Quotation Request

Petrol Station Shop & Forecourt

Disclosure
Proposer Details
Premises
Cover Details
Risk Protections
Claims

Disclosure Statement:

When taking out insurance wholly or mainly for purposes related to your trade, business or profession, you have a duty under The Insurance Act 2015 to make a fair presentation of the risk. This means that you must disclose every material circumstance which you and/or your senior management and/or anyone responsible for arranging your insurance know or ought to know. Alternatively, you must disclose sufficient information which would put the insurer on notice that it needs to make further enquiries for the purpose of revealing those material circumstances. You are expected to carry out a reasonable search in order to make a fair presentation of the risk and will be deemed to know what should reasonably have been revealed by the search.

Your duty of fair presentation applies at the start of the policy, at renewal and when any variation of the policy is arranged. If you fail to make a fair presentation, the insurer may refuse to pay your claim or reduce the settlement amount, depending on the circumstances.

I have read this statement:

Neither the Proposer, nor any directors or partners in the business have ever:-
had an insurance contract cancelled by an insurer.
Please provide full details:
had an insurance contract declared void by an insurer.
Please provide full details:
had different terms applied to an insurance contract by an insurer due to misrepresentation by:

  • providing misleading or incorrect information

  • deliberately or recklessly withholding information

  • providing false documents

    • Please provide full details:
    had insurance cover restricted or cancelled due to non-compliance with risk improvement requirements.
    Please provide full details:
    been convicted of or charged with but not yet tried for a criminal offence other than motoring offences.
    NOTE: Spent convictions (as defined under the Rehabilitation of Offenders Act 1974 or any similar or subsequent legislation) do not need to be declared.
    Please provide full details:
    Health & Safety
    Neither the Proposer, nor any directors or partners in the business either personally or in connection with the business or in any other business capacity has ever been:-
    convicted of (or charged but not yet tried with) a breach of any UK health and safety legislation by any official body regulatory authority or enforcing authority.
    Please provide full details:
    served with a prohibition notice or improvement notice in connection with any UK health and safety legislation by any official body regulatory authority or enforcing authority.
    Please provide full details:
    served with a clean-up notice in connection with any UK health and safety legislation by any official body regulatory authority or enforcing authority.
    Please provide full details:
    All lifting plant and pressure vessels/boilers which are subject to Statutory Regulations are regularly inspected by qualified engineers as required by the legislation.
    To the best of their knowledge the proposer complies with their legal obligations under UK health and safety legislation.
    Financial
    Neither the Proposer, nor any directors or partners in the business or in the name of any other business which any of us had an interest have:-
    been declared bankrupt or insolvent either as private individuals or in connection with any business within the last ten years.
    Please provide full details:
    been disqualified from holding a directorship.
    Please provide full details:
    been the subject of a County Court Judgement (or the Scottish equivalents) in respect of debt as private individuals or in connection with any business within the last six years.
    Please provide full details:
    been a director or partner in a business that has been the subject of a County Court Judgement (or the Scottish equivalents) in respect of debt within the last six years.
    Please provide full details:
    been officers of a company that has been declared insolvent, or had a receiver or liquidator appointed, or entered into arrangements with creditors in accordance with the Insolvency Act 1986 within the last ten years.
    Please provide full details:

    Proposer Details

    Inception Date
    Proposers name and trading name in full
    i.e. Mr & Mrs John Smith t/as The White Horse
    Contact Name
    Date of Birth
    Contact Number
    Mobile Number
    Email Address
    Company Number
    Reason for being ERN Exempt:
    Is there a Third Party Interest to be Noted?
    Third Party Interest
    Risk Address
    Please give full details of any previous Ownership / Managerial experience with the same trade?

    Premises

    The Premises / Buildings of the Business being proposed:
    have walls built of brick, stone or concrete?
    Please provide full details:
    have a roof of slate, tile, metal or concrete, excluding any flat roof area?
    Please provide full details:
    Please advise construction:
    are in a good state of repair and kept in a like manner?
    have a listed status?
    What Grade?
    Please advise what year the premises was built:
    located in a shopping centre, arcade or mill complex?
    Please provide full details:
    i.e. what type of building, what floor, etc.
    trade all year round?
    Please provide full details:
    i.e. when is the business closed, does the owner/employee live on whilst the premises are closed, etc.
    are entirely self contained?
    i.e. with a separate lockable entrance and exit
    Please provide full details:
    are occupied solely by the business?
    What is the nature of the other business/businesses?
    have residential accommodation at the premises other than that which acts as the private dwelling of the proposer or their employees?
    Is residential accommodation let to Students, Asylum Seekers, Refugees or persons who receive Housing Benefits directly or indirectly?
    Please provide full details:
    i.e. who resides, is the lease directly with the tenant, etc.
    occupied by the proposer, or their employees, overnight?
    are free from storm exposure and/or are in an area which is free from flooding and at least 400 metres away from the nearest river, canal, lake or tidal waterway?
    Please provide full details:
    are free from, and in an area (within 400m of the premises) which is free from any signs of subsidence, heave and/or landslip?
    Please provide full details:
    i.e. when did the subsidence/landslip/heave occur, what has been done to the premises since, etc.
    had the Electrical Installation tested by a certified NICEIC, ELECSA or ECA Contractor within the last 5 years and all reported defects remedied?
    Is there an ATM on the premises?
    Is the management of the ATM your responsibility?
    What is the limit the ATM can hold at any one time?
    This amount needs to be included within the money limits if cover is required
    £
    Is the ATM bolted down?
    Is the ATM emptied every night?
    Is there CCTV covering the ATM?
    Is there an automated car wash on the premises?
    Has an open fire, woodburning or multifuel stove?

    Cover Details

    Buildings
    Day One Reinstatement Value
    Including substantial, structurally supported canopies; pumps; underground tanks etc.
    £
    Please provide full details:
    Loss of Rent Payable
    If Loss of Rent Receivable is required, please include in the Business Interruption figure
    £
    Tenants Improvements
    Including external signs, etc. for which the Insured is held legally responsible for
    £
    Trade Fixtures & Fittings, Machinery, Plant and all Other Contents (Ex. Stock in Trade)
    Including Property Held in Trust
    £
    Electronic Equipment & Computers (including EPOS systems and computerised tills)
    £
    Please provide full details:
    Stock

    Including Materials in Trade, the Property of the Insured or held in trust or commission for which the Insured is held legally responsible

    This includes all dry stock, frozen foods, soft drinks and beer

    £
    Stock of Fuel
    £
    Wines & Spirits
    £
    Is Loss of Licence cover required?
    Tobacco
    £
    Deterioration of Stock
    £
    Goods In Transit
    £
    Money During Business Hours and In Transit
    £
    Money in Locked Safe outside Business Hours
    £
    Business Interruption
    £
    Number of Employees
    Has a Health & Safety Risk Assessment of the premises been carried out?
    A formal procedure is to be established that periodically audits the effectiveness of the companies health and safety documentation and procedures against best practice and to ensure that it reflects the hazards and risks to which the organisation and its employees and visitors are exposed. Once reviewed the documents should be signed and dated by a director and brought to the attention of all employees on a signed receipt basis.
    Is there a Health & Safety Policy in place?
    Estimated Annual Turnover
    £
    Estimated Annual Wageroll
    £
    Employers' Liability is automatically included at £10,000,000
    Public and Products Liability is automatically included at £5,000,000
     

    Risk Protections

    Does the proposed premises comply with the minimum security requirements described below?

    While the insured premises is closed for business or left unattended you must ensure that the physical security measures at the insured premises comply with the following criteria and all security devices were in full and effective operation when the damage occurred:

    1. All doors, other than any designated fire exit, providing a final point of entrance to or exit from the insured premises are secured by a key operated lock which engages with the door frame and can be engaged from both sides.

    2. All designated fire exits are secured by:

    a. a panic bar locking system incorporating bolts which engage both the head and sill of the door frame; or

    b. a mortice lock having specific application for emergency exit doors and which is operated from the inside by means of a conventional handle or thumb turn mechanism.

    3. All windows and skylights which are accessible from the ground or easily reached by climbing are:

    a. secured by means of a key-operated locking device;

    b. permanently screwed shut; or

    c. protected by solid steel bars, not more than 10cm apart, or metal grilles.

    Please provide full details:
    i.e type of locks, how they don't comply, etc.
    Are the premises thoroughly protected by an intruder alarm system, under the sole control of the insured?
    What type of alarm is installed?
    Does the alarm have Police Response?
    Is the CCTV recordable?
    How many days are the CCTV recordings stored for?
    Are CCTV recordings kept offsite?
    Is the business open 24 hours?
    What time do you start and stop using the service hatch?
    Are there panic buttons installed?

    Claims

    Has the Proposer(s), Partner(s) or Directors(s) suffered a loss, claim or incident (which may give rise to a claim) at these premises, or any other premises, whether insured or not within the last 5 years?
    Please provide details:
    Date Type of ClaimDetails PaidReserveMeasures Taken
    Add row

    Additional Information

    Do you want to bring any further information to the underwriters attention?
    Please provide full details:
    Current Insurer
    Target Premium
    £
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