An insurance proposal form is a document which presents an insurance plan to a potential customer and has some questions which must be answered by the customer about himself and the asset to be insured. The purpose of an insurance proposal form is find out the risk associated with insuring that particular asset and then analysing whether this case will be profitable for the insurance firm or not. Depending on the responses of the customer, the firm can come up with a policy which will suit the requirements and also reach a profitable premium amount which has to b paid by the policyholder in return for getting his assets secured.

Sample Insurance Proposal Form:


Name of company to be insured: ________

Date when company was established: _________

Address: _________

Phone: ___________

Email ID: __________

Website: _____________

Please give full names and designations of owners and partners of the company.



Description of products and activities: ____________

Estimated annual turnover: __________

Previous year’s turnover: _________

Name and amount of last three big contracts: ____________

What is the average contract size? ___________

Mention the states where the company offers services. ___________

Name principal cities where the company has its centres. ____________

Give the name of present insurance policy and the policy number. _________

Are you going to renew the present policy or want to cancel it? Yes _____ No ________

Is the equipment in your factory regularly checked and inspected? Yes ____ No ______  How often? ______

The proposer agrees that the statements mentioned in the proposal are true.