Application for Annual Construction and Erection Works All Risk Insurance

Policyholder / Name of the company / First name, surname / Registry code / Personal identification code
Address (street, house, city, rural municipality, county, postal code)
Phone / E-mail
Year of establishment of the company / work experience in the field
Construction and erection works / The kind of construction works the company performs (including the percentages of various works)
Earlier major objects constructed (including the volume of construction works)
The company usually performs construction works
as the main contractor
as a subcontractor
Construction volumes of earlier periods
year euros
year euros
year euros
The largest cost of one construction work
euros
Estimated number of construction works to be performed
works per year
Liability insurance / Number of employees of the company
construction workers
project managers
administrative employees
Does the company use outsourced workers on construction works? (If so: how many and what type)
yes
no
Number of outsourced workers, type of work they are used for
Earlier losses / Loss events in the previous five years (description of the loss / reason for the loss / loss amount)
Insurance amounts / Property insurance / Insured object / Insurance amount (euros)
1. Construction and erection works
(estimated annual volume of construction works)
2. Tools
(hand tools, scaffolding and formwork)
3. Temporary structures
4. Office appliances and furniture
5. Plans and documents
6. Cleaning
7. Additional and overtime work
Flood insurance / yes no
Requested indemnity limit (€100,000-2,000,000)
Liability insurance / General liability insurance
Existing property
Cross-liability yes no
Insurance cover for vibration and removal of supports (liability) yes no
Liability insurance for maintenance period yes no
General contractor liability insurance (conditions no 124-130) yes no
Security on construction sites / Is the construction site hoarded: no yes
Does the site have manned security: no yes
Security provided by: own employee security company, name other
Specification or other security measures:
Manned security means a guard who has to ensure the immediate detection of a fire, the immediate detection of a third party entering or exiting the insured place or seizing property in the case of an offence, and that necessary measures are taken to prevent or reduce damage.
Deductible / Property insurance / 635 euros
955 euros
1600 euros
3 200 euros
Liability insurance / 635 euros
955 euros
1600 euros
3200 euros
Comments/special agreements (the length of the maintenance period)
Insurance conditions / Seesam Construction and Erection Works All Risk Insurance Conditions 1/2015 (effective as of 1 July 2015)
General Conditions 1/2008 (effective as of 1 July 2008) / Seesam does not provide immediate insurance cover (section 439 of the Law of Obligations Act)
Policyholder's signature / I have provided objective data for making the offer and I am aware of the consequences of providing false information. I have received and read the standard conditions applicable with respect to the insurance contract. The contents of the provisions set out in legislation with respect to personal data have been introduced to me and I am aware of them and consent to my personal data being processed. I undertake to immediately notify Seesam of any changes in material circumstances or personal data in a format which can be reproduced in writing.
Date of completing the application / Name of person completing the application / Policyholder's signature
Insurer / Seesam Insurance AS
Vambola 6, 10114 Tallinn, registry code 10055752
Phone 628 1800, e-mail
Receipt of the application by Seesam's representative / Name of Seesam representative who received the application / Date / Representative's signature