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Nkorl Sample

This document is a declaration from a contractor to an insurance company regarding a construction project. It declares that there have been no losses on the project to date. It gives consent for a higher excess and excludes several risks, such as fire, floods, terrorism, and design defects, from insurance coverage. The contractor agrees to the terms and signs the document, declaring that all information provided is true and correct.

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1K views1 page

Nkorl Sample

This document is a declaration from a contractor to an insurance company regarding a construction project. It declares that there have been no losses on the project to date. It gives consent for a higher excess and excludes several risks, such as fire, floods, terrorism, and design defects, from insurance coverage. The contractor agrees to the terms and signs the document, declaring that all information provided is true and correct.

Uploaded by

JAHNVI
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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Date: Mention date

To,
M/s Shriram General Insurance Co. Ltd
Head office, Jaipur
Subject: - Declaration regarding NKORL (NOT KNOWN OR REPORTED LOSS) till date & consent for higher excess/
deductible.
Risk Location: (Mention complete Risk Location address)

Project Description: (Mention Project Description)

This refers to the project at Tendered Cost Rs. (Mention Sum Insured) /- inclusive of taxes, duties etc. undertaken by
M/S (Mention contractor name) on the following terms & conditions. We undertake & declare that there is Not Known
or reported loss/damages till date under above mentioned project undertaken by us.

Project Duration (Construction period):. 02/08/2010 TO 31/03/2014 (44 Months)), Not Liable Period: 02/08/2010 To
Premium deposit date

Further we undertake, agree and give our consent voluntarily for the following terms and conditions of the CAR Policy of
above said project. :-
 100 times Normal Excess – (Mention excess as per quote given).

 Exclusion –Fire, Storm Tempest Flood & Inundation, Terrorism Damage Exclusion Warranty, Water losses, Wet
risk, Riot, Strike and Malicious Damage (RSMD), Burglary, Theft, Impact Damage , Major Collapse/damages and
Breakdown are excluded from policy coverage

 Loss or damage due to faulty design, design defect, defective material or casting, bad workmanship, any faults in
project erection/construction are not covered under policy purview.

 Warranted that liability arising out of damage to the existing underground pipelines, underground cables are
excluded from the scope of cover.

 Warranted that Gap Period is not covered "Company is not liable for any loss from date of arrival of first
consignment/ date of start of work to actual date of collection of premium".

I hereby declare, agree and undertake that all information furnished above is true and correct and this consent is given
voluntarily.

Yours sincerely,

Need Insured sign & Stamp Here

Full name and signature of Contractor with office Seal/Stamp and Signature.

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