The New India Assurance Company Limited 
                    Head Office: 87, M G Road, Fort, Mumbai-400001 
                  
                PROPOSAL FORM FOR CATTLE INSURANCE    
  (This proposal must be accompanied by a certificate given by a qualified Veterinary Surgeon)

		 BENEFITS OF THE POLICY

The Insured animals are covered against death by diseases contracted or occurring during the period of policy, or accident (including of fire, lightning, flood, inundation, storm, hurricane, earthquake, cyclone, tornado, tempest and famine) occurring anywhere in India or such other country or countries as the Company may agree to but excluding death directly or indirectly due to or resulting from:
1.	Malicious or willful injury or neglect, overloading, unskillful treatment or use of animal for purpose other than stated in the policy without the consent of the Company in writing.
2.	Accident occurring and/or diseases contracted prior to commencement of risk.
3.	Intentional slaughter of the animal except in cases whether destruction is necessary to terminate Incurable suffering on humane consideration on the basis of certificate issued by qualified veterinary surgeon or in cases where destruction is resorted to by order of lawfully constituted authority.
4.	Transport by air and sea.
5.	Rinderpest, Blackquarter, Haemorrhagie, Septicaemia, Anthrax and Food and Mouth disease. These diseases are covered by the policy if the animal is successfully inoculated and necessary vet. Certificate are supplied to the Company.
6.	Pleuroneumonia in respect of Cattle in Lakhimpur and Sibsagar District of Assam.
7.	Consequential loss of whatsoever nature.
8.	Theft or clandestine sale of the Insured animal.
9.	Partial Disability of any type, whether permanent or temporary.
10.	Permanent Total Disability which in the case of Milch Cattle results in permanent and total incapacity to conceive or yield milk, which in the case of Stud Bulls results in permanent and total incapacity for breeding purpose.
11.	War invasion, act of foreign enemy hostilities (whether declared or not) civil war, rebellion, revolution, insurrection, mutiny tumult, military or usurped power or any consequences thereof or attempt threat.
12.	The indemnity or compensation provided by this policy shall not apply to or nor include any accident, loss, destruction, damage or legal liability directly or indirectly caused by or contributed to by or arising from nuclear weapons materials.

1.	Name of Proposer(s): ______________________________________________ 

2.	Address: _________________________________________________________

3.	Occupation: ______________________________________________________

4.	Give the following particulars in full, of each of the animals proposed for Insurance:

Animal’s No or Mark and how identifiable 	Species and Breed	Sex, colour and full distinguishing
Mark (such as ear mark, soars etc)	Age in Years	Height	Date of purchase by the proposer and cost price to the proposer	Present
Market 
Value	Sum for which Insurance is required 	

5.	(a) State for what purpose the animal/s will be used: _________________________ 

(b) Number of calvings: ________________________________________________

(c) Date of last calving: ________________________________________________

(d) Location of the Farm of place where the animals are stabled: ________________

6.	(a) Where is/are animal/s stabled: _________________________________________

(b) Give full particulars of the construction of the stable: _______________________

(C) Is it under your sole occupation? If not, whose other: _____________________  
           animals are stabled in it?

7.	Is /are the animals in the stable sound & healthy & free from vice? ________________
If not, give full particulars of defects & ailments, if any__________________________

8.	Veterinary Services available:
(a)	Whether own veterinary services available or dependent on Government veterinary services______________________________________________
(b)	 Number of qualified veterinaries whether part-time or whole time or on retainer basis _________________________________________________________        
(c)	Veterinary services provided_______________________________________
(d)	Number of cattle covered by each veterinary surgeon___________________
(e)	Total area covered by each veterinary surgeon________________________
(f)	Distance from veterinary dispensary _______________________________
(g)	Annual budget sanction for drugs, vaccine, etc. for the entire dispensary_____
(h)	Storage conditions for drugs, vaccine etc. _____________________________
(i)	Details of veterinary check up that insured animal gets as part _____________
Of routine veterinary attention
9. (a) Have you lost any animal/s during the last three years? If so state particulars
      
Year	                Cause of Loss	 Number of animals lost	

(b) Previous Cattle Insurance Claims experience (for the last three years)
 
Year 	Policy No.	Name of the Insurer	Claim Amount 	Whether claim settled in full or part or outstanding or repudiated	

10. Have any of the animal/s proposed for insurance be a ill or incapacitated through injury/s during the past 12 months? If so, give particulars and state whether a Veterinary Surgeon was in attendance. _________________________________________________

11.	(a) How many other animals do you own? _________________________________
(b) Are they insured and where? ________________________________________
(c) If not, why are they not proposed for insurance now: ____________________
(d) Were they insured previously and if so, where? _________________________
        
12.	Are any of the animals now proposed for insurance or have any other animals
belonging to you have been previously insured? If so, state name of the Company or Underwriter: _________________________________________________________

13.	(a) What is the mode of branding /marketing the animals for the purpose of I 
         identification as  indicated under question (4) above? _______________________
       (b) Are the animals owned by the proposer but not proposed for insurance hereunder   
            also similarly branded/marketed? ______________________________________

14.	Has any Company or Underwriter
(a)	Declined Insurance of any of your animals, or _________________________
(b)	Refused to renew their insurance or _________________________________
(c)	Increased your premium or imposed special conditions on renewal _________

15.	For what period is insurance required? For _________ months from ______________

16.	(a) Are you the owner of the animal? If not state name and address of owner and also nature of your interest in the animal. _______________________________________
(b) Is any bank or other financing institution interested in the animals? If so, state (i) name and address of the bank (ii) amount of loan outstanding ___________________
(c) Is/are the animal/s proposed for insurance covered by SFDA/MFAL project. If so state: (i) Address of the SFDA/MFAL agency _________________________________ 
		 (ii) Amount of subsidy obtained from SFDA/MFAL agency __________________

I/WE hereby propose to insure the abovementioned animal/s owned by me/us with THE NEW INDIA ASSURANCE CO. LTD. subject to the terms, conditions and exclusions of the Company’s policy. I/WE warrant that the answers to the above queries are true and that all the animal/s are correctly described, are sound, in good health and free from vice and that they are and shall be used solely for the purpose above stated. I/WE declare that no information material to the insurance has been withheld and agree that this proposal shall be the basis of the contract between me/us and the Company.

Date: _______________     					____________________

Place: ______________					         Signature of the proposer

                             PROHIBITION OF REBATES:
        The following is an extract of Section 41 of Insurance Act,1938
1.	No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an Insurance in respect of any kind of risk relating to live or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown in the policy; nor shall any person taking out or renewing continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses of rebates of the Insurer.
2.	Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five hundred rupees.