AUREOL INSURANCE COMPANY LIMITED
INCORPORATED IN SIERRA LEONE
KISSY HOUSE, 54 SIAKA STEVENS STREET, FREETOWN
Tel : +23278175175/+23233175175/+23288175175
Email : info@aureolinsurance.com
website : www.aureolinsurance.com
BRANCH OFFICE:
17 Tikonko Road
Bo
Mobile: +232(79)175175
PROPOSAL FOR CONTRACT WORKS INSURANCE
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……………
SECTION A
1. Name of Principal for whom work is to be carried out.
2. If Proposer is a sub-contractor for the work , give name
and address of principal contractor.
3. (a) Describe the general nature of the work to be undertaken (a)
(b) Duration of the Contract. (b)
(c ) Period of contract. (I) Construction Period (c ) (I)…………….months from…………………..20…..
(ii) Maintenance Period (ii)……………months thereafter.
4. If the Contract is on a form approved by a professional organisation,
e.g., The Institution of Civil Engineers, state name of organisation and
edition of form.
If not, attach a copy of the Contract conditions.
5. If Construction Period is more than 12 months give brief details of
works programme. If a plan of the works is available please submit a
copy with the proposal.

A COPY OF THE POLICY IS AVAILABLE UPON REQUEST.

Give details, including dates, of any similar work undertaken by you:
Date For whom undertaken Nature of work Amount
………………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………..
SECTION B Please complete fully.
SUMS TO BE INSURED
6. (a) Contract Price (a)
(b) Temporary Works, if any, not included in (a) above. (b)
(c) Value of Contractors’ Plant, Machinery Equipment
to be used on site. (c)
(d) Architects’, Surveyors’ and Consulting Engineers’ Fees. (d)
(In connection with reinstatement of Property Insured
in the event of loss)
(e) Removal of Debris Costs (if required). (e)
TOTAL SUM INSURED
(f) Give value and nature of any items under (c) above (f)
exceeding Le10,000,000.00 or currency equivalent.
7. (a) Nature of subsoil at situation of the contract. (a)
(b) Distance from sea. (b)
(c) Height above sea level. (c)
(d) Give details of any rivers, streams, canals or other water (d)
in the area and state distance therefrom.
(e) Has the area been subject to flooding in the past? If so, (e)
give details.
(f) State whether region is subject to weather conditions (f)
such as monsoons, typhoons, hurricanes and the like
and months when to be expected.
(g) Are there any mines or disused workings in the vicinity? (g)

8. (a) State depth of excavations. (a)
(I) Average depth. (I)
(ii) Maximum depth. (ii)
(b) Are there at present any underground main services on (b)
or about the situation of the contract? If so, give details.
(c) Will any blasting be carried out at or near the situation of (c)
the contract?
(d) If so, give details. (d)
(e) Describe any special features of the work to be (e)
undertaken at the situation of the contract.
9. Give particulars of all loss or damage sustained on contracts Date Cause of Loss or Damage Amount
SECTION C. To be completed only if Public Liability cover is
required.
10. Amount of indemnity required for any one accident.
11. Is the Principal’s liability to be included in the cover?
12. Give particulars of all claims made on your during the past DATE NATURE OF CLAIM AMOUNT
five years.

SECTION D. Please answer all questions fully.
13. (a) Has any Insurer at any time declined to insure you for (a)
Contract Works or Public Liability Insurance?
(b) If so, please give details including name of Insurer. (b)
14. What other insurances have you with the Company?
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15. Do you require cover against the special risks specified below?
Fire Explosion—–Yes/No
Flood, Inundation—Yes/No
Landslide, Storm, Explosion—Yes/No
Blasting Work ——–Yes/No
Volcanism, Tsunami —–Yes/No
Earthquake ——Yes/No
DECLARATION
I/We desire to effect with the Company an insurance in the terms of the policy used for this class of business,
and I/We warrant that the above statements and particulars are correct and complete. I/We agree that this
proposal shall be the basis of the contract between me/us and the Company.
Dated………………………………………………………… Signature……………………………………………………………
NOTE: THE COMPANY RESERVES THE RIGHT TO DECLINE ANY PROPOSAL.