RSA Home Proposal Form
Transcript of RSA Home Proposal Form
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HOME INSURANCE
HOME
Coverage for everything that makes your house a home.
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A POLICY THAT SUITS ALL YOUR INSURANCE NEEDS
RSA is a world renowned international company, well equipped with the expertise, product offerings and back-up
services for all your insurance needs. So you can be assured that your home and possessions are well protected!
Insurance knowledge perfected over time
We’ve been tailoring insurance solutions and products relevant to the UAE for over 50 years. Supported by a 300year heritage, with international credentials and a reputation for seamless and efcient claims handling, isn’t it time
you harnessed our global power and local knowledge to your advantage?
Expertise with convenience
Any policy you take is supported by efcient customer service. Call our service centres anytime between
8am - 8pm, Sunday to Thursday and 8am - 5pm on Saturday. Our knowledgeable team of advisors will gladly assist
you with any queries that you may have and guide you through the application process.
Perfection is our policy With the experience we have garnered through an established global presence and ve decades in this region, we
can now offer you a wide range of comprehensive insurance options, ensuring you will nd the policy that provides
you with all the cover you need under one roof!
Our home insurance cover includes:
• A New for Old Cover that ensures that damaged items are replaced with new ones i.e. there is no depreciation
for wear and tear (like for e.g., with clothing) provided that the sums insured are at new replacement values.
• Free of cost accidental damage for all Contents and Buildings Cover.
• Legal Liability and Worldwide Personal Liability of up to AED 1 million for the policyholder or a member of the
family (as occupiers under the Contents section). Owner’s liability to the public is also covered if Buildings
Insurance has been taken.
• All Risks Cover available for personal possessions (both specied and unspecied) anywhere in the UAE for the
duration of the policy, and worldwide for 60 days.
• 24-hour Cover for Workmen’s Compensation for all sponsored employees in the household such as servants
and maids, and Employer’s Liability Extension of up to AED 250,000.
For more information, please call any of our ofces/agents or log on to www.rsadirect.ae
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YES NO
YES NO
‘HOME INSURANCE’ PROPOSAL FORM
Please complete this form in BLOCK letters and fax it to our ofces. Please attach a separate sheet(s), if required.
Full Name
PO Box
Mobile
Occupation
Emirate
Email
I. Insured’s Details
Building Name
Flat/Villa No.
Street
Emirate
II. Building Details
Effective Date (DD/MM/YY)
Is your property:
III. Policy Details
Expiry Date (DD/MM/YY)
IV. General Questions
Building Value in AED
If required on the policy, please state the details of the nance
company / mortgagee and the telephone number.
Loan Amount
If you have suffered any claim for the building, please provide details
including the Date of Loss as well as claim amount paid.
V. Cover 1 - The Buildings
Value includes the home and domestic outbuildings, garages, swimming pools, tennis courts, patios, terraces, drives,
pavement, walls, gates, hedges & fences, including landlords xtures & ttings - all on the same site.
Claim Amount (in AED)
Value includes household goods, furniture, personal effects and valuables
(Note: Each item valued over AED 20,000 to be listed separately)
If you have suffered any claim on the contents, please provide details
including the Date of Loss as well as claim amount paid.
VI. Cover 2 - Contents
Claim Amount (in AED)
Claim Amount (in AED)
YES NO
YES NO
YES NO
Is your home built of concrete?
Is your home used solely as a private living accommodation for your household?
Has your home been built on reclaimed land?
Do you ever leave your home unattended for more than 60 consecutive days?
Has any insurer declined / cancelled / imposed special terms or conditions?
If you have ticked any of the shaded boxes, please give details here or separately.
Apartment Detached Semi-detached Terraced
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VII. Cover 3 - Personal Possessions
VIII. Declaration
In addition to any other details supplied to the Insurers, I, the undersigned, declare that to the best of my knowledge
and belief the information given by me is true and complete and that all material information has been disclosed
and I agree that this application shall be the basis of the contract between me and the insurance company. I further
declare that the payment of my premium is made from my own source. I understand and accept that the insurers
reserve the right to accept or reject a proposal at their discretion. I will give notice to the company of any change
in the information relating to the insured, as stated above.
Signature Date Location
Please note that we reserve the right to ask for any additional information, impose special terms or decline.
The liability of the Company does not commence until the acceptance of the Proposal has been intimated by the
Company or ofcial cover note issued.
Registered under UAE Federal Law No. (9) of 1984, Registration No. 65
Are you interested in a quote for any of the following personal insurances?
a) Unspecied Valuables
It covers personal items you can take outside home like expensive jewellery & other
personal effects. Please note maximum value of one item not to exceed AED 5,000/-
b) Specied Valuables
It covers clothing, valuables, personal effects, mobile phones, cameras, laptops and similar
personal equipment.
c) Sports Equipment & Accessories
It covers any accidental loss or damage to sport equipment & accessories owned by
any member of your household.
Proof of purchase / valuation is required for items under section VII (b) & (c) whose value is above AED 5,000.
At the time of issuance of the policy we will contact you to arrange for a copy of these documents.
d) Pedal Cycles & Accessories
It covers any accidental loss or damage to pedal cycles and accessories
owned by any member of your household.
If you have suffered any claim on the Personal Possessions, please provide details
including the Date of Loss as well as claim amount paid.
Do you require Workmen’s compensation for any domestic
staff under your sponsorship?
Unspecied Valuables Value
(in AED)
Specied Valuables Value
(in AED)
Sports Equipment Value
(in AED)
Pedal Cycles Value
(in AED)
Make Model Serial No.Value
Claim Amount (in AED)
No. of Staff YES NO
Travel Motor Golf Yacht Medical Personal Accident
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With a presence in over 130 countries and a total of over 20 million customers worldwide,
we’re one of the largest and most trusted names in insurance. And as we’re the longest
established insurer in the Middle East, you can rely on us for cover and service that
understands and suits you perfectly.
RSA Personal Insurance covers:
Motor Insurance, Travel Insurance, Yacht and Pleasure Craft Insurance, Medical Insurance,
Golf Insurance, Personal Accident Insurance
DubaiGround Floor, Ofce Court Building, Oud Metha Road
PO Box 28648 Dubai
Tel +971 4 302 9800 / 334 4474
Toll Free 800 RSA (772)
Fax +971 4 337 7230 / 334 8861
Email [email protected]
Abu DhabiSuite 2, Habib Bank Building, Hamdan Street
PO Box 646, Abu Dhabi
Tel +971 2 635 1800
Fax +971 2 635 1808
Email [email protected]
SharjahSuite 701, Al Mubarak Centre, Al Arouba Street
PO Box 3761, Sharjah Tel +971 6 563 1819
Fax +971 6 563 1850
Email [email protected]
For more information visit www.rsagroup.ae
For an online quote visit www.rsadirect.ae