| Type of Insurance Required |
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Trade & Services Insurance Quote |
Policyholder One Full Name: |
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| Policyholder One Date of Birth: |
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| Policyholder One Occupation: |
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| Policyholder Two Full Name: |
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| Policyholder Two Date of Birth: |
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| Policyholder Two Occupation: |
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| Postal Address: |
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| Telephone (Home): |
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| Telephone (Work): |
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| Telephone (Mobile): |
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| Email Address: |
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Describe your business in full:
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How many years have you been:
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In this business
years
Similar business
years |
Interested parties in your tools of trade and office contents: |
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Interested parties’ address:
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Do you maintain detailed records of purchases & sales:
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General Propery Part A: Accidental Damage & Fire (Any sudden of unexpected or unforseen occurrence not otherwise expected.) |
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Sum Insured |
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Sum Insured
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Sum Insured
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Sum Insured
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General Propery Part B: Restricted Cover (1. Fire [whether resulting from explosion or otherwise],
2. Collision and/or overturning of the conveying vehicle,
3. Flood) |
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Unspecified items or tools relating to your trade of profession (excluding mobile phones, photographic equipment & computer equipment).
Sum Insured
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Sum Insured
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Sum Insured
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Sum Insured
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Sum Insured
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Stock in trade (including customers’ goods & items held in trust of on commission) Sum Insured
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Office contents
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Sum Insured
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Limit of Indemnity Required: |
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Business Turnover: |
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Annual Turnover |
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Number of Staff (inc proprietors) |
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Annual Wages |
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Professional or Other Services:
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Do you provide any professional, technical, consultancy, advisory or like services either for a fee or as an ancillary service to your business?
If ‘yes’, give details of such services and to whom such services are offered.
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Description of Contractual Liability Exposure:
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Have you assumed any obligations under any contracts of agreements, including hold harmless of indemnification agreements? If ‘yes’ and you require cover for any such contracts or agreements, list below.
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Optional Extension: property in your physical or legal control:
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Indemnity Required: $
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(i) List all non-owned premises, e.g. real property occupied under lease of rental agreements: |
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| (ii) List all property of other in your care, physical or legal control (include details of all goods, merchandise of equipment being leased, repaired, serviced, treated or on consignment of bailment): |
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| Have any hold harmless or indemnification agreements been executed which relate to the destruction of or damage to the property listed above.
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| Does any other person (financier, lessor etc) have any interest in the property and/or goods stated in a) above?
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Products Liability: Describe fully the types of products manufactured, sold, handled, treated, hired out and/or the type of services that are performed for others. |
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Do you design parts of completed components for others?
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Do you manufacture to the designs, formulae, plans and/or specifications of others?
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Have product brochures been published?
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IMPORTS: Supply details of all imported goods, including the use of such goods and the country(s) origin.
Include the percentage of turnover derived from such goods:
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Previous History: |
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