Quotation Request

Property Owners

Disclosure
Proposer Details
Premises
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/or trading name in full
    Contact Name
    Date of Birth
    Contact Number
    Mobile Number
    Email Address
    Company Number
    Is the Proposer ERN exempt?
    UK businesses employing one or more people are required to have an ERN (Employer’s Reference Number, also commonly referred to to as the ‘Employer PAYE Reference’), which is a unique reference number for your employees’ income tax and national insurance contributions. You will find your ERN printed or written on mandatory documents including the P45, P60, P11/D and on most payslips. It looks something like this: NNN/Aznnnnn (maybe with up to 7 digits).
    Reason for being ERN Exempt:
    Is there a Third Party Interest to be Noted?
    Third Party Interest
    Correspondence Address

    Premises

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    Add another premises.... Add row
    Buildings Sum Insured - Total:
    Playing Surfaces, Artificial Surfaces and Floodlights - Total:
    Loss of Rent - Total:
    Landlords Contents - Total:
    Alternative Accomodation - Total:

    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:
    DateType of ClaimDetailsPaidReserveMeasures TakenWhich Address?
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    Additional Information

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