1.Full Name(s) of Company(ies).
Telephone Number:
3.Is the above address a
4.Website address
5.Business Description
6.Date business established
7.Date Insurance to commence
Note: This proposal is based on there being one location, if there are multiple locations to be insured please contact us
Property Damage, Money and Business Interruption – the levels of cover provided under this policy are as stated below, should you require a variation from these please contact Tour Indemnity
Business Interruption – we provide Increased Cost of Working as standard per Policy Summary but if you require cover for Gross Revenue protection or a higher limit under Increased Costs please contact us.
Employers Liability – cover is provided for £10,000,000 Limit of Indemnity as standard
Public & Products Liability – standard limit provided for £2,000,000
General
If ‘YES’, please provide full details below
Statement of Fact
Terms will be based on the information provided and therefore we require the Statement of Fact to be completed before a quotation can be released .You must declare that You (the Proposer) accept and comply, where applicable, with the following facts.
Have you or any partner, director or family member involved in the Business
Please confirm if the following apply and where the answer is NO please discuss with your broker or provide details in the Additional Information box provided at the end of this form.
Minimum Standard of Security
It is a minimum standard requirement that all Doors (whether external or to your internal perimeter) & accessible windows should be secured with appropriate locking mechanisms e.g 5 lever deadlocks conforming to BS 3621-2004 and key operated window locks or for aluminium or UPVC framed doors a cylinder operated mortice deadlock or a deadlocking multi-point locking system.
Any door or window officially designated a fire exit by the fire authority is excluded from these requirements.
Fire/Intruder alarms/detectors where applicable must remain operational and under a contract of maintenance.
All computer records should be backed up either on line or stored off-site.
Electronic equipment away from the premises should be prominently and permanently marked with the business address where such items have an individual replacement value of £1,000 or more.
Money kept on site is to be secured in a safe or strongroom built to a suitable strength for the value of Money kept within it.
Any Additional Information / Material Facts
CONTACT/ REPLY DETAILS.
Please give the details of the person who you wish to receive our quotation.
DECLARATION
I /We declare that :
To the best of my/our knowledge or belief, the statements and particulars given hereon are true and complete and that no material facts that are likely to influence the acceptance and assessment of this proposal and statement of fact have been withheld. (if you are in any doubt as to whether a fact is material, you should disclose it)
I/We agree to inform the Company immediately of any change to any material fact
I/We declare that if any information on this Proposal/Statement of Fact has been completed by another person on my/our behalf, that person acted as my/our agent for that purpose
I/We agree that this Declaration shall be the basis of the contract between me/us and the Company
Data Protection
Travelers Insurance Company Limited will collect certain information about individuals within or connected to your company and any subsidiaries ("data subjects") in the course of considering your application and, if we issue a policy, in conducting our relationship with you. This information will be processed for the purpose of underwriting your insurance coverage, managing any policy issued, providing risk management advice and administering claims. We may pass the information to our reinsurers, legal advisers, loss adjusters or agents for these and other purposes. This may involve its transfer to countries which do not have data protection laws.
Some of the information we collect may be classified as 'sensitive' - that is, information about disciplinary proceedings, convictions, sentences or alleged criminal activities. Data protection laws impose specific conditions in relation to sensitive information including, in some circumstances, the need to obtain the explicit consent of data subjects before we process the information.
Data subjects have a right of access to, and correction of, information that we hold about them. If they would like to exercise either of these rights, they should contact our Data Protection Compliance Officer at 60 Gracechurch Street, London, EC3V 0HR.
By signing this proposal form you confirm the consent of the data subjects to the processing and transfer of information (including sensitive information) described in this notice, and that you have taken all steps necessary to inform them of our processing and your disclosure of information to us for the purposes described above. Without this consent and your confirmation of these matters, we would not be able to consider your application.
I have read and understood the above declaration Type 'I AGREE' to confirm.
