any valid claim. The following serves to further illustrate the principle:

Calculation Formula:
Example:

Sum Insured
$100,000

divided
by

Replacement Cost
$200,000

multiplied
by

Amount of Loss
$50,000

Policy Payment (before Deductible*)
$25,000

Therefore:

Amount of Loss
$50,000

less

Policy Payment (before Deductible*)
$25,000

Insured's Contribution
$25,000

*Where a Deductible or Excess exists on a Policy, this will be subtracted from the final payment of any claim after the operation of the Condition of Average.

Please note that in the event of a total loss the policy will pay the lower of the amount of the loss or the sum insured. This means that in the event of you being underinsured and having a total loss you will receive only the sum insured, which will not reimburse you for the full amount of the loss you may have suffered.

The basic concept of insurance is that insured persons contribute to a pool based on the risk (the value of their property) they bring to the pool. If the insured does
not pay premium based on his full exposure e.g. if he only insures 50% of his risk, as above, then he has contributed less to the pool than he should. Because of
this, he cannot take out of the pool the full amount (100%) of his loss, but rather would get the percentage of the loss that he contributed in premium to the pool, which in the above example is 50%. If you have any questions about the way the Condition of Average may affect you please discuss with Insurance Management (Bahamas) Limited.

This notice is given to you in fulfillment of the requirement set out in Section 214 of the Insurance Act, 2005, to provide you with information on the nature and effect of the Condition of Average stated in your Policy.

I/We have had the Condition of Average explained to me/us and understand that if the sums insured do not represent the full replacement value of the property insured I/we may be penalized in the event of a claim.

I/We declare that, to the best of my/our knowledge and belief, the particulars and answers are true and correct and that I/we have not withheld any information that is likely to influence the decision of the Insurers in regard to this proposal.

I declare that to the best of my knowledge, the particulars and answers given are true and correct

Signing this form does not bind the Proposer to complete the insurance but it is agreed that this form shall be the basis of the contract should a policy be issued. No liability attaches to the Insurers until this proposal has been accepted.

HOME INSURANCE PROPOSAL FORM

YOUR HOME Please complete in all instances

1. Is your home

2.

Please state the construction material of:

3.

With regard to the sections of cover you are selecting, have you or any person normally residing with you, at your present address or elsewhere

4.

Have you or any member of your family residing with you, or directors where the Proposer is a limited company, ever been convicted of an offense other than driving offenses?

5. Is the Property

SECTION 1 - BUILDINGS

1.

What is the full rebuilding cost of your home?

2.

Loss of Rent/Alternative Accommodations

3.

What is the approximate area of your home in square feet?

4.

Mortgage or Other Interest

SECTION 2 - CONTENTS WHILST IN THE HOME

1.

a. What is the replacement cost of your High Risk Items, i.e.:

b. Total other Contents

c. Total a. plus b.

d.

If the replacement cost of High Risk Item exceeds $5,000 list the item(s) and value(s) below:

SECTION 3 - "ALL RISKS"

1. Unspecified Items:

2.' Specified Items:

SECTION 4 - LIABILITIES

SECTION 5-PERSONAL ACCIDENT BENEFITS PAYABLE IN CONSEQUENCE OF A CRIMINAL ASSAULT OR MOTOR VEHICLE ACCIDENT

DECLARATION, DATA PROTECTION ACT NOTICE & CONDITION OF AVERAGE NOTICE

Contact Us

About IMB

What You Should Know

Forms

HOME INSURANCE PROPOSAL FORM

YOUR HOME Please complete in all instances

1. Is your home

2. Please state the construction material of:

3. With regard to the sections of cover you are selecting, have you or any person normally residing with you, at your present address or elsewhere

4. Have you or any member of your family residing with you, or directors where the Proposer is a limited company, ever been convicted of an offense other than driving offenses?

5. Is the Property

SECTION 1 - BUILDINGS

1. What is the full rebuilding cost of your home?

2. Loss of Rent/Alternative Accommodations

3. What is the approximate area of your home in square feet?

4. Mortgage or Other Interest

SECTION 2 - CONTENTS WHILST IN THE HOME

1. a. What is the replacement cost of your High Risk Items, i.e.:

b. Total other Contents

c. Total a. plus b.

d. If the replacement cost of High Risk Item exceeds $5,000 list the item(s) and value(s) below:

SECTION 3 - "ALL RISKS"

1. Unspecified Items:

2.' Specified Items:

SECTION 4 - LIABILITIES

SECTION 5-PERSONAL ACCIDENT BENEFITS PAYABLE IN CONSEQUENCE OF A CRIMINAL ASSAULT OR MOTOR VEHICLE ACCIDENT

DECLARATION, DATA PROTECTION ACT NOTICE & CONDITION OF AVERAGE NOTICE

Contact Us

About IMB

What You Should Know

Forms

2.

Please state the construction material of:

3.

With regard to the sections of cover you are selecting, have you or any person normally residing with you, at your present address or elsewhere

4.

Have you or any member of your family residing with you, or directors where the Proposer is a limited company, ever been convicted of an offense other than driving offenses?

1.

What is the full rebuilding cost of your home?

2.

Loss of Rent/Alternative Accommodations

3.

What is the approximate area of your home in square feet?

4.

Mortgage or Other Interest

1.

a. What is the replacement cost of your High Risk Items, i.e.:

d.

If the replacement cost of High Risk Item exceeds $5,000 list the item(s) and value(s) below: