COMMERCIAL COMBINED PROPOSAL FORM

Transcription

1 COMMERCIAL COMBINED PROPOSAL FORM Incorporating Manufacturing Light Industrial High Risk Property Heavy Industrial Please answer all the following questions for each of the relevant sections as fully as possible. Incorrect answers or failure to disclose all material facts may render the insurance in-operative. Material facts are those which would influence acceptance or assessment of the insurance risk. If you are in doubt, please disclose them or seek assistance from your insurance representative. PROPOSERS DETAILS Proposer s Name: Trading Name (if different to above) Trading Address Town: County: Postcode: Business Description: (incl. details of Manufacturing processes) How Long Trading at 1) These Premises:..years 2) Other premises: years ABOUT THE BUILDINGS Are any part of the premises unoccupied If YES, please give full details.. Please give full description of the construction of the following: WALLS. ROOF.. FLOORS.. STAIRS... If flat roof, give percentage of total roof area, construction and age etc. Are the premises single or multi-tenure SINGLE / MULTI If Multi-tenure, please give details of other tenants etc Please indicate the type of area the premises are located in (please tick) Residential Commercial Industrial Rural How many storeys are there?. How old is the Building?. How are the premises heated? Do the premises have any undue exposure to Storm, Flood or Subsidence Is waste removed daily? Proximity to adjacent premises..

2 SECURITY / PROTECTIONS Are the premises protected by an alarm system If YES, pleas tick which one: Bells Only Central Station/Digicom Redcare Does it incorporate perimeter and space protection Is the Alarm Company who installed/maintain the system under contract with NACOSS Are the front doors protected by exterior locking metal roller shutters Are windows fitted with fixed internal / external metal bars or grilles Are rear or side doors fitted with 5 lever Mortice Deadlocks Are there other protections e.g. CCTV or Anti Ram Raid Bollards etc. (please advise) Proximity of Police Station to insured premises Is there a sprinkler system on the premises. If YES, please provide full details... Do you hold a current IEE Certificate If NO, are you prepared to obtain one Does the premises have a Fire Certificate Are Fire Extinguishers installed and maintained under contract Are Smoke Detectors fitted SECTION MATERIAL DAMAGE (Normally on a re-instatement basis): Fire, lightning, explosion, aircraft, earthquake, storm, tempest, flood, bursting/overflowing/water pipes/apparatus, riot, strikes, impact, theft (forcible, violent entry and/or exit), malicious damage. Cover is restricted if unoccupied. Are any of the following required: Accidental Damage Subsidence Sprinkler Leakage All Risks Full Terrorism (Please note: an additional premium may apply) Buildings including landlord s fixtures & fittings Tenants Improvements & interior decorations Glass consisting of External fixed glass Internal glass including showcases Countertops etc. Sanitary ware External signs, blinds & frontage Contents / Plant, Machinery etc. Stock comprising of Wines, Spirits & Tobacco Clothing (finished goods) Clothing (raw materials) Electrical goods Other stock (please advise). SECTION BUSINESS INTERRUPTION If Consequential Loss is required, the following details are required: Perils insured will follow those perils selected under Section A: Material Damage Gross Profit Sum Insured Additional Cost of Working Rent Receivable Indemnity Period. Extensions: Please tick if required providing Names / Addresses / %Age for Extensions 1 4 1) Suppliers. 2) Customers. 3) Outworkers. 4) Contract Sites. 5) Public Utilities. 6) Denial of access. 7) Murder/Suicide. 8) Contamination. (Note: This cover follows perils insured under Section Material Damage only. It does not follow any losses insured under the sections).

3 SECTION LOSS OF MONEY & PERSONAL ASSAULT Limits required for: During business hours & in transit In safe* outside business hours *Make & Model of Safe:... Out of hours & out of safe Estimated annual carryings Capital benefit Temporary total disablement weekly benefit Number of employees SECTION GOODS IN TRANSIT Transit by road own vehicles any one load No of vehicles.. Transit by road carriers vehicles any one load Transit by rail any one consignment Transit by post any one package Estimated Annual carryings SECTION BUSINESS EQUIPMENT Territorial Limits please delete as appropriate United Kingdom / United Kingdom & Europe / Worldwide Insured property Item 1. Unspecified machines (limit any one item.) Item 2. SECTION BOOK DEBTS Sum Insured required Are books and records kept in a fire resistant safe Are duplicate books & records kept away from the premises Perils insured will follow those perils selected under Section A: Material Damage If you require different perils to be insured under this section then please advise separately SECTION STOCK DETERIORATION FOLLOWING REFRIGERATION BREAKDOWN No of cabinets / Freezers. Sum Insured in each Age of Cabinets / Freezers. years Are the cabinets / Freezers subject to an annual maintenance agreement SPECIAL EXTENSION LOSS OF LICENCE Sum Insured required (being the description in value of the interest of the Insured in the premises by the forfeiture of or refusal to renew licence. Is there a special hours licence What is the renewal date.../.../... Has the licence been transferred during current licensing period Have there been any formal objections to the licence during the last 5 years If YES please give detail Have any of the present Partners, Principals, Directors or Managers been refused a licence at any time to operate this type of business How many incidents, if any have occurred during past three years resulting in police having to be called to the premises for any reason

4 SECTION LIABILITIES EMPLOYERS LIABILITY Employer Reference Number:... Estimated Wages & Salary: Clerical/Managerial Woodworking Work away Heat work away... Others (please detail).... Others (please detail).... PUBLIC / PRODUCTS* LIABILITY (*delete if not required) Limit of Indemnity required (please supply copy of brochure if applicable) Estimated Annual Turnover in United Kingdom Europe USA/Canada Elsewhere (please state)... PROPERTY OWNERS LIABILITY Is cover required If YES, please give Indemnity required

5 OTHER INFORMATION Has Insurance cover ever been declined, renewal refused, special conditions imposed, premium loaded and/or cover withdrawn? Have you or any director, partner or principal of the proposer during the last 5 years been the subject of a bankruptcy order or an individual voluntary arrangement with creditors or been a director of any company which has become insolvent during that time Have you or any director, partner or principal of the proposer during the last 5 years been charged with or convicted of any criminal offence? Have there been any claims, settled or not, in the past 5 years (in this or any other business) If YES, please advise: DETAIL COSTS IMPORTANT 1) All questions in the proposal form should be answered to the best of your knowledge and belief 2) You must disclose all material facts, Failure to do so may nullify the policy or certificate issued. (A material fact is one which is likely to influence the acceptance or assessment of this proposal form by Underwriters. If you are in doubt as to what constitutes a material fact please consult your insurance representative) 3) If you are unable to answer any question because it requires expert knowledge which you are unable to provide, please state so in your answer 4) Please note that where a sum insured is less than the full amount at risk, Underwriters liability will be limited to a proportional part of any loss Are there any circumstances not otherwise disclosed in answers to questions in this proposal form which would be material to the risk sought to be insured under this proposed insurance. If YES, please provide full details I/We declare that the above statements are true and full and that to the best of our knowledge and belief nothing materially affecting the risk has been concealed, and that the amount proposed of Insurance represents the full value of the property to be insured and I/We agree that this proposal form shall be the basis of the contract between Me/Us and the Underwriters/Insurers. Date: / / Signature of Proposer.