Proposer: (if not a limited company show the full names of all the principles and partners and any trading name. Show any subsidiary companies to be insured).

Type of Cover

If any further covers are required, please see APPENDIX at the end of this question set.

Business Speciality

Please indicate whether you are involved with any of the following vehicles and to what extent:

Construction & Security

1. Are your premises built only of brick, stone, concrete, concrete block or uninsulated metal cladding with slate or tile supported by timber framing, metal, asbestos or concrete roof?

2. Number of storeys?

1. Are your premises built only of brick, stone, concrete, concrete block or uninsulated metal cladding with slate or tile supported by timber framing, metal, asbestos or concrete roof?

4. Are the premises part or wholly unoccupied?

4. Are the premises part or wholly unoccupied?

6. Do you undertake Waste Removal from the Premises on at least a weekly basis?

7. Do you undertake appropriate Storage of Flammable Liquids and comply with Control of Substances Hazardous to Health (COSHH) regulations?

Alarm Details

8. Is there an intruder alarm installed at the premises?

9. Alarm installer and type of signalling:

10. Is the alarm maintained under contract?

11. Is the maintenance company National Security Inspectorate (NSI)/Security Systems and Alarms Inspection Board (SSAIB) approved?

12. Is there police response? If yes, what level?

13. Have you had an Electrical Installation check within the last 5 years?

14. How many Fire Extinguishing Appliances (FEAs) do you own?

15. Are the FEAs maintained under contract?

16. How are vehicle keys protected?

17. Please provide full security details (including fencing, security posts, walls, CCTV etc.):

18. Is subsidence, ground heave or landslip cover required?

If “Yes” to Q.18, please complete the following questions:

(a) Do the buildings at the premises or neighbouring buildings show any evidence of damage by these perils, such as cracking or bulging of wall?

(b) Have the buildings been erected on made up ground (such as filled pits, rubbish tips and the like)?

(c) Is there history of subsidence or ground heave or landslip in the area?

(d) When were premises last surveyed by an insurance company surveyor (please provide both month & year)?

(d) When were premises last surveyed by an insurance company surveyor (please provide both month & year)?

(d) When were premises last surveyed by an insurance company surveyor (please provide both month & year)?

Material Damage:

Property to be insured 

Buildings belonging to You or for which You are responsible including landlords fixtures and fittings, fixed glass, outbuildings, kiosks, canopies, fixed signs, wind turbines, solar panels (attached to buildings), walls, gates, fences, roads, car parks, yards, paved areas, pavements and footpaths and any mains services

Sum Insured:

Loss of rent receivable / payable:

Number of months

Tenants Improvements

Stock of in vehicle entertainment equipment (whether or not contained in vehicles), MP3 players and/or mobile phones in £

Stock of cigarettes, tobacco, CDs, DVDs, wines, spirits and/or clothing in £

All other Stock (Excluding vehicles / Including spare parts, fuel and oil stocks and materials in trade belonging to you or for which you are responsible) in £

Portable hand tools in £

Contents of customers’ vehicles or personal property in any other vehicle, whilst in your custody or control in £

Property whilst in transit

All other Property (Including fuel pumps, underground tanks and associated pipes and cables, machinery, plant and tools, office furniture, equipment and records) in £

Your own Vehicles in £

Customers Vehicles in £

Percentage of vehicles kept overnight:

Inside locked and secure buildings

Inside an enclosed and secure compound or yard

Elsewhere in the open

Money:

Money limits required:

Money on the premises during business hours or in transit or in a bank night safe:

Money locked in safe at business premises

Details of safe:

Make:

Model:

How is it secured?

Limit in £

Road Risks:

Driver Details

You must also disclose ALL driving convictions of any person likely to drive vehicles with your authority.

Please note you should provide full details of how the following conviction codes were obtained: AC, BA, DD, UT, XX, IN, DR, CD40 – CD71, MS50, TT99 (disqualification) NE99 (disqualification) or any offences or combination of offences resulting in a disqualification from driving or has a prosecution pending.

Convictions spent under the terms of the Rehabilitation of Offenders Act 1974, or any subsequent amendments, should not be disclosed.

Does any person likely to drive vehicles with your authority have of any disease or physical infirmity which impairs their ability to drive. If Yes, give details including terms or restrictions imposed on licence by DVLA.

The Fourth EU Motor Insurance Directive

The Fourth EU Motor Insurance Directive is designed to improve the claims process for EU citizens who are involved in motor accidents in other EU member countries. The principle requirement is that a claimant should be able to identify the relevant insurer from the vehicle registration mark. This may also help combat uninsured driving. 

In the UK this legislative requirement is met by the Motor Insurance Database (MID), which has been designed to provide a record of all Insured motor vehicles registered for use on the road.

WE REQUIRE ANY ADDITIONS OR VEHICLE ALTERATIONS TO BE NOTIFIED WITHIN 5 WORKING DAYS OF ANY CHANGES TAKING PLACE. PLEASE INDICATE YOUR PREFERRED NOTIFICATION METHOD FROM THE CHOICES BELOW:

Business Interruption

Employer’s Liability:

Public and Products Liability and Defective Workmanship:

Turnover:

Please provide details of how turnover will be derived for the coming year

General Information:

Have you or any director or partner ever been:

i) In respect of the business which is the subject of this quotation, or any other business which you, your partner(s) or director(s) have been involved with in condition that, no insurer has ever:-

Claims Experience:

Please detail any losses or claims incurred by your business within the last 3 years. A 3 year authenticated experience will be required from your previous Insurer(s).

Important: It is imperative all losses or claims (including losses where you did not make a claim) are detailed, even if subsequently declined by your previous insurers.

Material Facts

 Material facts are those which are likely to influence us in the acceptance or assessment of this proposal and it is essential that you disclose them. If you are in doubt about whether a fact is material, you should disclose it, since failure to do so could invalidate your policy.

It is important that you check all the information in the enclosed documents immediately. If there are any inaccuracies or omissions please advise your Insurance Adviser without delay. Any inaccuracies or omissions may invalidate the Insurance Contract from inception or result in a claim being repudiated.

Important – Your Records

We strongly recommend that you keep a record of all information you have provided to your Insurance Adviser.

Appendix

Additional Covers Required: please indicate by checking the appropriate box what cover is required

Engineering INSPECTION

MOT Loss of Licence:

Conversion:

Personal Accident:

Directors & Officers Liability (D&O):

Commercial Legal Expenses:

Your Legal Disputes History

Your Contract Circumstances

Your Employment Procedures

Do you have established policies and procedures, of which ALL employees are aware, for the following?

Your Health & Safety Circumstances