* This form consists of three pages Serial No......................... Policy No................................ KERALA STATE INSURANCE DEPARTMENT MARINE HULL PROPOSAL FORM Proposer's (Owner's) Name ............................................................................................................ Address............................................................................................................................................. .............................................................................................................................................................. Name of vessel Type of vessel Name of Builders Palce where built Year of Purchase Price paid by Proposer ance Gross Reg: Tonnage Material of which built Registered Registered Registers Length Breadth Depth Draft If built of wood state Year in whether copper- sheathed which built or not Present Estimated Value of Amount proposed for Insur- Hull Machinery Hull Machinery Port of Registry Name of Registration /Authority Number of Registration By whom where and Certificate when was the Vessel last surveyed 1. Is the vessel classed with a recognized classification society? If, so, State Symbols assigned. ................................................................ 2. Is the vessel licensed or approved by any local authority ? If so, please give full particulars. ................................................................ 3. Is the vessel equipped with (a) Windglass ? (a) ................................................................ (b) Rubbing Bands ? (b) ................................................................ (c) Fire Fighting Appliances? (State type) (c) ................................................................ 4. Is the vessel covered in forward, Aft and Round Sides? ................................................................ 5. State the cruising speed of the vessel ................................................................ 6. State the reason for the diference between the ................................................................ purchase price and the amount proposed for insurance ................................................................ PARTICULARS OF ENGINE?MACH INERY Maker's Name Type of Engine Fuel used & quantity on board Is Reverse Gear provided? No. of propollers Horse Power No. of Cylinders Type of Engine No and Casing PARTICULARS RELATING TO EMPLOYMENT OF THE VESSEL : 1. For what purpose is the vessel used ? ........................................................................ If the vessel is trading, give full particulars ........................................................................ of the trade engaged in. 2. For what geographical limits is insurance required ? NB:-As the insurance of the vessel will ........................................................................ be restricted to the above geographical ........................................................................ limits, it is important to state your ........................................................................ requirement clearly. 3. Will the vessel be laid-up during the South-West or North-East Monsoon ? If so, (a) Where it will be laid up. (a) ........................................................................ (b) Period for which it will be laid up. (b) ........................................................................ 4. Does the vessel ever undertake any towage? ........................................................................ If so, please attach form used by you laying down conditions on which towage is accepted ........................................................................ Particulars of Master and Crew : 1. (a) Is the vessel in charge of a qualified master? (a) ....................................................................... (b) State his qualification (b) ....................................................................... (c) How long has been your employepe ? (c) ....................................................................... (d) Will he live abheoad the vessel? (d) ....................................................................... (e) If not in charge of a qualified master state brief details of the person who will be in charge of the vessel. (e) ....................................................................... 2. What is the total number of crew on board the vessel GENERAL : 1. (a) What accidents have happened during the past three years to any vessel owned by you? (a) (b) If any, which of them have occoured in ....................................................................... connection with the vessel herein proposed ? (b) 2. Has any Company or Insurer in respect of any of the risk to which this proposal applies : (a) Declined to insure you ? (a) ....................................................................... (b) Refused to renew your Insurance ? (b) ....................................................................... (c) Increased your premium on renewal ? (c) ....................................................................... 3. Is the vessel at present insured with any other ....................................................................... insurer ? If so, please give name of the insurer ....................................................................... and breif details of the cover. 4. State the risks against which you wish to ....................................................................... insure the vessel. ....................................................................... 5. For what period or voyage is the insurance From required ....................................................................... To I / We the undersigned, hereby declare that the above statements and particulars are true and complete, and further declare that I/We have not withheld any information which is calculated to influence the decision of the Government in accepting the insurance, and agree that this declaration shall be the basis of the contract between me/us and the Governor of Kerala (herein referred to us ''The Government''). Dated at ................................. this........................dayProposer's Signature.............................. of ...................................20............ The liability of Department does not commence until the acceptance of the proposal has been formally intimated by the State Insurance Department. Section 41 of the Insurance Act, 1938, which is in force from the 1st July 1939, reads as follows : (1) No person shall allow or offer to allow, either directly, or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer. (2) Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five hundred rupees. The offer, payment or acceptance of a rebate of the premium hereunder is therefore a Breach of the Law
