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Company Name :
Line of Business :
Office Telephone :
Mobile :
Fax :
E-Mail :
Tax Office :
Tax ID No :
TC Identity No find
If you are a Turkish Citizen
:
Address :
What is the position of the insured
Owner Lease Mortgage Other
Insured/Insuree :
Insured/Insuree Address :
 INSURANCE VALUE
Building (YTL) :
Machinery (YTL) :
Office Equipment (YTL) :
Contents (YTL) :
Vat Included (YTL) :
Safe (YTL) :
Glass (YTL) :
 Relating to Risk Information
1-) Building Type
Concrete Reinforced Brick Reinforced
Timber Reinforced
2-) State the requested risks’ business activity and field
3-) What is the type of the roof of your place ?
Steel Construction. Timber Framing Terrace Roof Other
4-) Did you have any claim in the last 5 years ?
Yes No
If yes why and when ?
5-) Is your premise in a business building ?
Yes No
6-) Any Stock Inside Building
Yes No
7-) The stocked merchandises'height from the ground ?
meter
8-) Have you ever been under flood ?
Yes No
9-) Define the area where your premises are.
On-Street Dwelling Locality Street Other   
 
 
10-) State the protection measurements taken towards theft.