Beruflich Dokumente
Kultur Dokumente
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
Roof/Others
No. of Storey
External Wall
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
( )Office Bldg. (Name) ___________________ ( ) School Bldg. (Name)Marcos Pre-Fabricated Sch. Bldg
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
( )Office Bldg. (Name) ___________________ ( ) School Bldg. (Name)Marcos Pre-Fabricated Sch. Bldg
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
( )Office Bldg. (Name) ___________________ ( ) School Bldg. (Name)Marcos Pre-Fabricated Sch. Bldg
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
( )Office Bldg. (Name) ___________________ ( ) School Bldg. (Name)DepED School Building (Standard)
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
( )Office Bldg. (Name) ___________________ ( ) School Bldg. (Name)Bagong Lipunan Sch. Bldg Type I
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
( )Office Bldg. (Name) ___________________ ( ) School Bldg. (Name)Bagong Lipunan Sch. Bldg Type I
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
( )Office Bldg. (Name) ___________________ ( ) School Bldg. (Name)Bagong Lipunan Sch. Bldg Type I
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
( )Office Bldg. (Name) ___________________ ( ) School Bldg. (Name)Bagong Lipunan Sch. Bldg Type I
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date
Address
San Jose, Catmon, Cebu
Type of Building:
( )RESIDENTIAL
( )COMMERCIAL
( ) INDUSTRIAL
( )OTHERS
( )Office Bldg. (Name) ___________________ ( ) School Bldg. (Name)DepED School Building (Standard)
Contents
Location
Block No.
Lot No.
No. of Storeys
1st Storey
2nd storey
3rd Storey
4th Storey
5th Storey
6th Storey
7th Storey
ROOF/
FLOOR
WALL
FRONT
RIGHT
LEFT
REAR
TO BE INSURED
FRONT
RIGHT
LEFT
REAR
IV. THERE IS A NIPA HOUSE WITHIN _________________ METERS AWAY FROM BUILDING TO BE INSURED
B. RISKS INSURED AGAINST:
( Please Check Preferences)
( ) Fire and Lightning
( ) EarthQuake-Fire
( ) Typhoon And/Or Flood
( ) Earthquake-Shock
( ) Unauthorized Dismantling
( ) Others(Specify)
IMPORTANT: Attach INVENTORY of Office Furniture/Fixtures/Equipments/Etc. At the back of this form, draw a SKETCH
of the Location of the Building proposed for coverage.
I hereby declare that the above particulars are complete
and true to the best of my knowledge and belief and
I agree that this Fire Insurance Applicant shall be the
basis of a contract between me and the GSIS.
_________________________________
______________________________
Signature
_________________________________
Head Office
Date
Signature
______________________________
Accountant/Treasurer
Date
Contact Number
+639215809138/+639173149394
Value
P
Value
P
Total
P
OCCUPIED AS
a SKETCH
_________________________
Signature
_________________________
countant/Treasurer
Date