Mall Tenant’s Insurance application form

Exact Location *

Trade Name: *

Nature of the Business: *

Area size in sqm: *

Owner's details:

Prefix

First Name *

Middle Name

Last Name *

Mobile Number *

Street Address *

Active Email Address *

Alternate Email Address

Owner's representative, if any:

Prefix

First Name

Middle Name

Last Name

Position

Phone

Active Email Address

Alternate Email Address

Choose a package *

Fire Insurance: Breakdown of Coverage

You've chosen Package 1 that has Php 100,000 Fire Insurance Coverage. Please split the said amount with categories as follows: (please be guided by the example given in the box)

Fire Insurance: Breakdown of Coverage

You've chosen Package 2 that has Php 500,000 Fire Insurance Coverage. Please split the said amount with categories as follows: (please be guided by the example given in the box)

Fire Insurance: Breakdown of Coverage

You've chosen Package 3 that has Php 1,000,000 Fire Insurance Coverage. Please split the said amount with categories as follows: (please be guided by the example given in the box)

Fire Insurance: Breakdown of Coverage

You've chosen Package 4 that has Php 1,500,000 Fire Insurance Coverage. Please split the said amount with categories as follows: (please be guided by the example given in the box)

Fire Insurance: Breakdown of Coverage

You've chosen Package 5 that has Php 2,000,000 Fire Insurance Coverage. Please split the said amount with categories as follows: (please be guided by the example given in the box)

Fire Insurance: Breakdown of Coverage

You've chosen Package 6 that has Php 2,500,000 Fire Insurance Coverage. Please split the said amount with categories as follows: (please be guided by the example given in the box)

Fire Insurance: Breakdown of Coverage

You've chosen Package 7 that has Php 3,000,000 Fire Insurance Coverage. Please split the said amount with categories as follows: (please be guided by the example given in the box)

Fire Insurance: Breakdown of Coverage

You've chosen Package 8 that has Php 5,000,000 Fire Insurance Coverage. Please split the said amount with categories as follows: (please be guided by the example given in the box)

Fire Insurance: Breakdown of Coverage

You've chosen Package 9 that has Php 10,000,000 Fire Insurance Coverage. Please split the said amount with categories as follows: (please be guided by the example given in the box)

Leasehold improvements *

Machineries *

Leasehold improvements *

Machineries *

Leasehold improvements *

Machineries *

Leasehold improvements *

Machineries *

Leasehold improvements *

Machineries *

Leasehold improvements *

Machineries *

Leasehold improvements *

Machineries *

Leasehold improvements *

Machineries *

Leasehold improvements *

Machineries *

Stocks *

Contents *

Stocks *

Contents *

Stocks *

Contents *

Stocks *

Contents *

Stocks *

Contents *

Stocks *

Contents *

Stocks *

Contents *

Stocks

Contents *

Stocks

Contents *

Others (Optional)

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