AUREOL INSURANCE COMPANY LIMITED
INCORPORATED IN SIERRA LEONE
KISSY HOUSE, 54 SIAKA STEVENS STREET, FREETOWN
Tel : +232 22 223435/+232 22 223441/+232 22 225290
Fax : +232 22 229336
Mobile : +23278175175/+23233175175/+23288175175
email : info@aureolinsurance.com
website : www.aureolinsurance.com
BRANCH OFFICE:
13 Tikonko Road
Bo
Tel: +232 32-320108
Mobile: +232(79)175175
PROPOSAL FOR GOODS-IN-TRANSIT 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……………
1. Describe fully the type of goods to be insured……………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………..
2. Are the goods to be transported “own goods” or “general haulage.”……………………………………………………………….
………………………………………………………………………………………………………………………………………………………..
3. State the total number of vehicles
(a) owned by you……………………………………………………. carrying capacity……………………………………………..
(b) hired by you………………………………………………………. carrying capacity…………………………………………….
4. Will any of your loaded vehicles be left unattended in the open during the night?…………………………………………………
If so, please state details.
5. Do you have printed conditions of carriage?………………………………………………………………………………………………
(If so, please attach a copy).
6. Has any Insured ever:
(a) Declined your proposal?……………………………………………………………………………………………………………….
(b) Increased your premium?………………………………………………………………………………………………………………
(c) Refused to renew or cancelled your Policy?……………………………………………………………………………………….
(d) Imposed special terms?…………………………………………………………………………………………………………………

A COPY OF THE POLICY IS AVAILABLE UPON REQUEST.

7. Please state records of claims or losses during the past three years. 20……………….
20……………….
20……………….
8. Aggregate Annual Sum Insured………………………………………………………………………………………………………………….
9. Indemnity required in respect of any one loss or series of losses arising out of one event…………………………………………..
DECLARATION: I/We warrant that the answers given above are correct and agree that this proposal shall be the
basis of the contract between me/us and the Aureol Insurance Company Limited to be expressed
in the terms and conditions contained in the Company’s Policy.
Date:……………………………………………….. Signature:………………………………………………….
NOTE: THE COMPANY RESERVES THE RIGHT TO DECLINE ANY PROPOSAL.