AUREOL INSURANCE COMPANY LIMITED
INCORPORATED IN SIERRA LEONE
KISSY HOUSE, 54 SIAKA STEVENS STREET, FREETOWN
Tel : +232 88/78/175175
email : info@aureolinsurance.com
website : www.aureolinsurance.com
BRANCH OFFICE:
17 Tikonko Road
Bo
Mobile: +232(79)175175
THEFT PROPOSAL (RESIDENCES)
NAME OF PROPOSER IN FULL………………………………………………………………………………….
(If an unlimited company or partnership include full names of all parties)
PROFESSION OR OCCUPATION………………………………………………………………………………
ADDRESS………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………..
TEL. NO…………………………………FAX……………………………..EMAIL……………………………..
NAME IN WHICH THE POLICY IS TO BE ISSUED……………………………………………………………..
……………………………………………………………………………………………………………………..
TERM OF INSURANCE: FROM…………………….……..20……….. . TO…….………………...20…………..
1. (a) Situation of Premises (a)
(b) State whether a Private Dwelling house, Flat, Hotel, (b)
Boarding House or Apartments, unfurnished or furnished.
(c ) If a Flat
(1) is it self-contained with separate entrance, (I )
exclusively under your control?
(ii) if not self-contained, state number of other
tenants in the building (ii)
(d) Are the premises occupied solely by you and your family
and servants? (d)
If not, state number of tenants, lodgers or paying guests.
(e) Will the premises be at any time left unoccupied? (e)
(f) Give details of any trade or profession carried on in any (f)
part of the building.
2. (a) Is cover required against Fire? (a)
(b) If so, is the building constructed of brick, stone or (b)
concrete with slate, tile, metal or concrete roof? If not,
state nature of construction.

A COPY OF THE POLICY IS AVAILABLE UPON REQUEST.

3. Are you at present insured against Fire, Burglary or All Risks
and if so, with whom?
4. Give full particulars of all
(a) losses sustained by you (a)
(b) claims made by you in respect of any risk to which this (b)
proposal applies
5. Has any Company or Insurer in respect of any insurance Names of all Companies or Insurers to be given)
against Fire, Burglary or All Risks
(a) declined to insure you? (a)
(b) required special terms to insure you? (b)
(c) cancelled or refused to renew your insurance (c)
(d) increased your premium on renewal (d)
6. Have you any other insurances with this Company?
If so, give particulars
SCHEDULE OF PROPERTY TO BE INSURED, all (unless otherwise stated) belonging FULL VALUE
to the Proposer or to such of the Proposer’s family or domestic servants as of the whole
permanently reside with him. of such property
1. HOUSEHOLD FURNITURE and EFFECTS (except as after-mentioned) .. .. .. ………………………...
2. JEWELLERY, WATCHES, FURS, PRECIOUS METALS, PRECIOUS STONES
or articles composed of any of them .. .. .. .. .. .. .. .. .. .. .. ………………………...
3. PERSONAL EFFECTS including clothing but excluding property as described
in items 1 and 2 above ………………………...
4. Articles to be specifically insured viz ………………………...
5. …………………………………………………………………………………………….. ………………………...
…………………………
TOTAL SUM TO BE INSURED
Any article (furniture, pianos and organs excepted) to be insured for a sum exceeding 5 per cent of the total sum to be
Insured must be separately described and the value thereof stated. Deeds, bonds, bills of exchange, promissory notes, money or securities for money, coins, medals, stamps, stamp collections, documents of title to property, contracts , or other documents, business books, manuscript, curios, sculptures, rare books, plans, patterns, moulds, models or designs, motor vehicles and accessories or livestock are not insured except by special arrangement.
I desire to effect with the Company an insurance in the terms of the policy used for this class of business and I
warrant that the above statements and particulars are correct and complete. I agree that this proposal shall be the
basis of the contract between me and the Company.
Dated…………………………………………………..2…………… Signature………………………………………………….
NOTE: THE COMPANY RESERVES THE RIGHT TO DECLINE ANY PROPOSAL.
THE PROTECTORSP
ON REQUEST