Tour Indemnity

COMBINED LIABILITY INSURANCE PACKAGE
FOR TRAVEL AGENTS & TOUR OPERATORS
PROPOSAL FORM
GOLD LEVEL

All questions must be answered in full.

1. Full Name(s) of Company(ies).

2. Full Address including Post Code.

Telephone Number:

3. Is the above address a

Private Dwelling
Office establishment

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 – please state the levels of cover required in the boxes provided. Details of standard limits provided are found in the policy Summary attached. If higher limits are required please state below.
Standar Property Damage Deductible is £250 but £1,000 for Subsidence where provded and £100 Money.

8. Contents including Documents and Business Books
£
9. Tenants Improvements (not Buildings) £
10. Computer Equipment including records -
breakdown cover for Increased Cost only included		 £
11. Money in safe (£5,000 cover included as standard)
If more cover is required, please adjust amount 		£
12. Money in Transit/Bank Night Safe
(£5,000 cover included as standard)
If more cover is required, please adjust amount 		£
13. Are the premises Alarmed?
Yes No
If ‘YES’, please provide alarm/signalling type

14. Other security features

15. Are the premises in an area at risk of flood?
Yes No
If ‘YES’, please give details

Optional Extensions

Buildings Insurance

16. Buildings - sum insured
£
     - are the Buildings Listed
Yes No
17. Glass - sum insured (if higher than £2,500 limit)
£
     - are premises protected with metal roller shutters?
Yes No
18. Subsidence cover required
Yes No
     - Is there any history of subsidence?
Yes No

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 indicate below so that your quotation can be prepared on that basis.

19. Loss of Revenue £

20. Increased Cost of Working £

Optional Extensions to Business Interruotion

21. Book Debts (max £25,000) £

22. Infectious Disease (max £50,000) £

Employers Liability – cover is provided for £10,000,000 Limit of Indemnity as standard

23. Clerical wageroll (all office based) £

24. Do your employees undertake holiday
location reviews away from Business Premises ?
Yes No
If ‘YES’, please state
Wageroll (other activities)
£

Total number of Employees

How many employees work Away

Explain any other activities

Public & Products Liability – standard limit provided for £2,000,000

25. Limit of Indemnity required
(£2,000,000 cover included as standard)
If more cover is required, please adjust amount 		£

26. Estimated annual turnover (forthcoming year) £

General

27. Have you had any claims/accidents/incidents notified in the last 5 years for covers which are being requested hereon?
Yes No

If ‘YES’, please provide full details below

Date
Circumstances
Cost
Is it Settled or Outstanding?
/ /
£
/ /
£
/ /
£

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

a) ever been convicted of or charged (but not yet tried) with a criminal offence other than a motoring offence or ‘spent’ conviction as allowed for under the Rehabilitation of Offenders Act 1974
Yes No
b) ever been declared bankrupt, insolvent or disqualified from being a director of a company which went into liquidation, receivership or administration
Yes No
c) had any previous insurance proposals declined/special terms imposed or renewal refused or cancelled?
Yes No

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.

d) The business premises are fit for the purpose of the Business, in good state of repair, regularly maintained and of standard construction ie. Brick, Concrete, Stone, Slate or Tile or other non-combustible materials
Yes No
e) The business is UK domiciled
Yes No
f) All business activities are of a non manual nature
Yes No

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.

Full name. Email.

 

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

Full Name.
Position.
Date.

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.

 
Telephone: 0845 6021077, enquiries@tourindemnity.co.uk
© 2007 Tour Indemnity, all rights reserved. Design by Statusdesign.co.uk