Deterioration of stock

Corporate Information

Company Name *

Activity Of The Company *

Title*

First Name*

Last Name*

Occupation *

Mobile *

Email *

Address *

Website

Deterioration of stock (DOS)

Name Of Proposer

owner

lessor

lessee

tenant of the cold-storage house

Name and address of tenant

Name

Address

Name and address of cold-storage house

Name

Address

Nearest railway station/airport

Cold Storage house in operation

All the year round

Months in the year

Rel. Air Humidity

CO2 (%)

Insulation

Cork

Mineral Wool

Foam Plastics

Date of last check

Date of last replacement

Alternative storage facilities

Yes

If so

Distance ( KMs )

Period ( MONTHS )

Does a Machinery policy exist?

Yes

When was the refrigeration plant first put into operation?

Is switchover from one unit to the other possible?

Yes

What refrigerator capacity remains when cold-storage rooms are fully closed?

Refrigerant

NH3

Freon 22

Freon 12

Other

Pipes carrying refrigerant are

on the ceiling

on the walls

on the floor

Supervision

by own staff

by government

Maintenance is carried out by

manufacturer

lessor

own staff

maintenance firm

Is there also an independent calibrated reference thermometer in each cold-storage room?

Yes

Check Intervals (hours)

Yes

Rel. Air Humidity

CO2 and CO Concentration

Air Pressure

Are there any different arrangements for Sundays and public holidays?

Yes

Installed to show disturbance or failure of plant?

Yes

Can the cold-storage rooms be entered and inspected while in use?

Yes

Is the condition of goods checked during storage?

Yes

Is failure of power supply to be insured?

Yes

We hereby acknowledge and confirm that all the submitted data above are correct and We did not hide any information related to the risk to be insured. And We authorize Brokerage Insurance Brokerage in executing this insurance request with the concerned insurance company and facilitate the policy issuance, renewals and claims follow-up and communicate specific information about us and our account to third parties if needed, in accordance with the privacy policy. We also accept that this insurance application and approval be the basis of the contract and an integral part of the insurance policy.

Deterioration of stock

Deterioration of stock

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Corporate Information

Deterioration of stock (DOS)