Machinery Breakdown LOP Quotation

Proposer Type

Proposer First Name

Proposer Middle Name

Proposer Last Name

Mobile No.

Email Address

Which Global Insurance branch do you want to be served from?

Note: Machinery Breakdown Policy is a pre-requisite for Machinery Breakdown – LOP policy.

Insurance Start Date

Insurance End Date

Gross Profits

Indemnity period(In months)

Annual Increased cost of electricity

Annual Maximum demand charges

Do you wish to include cover for business interruptions due to the failure of public supplies (power, water, gas)?

Limit of Indemnity/Cover Birr

Do you wish to include cover for Additional Expenditure other than Increase in Cost of Working?

A Lump Sum Payment of Birr

A Daily Limit of Birr

Do you require time excess?

Please select the period of time excess required

Note: Gross Profits = Operating Profits + standing charges for 12 successive months of business