AUREOL INSURANCE COMPANY LIMITED
INCORPORATED IN SIERRA LEONE
KISSY HOUSE, 54 SIAKA STEVENS STREET, P O BOX 647, FREETOWN
Tel : +23278175175/+23288175175
Email : info@aureolinsurance.com
website : www.aureolinsurance.com
BRANCH OFFICE:
17 Tikonko Road
Bo
Mobile: +232(79)175175
PROPOSAL FOR INSURANCE OF CASH IN TRANSIT
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……………
CASH, ETC IN TRANSIT TO BE INSURED
If insurance is not required under any particular Limit for any Estimated Total amount
item please state “NIL” one loss in transit during the year
A. Cash, Bank Notes and/or Currency Notes in the custody of the Proposer’s
Employees whilst in transit from the Bank to the Proposer’s premises situate
as above for the payment of wages, salaries or other earnings.
B. Cheques drawn by the Proposer for payments referred to in item a above or
Petty Cash whilst in transit from the Proposer’s premises situate as above to
the Bank.
C. Cash Bank Note and/or Currency Notes (not included in item A above)
Money Orders and/or Postal Orders in the custody of the Proposer’s employees
whilst in direct transit from
(a) the Proposer’s premises situate as above to the Bank (a) (a)
(b) the Proposer’s premises situate as above to the Post Office (b) (b)
(c) the Bank or Post Office to the Proposer’s premises situate as above (c) (c)
D. Postage Stamps and/or Insurance Stamps in the custody of the Proposer’s
employees whilst in transit from the Post Office to the Proposer’s premises
situate as above.
E. Cash, Bank Notes, Currency Notes and/or Cheques (not included in the above
Items) in the custody of the Proposer’s employees whilst in transit from the Time
of receipt until delivery on the same day at the Proposer’s premises situate as
above or the Bank.
F. Other transits (e.g. Cash, Bank Notes and/or Currency Notes in transit to
Branches or outlying contracts) Full particulars to be given:-
CASH, ETC TO BE INSURED AT THE PROPOSER’S PREMISES
G. Cash, Bank Notes and/or Currency Notes (not included in item A above), ) Please delete any item for
Cheques, Money Orders, Postal Orders, Postage Stamps and/or Insurance Stamps ) which cover is not required
(I) locked in safe or strong room at the proposer’s premises situate as above-
against the risks of Burglary and Housebreaking only. (1) Sum to be insured…………………………
(11) whilst contained in the Proposer’s premises situate as above-against the risk
of theft due to “hold up” (ii) Sum to be insured………………………….
NOTE: The sums insured will be the limit for any one period of insurance.

A COPY OF THE POLICY IS AVAILABLE UPON REQUEST.

1. (a) By what means is the money conveyed? (a)…………………………………………….
(b) Please state what precautions are taken to safeguard money in transit, (b)…………………………………………….
giving the number of employees who have charge of it. …………………………………………….
2. What is the approximate distance between your premises and
(a) the Bank (a)…………………………………………….
(b) the Post Office? (b)…………………………………………….
(c) Any other place where money will be carried? (c)…………………………………………….
3. (a) Will money insured under item A above be paid out on the day of
receipt from the Bank? (a)…………………………………………….
(b) If not, how long will it remain on your premises? (b)…………………………………………….
4. Please give details of each safe or strongroom:-
Makers’ Name and Number Size and Square of Whether built in or Who has possession
Weight rounded edges fixed to wall or floor or keys
5. Are your employees insured under a Fidelity Guarantee Policy? ………………………………………………………………………………………….
6. Have you ever sustained a loss from the risks for which cover is now requested? ……………………………………………………………………..
7. (a) Are you now or have you been insured for loss of money? (a)…………………………………….…………………………………..
(b) Has any Insurer at any time for money or Fidelity Insurance -
(I) declined your proposal? (b) (I) ………………………………………………………………..
(ii) cancelled or declined to renew your insurance? (ii) ………………………………………………………………..
(iii) required an increased premium or imposed special conditions? (iii) ……………………………………………………………….
If so please give name of Insurer and details
I/We declare that to the best of my/our knowledge and belief all the foregoing statements and particulars are true and I/We agree that
this Proposal shall be the basis of a Contract of Insurance to be expressed in the usual terms of the Company’s Policy.
Date……………………………………………………………………. Proposal Signature…………………………………………………………
NOTE: THE COMPANY RESERVES THE RIGHT TO DECLINE ANY PROPOSAL.