IMD No: ___________________________

Wedding Insurance Package Policy – Proposal Form

Name of the Insured: _______________________________________________

Address of the Insured: _____________________________________________

Pin code: _________________ Tel: STD________ Tel: _____________

Mobile: ____________________ Tel: STD________ Tel: _____________

Wedding Date: ________________ Time of Mahurat: ______________________

Is the date on any public holiday, death anniversary, birth anniversary of any
politically influential person (dead or
alive):______________________________________

Have the cards been printed: Yes / No if Yes pl. attach one __________________

How many people are invited for the function: ___________________

Full Name of the Bride: ______________________________Age: _______

Full Name of the Groom: ______________________________Age: ______

Names of Blood Relations

1. Father of the Bride
2. Mother of the Bride
3. Father of the Groom
4. Mother of the Groom
5. Sister of the Groom
6. Sister of the Groom
7. Sister of the Groom
8. Brother of the Groom
9. Brother of the Groom
10. Brother of the Groom
11. Sister of the Bride
12. Sister of the Bride
13. Sister of the Bride
14. Brother of the Bride
15. Brother of the Bride
16. Brother of the Bride
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____
:______________________________Age:____

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 Is any one in above list seriously ill / in hospital / has a known medical
problem.

Venue of the Wedding (Address):

__________________________________________________________________

Tel: STD________ Tel: _____________

Is the venue an official regular location: Yes / No.

If No then pl. describe the

venue:____________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Any known hazards at / surrounding the venue:(eg: sensitive area, high rise
location etc.)
1)________________________________________________________________
2)________________________________________________________________
3)________________________________________________________________
4)________________________________________________________________

Is the venue being officially booked and the advances paid: Yes / No

How Much percentage:________ Amount: Rs._____________________/-

Indoors
Outdoors (If outdoors is there any provision made for a waterproof cover)

Fire fighting equipments at the venue:

1.
2.
3.
4.
5.
Emergency escape exits: Yes / No How many?

Security arrangement: Yes / No How Many?

Is there going to be any cooking at the venue?

Yes / No

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If Yes -> Is it in a separate identified enclosure or within the same enclosure.

Safety Precautions:
1.
2.
3.
4.
5.

Is the Residence of the insured & venue of the wedding going to be

decorated?

If yes pl. give break up of the costs involved: Residence

a) Lighting and related equipments: Rs._______________
b) Mandap / Tents: Rs._______________
c) Sets & decorations: Rs._______________
d) Others: Rs._______________
Total Rs._______________

If yes pl. give break up of the costs involved: Venue

a) Lighting and related equipments: Rs._______________
b) Mandap / Tents: Rs._______________
c) Sets & decorations: Rs._______________
d) Others: Rs._______________
Total Rs._______________

*These charges are a max. of the Sum Insured you choose i.e. Rs.2 / 4 / 8 / 10 Lacs.
** Proof of expenses is required during claim

Please provide break up to the cost of the Wedding as under:

a) Card Printing & Postage / Courier Rs._______________

b) Catering charges Rs._______________
c) Venue charges Rs._______________
d) Music / Decoration & Mandap Charges Rs._______________
e) Hotel rooms & lodging charges Rs._______________
f) Transportation & Travel charges Rs._______________
g) Any other charges Rs._______________
Total Rs.________________
*These charges are a max. of the Sum Insured you choose i.e. Rs.2 / 4 / 8 / 10 Lacs.
** Proof of expenses is required during claim

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Are any Jewelry, precious, money, metal & stones and expensive appliance given
to the bride or groom (only of the insured’s and not of the in laws to be) which is
kept / stored at the insured’s residence.

If yes,
a) Please provide detailed description along with a valuation certificate and if
possible a photograph of the items.
b) Is it stored in a safe or a locker in the residence?
YES / NO if no then what arrangement is made
c) Is there security arrangement at the residence?
YES / NO if no then what arrangement is made

 Cover Opted for

Option 1 ____ Option 2 ____ Option 3 ______ Option 4 ______

# All the above matter is true to the best of my knowledge and any
misinformation can result in material default resulting in cancellation of the
policy.

Name of the Insured :

Signature :

Date:

Place:

# Insurance is a subject matter of solicitation

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 Wedding Insurance
OPTION 1 OPTION 2 OPTION 3 OPTION 4
Sec.Coverage Sum Insured 1 Sum Insured 2 Sum Insured 3 Sum Insured 4 Excess
2 % of the claim
amount , subject to
I Wedding Cancellation / Postponement 200,000 400,000 600,000 800,000 a min. Rs.15,000/-

Due to Fire & Allied perils, Accident to Bride /

Groom, Accident in Blood relations - resulting
in hospitalisation -within 7 days to the printed
declared wedding date.Damage to the
insured's property / venue due to fire & allied
perils.RSMD - to the venue.
(Address's to be declared; names of
relatives; bride & groom; wedding card /date
)

Expenses on the folowing things will be

covered: A) Printing of Cards,B) Advances
given to venue C) Advances given to
caterer.D)Advances to Decorations, music
etc.E) Advance given to hotel room bookings
/ travel bookings.Subject to a max. of SUM
INSURED, (Proof of expenditure is
required )

1 % of the claim
amount , subject to
II Damage to Property * 200,000 400,000 800,000 1,000,000 a min. Rs.10,000/-
Std. Fire & Allied Perils
Can include: Residence decoration, hired
venue, sets, decoration
(SI, break-up req.)

III Personal Accident 200,000 400,000 800,000 1,000,000

(Wider Cover + 25 % Med Ext. to Named
People, incl. Blood relations, relatives,)
(Names to declared)

1 % Of the calim
amount, min. of Rs.
IV Money 200,000 400,000 800,000 1,000,000 10,000/-
Money in safe

2 % of the claim
amount , subject to
V Bruglary 200,000 300,000 500,000 700,000 a min. Rs.15,000/-
(Jwellery; precious mentals&stones,
appliances - given by Blood Relations & In-
laws)
(Valuation certificates, bills etc. needed)

For Property: 2 % of
the claim amount ,
subject to a min.
VI Public Liability 1,000,000 1,500,000 2,000,000 2,500,000 Rs.15,000/-
To Person / Property: due to food
poisioning;accidents at the venue, damage to
venue)

TOTAL INR 2,000,000 INR 3,400,000 INR 5,500,000 INR 7,000,000

Net Premium With Tax INR 3,770 INR 6,824 INR 11,057 INR 14,276

* These are section are compulsary

# Blood Relation is defined as : Parents ,Brothers, Sisters of the Bride or Groom .
(Age Limit for this cover is till age 70 yrs only)

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