JEWELLERS' BLOCK POLICY PROPOSAL FORM

Transcription

1 JEWELLERS' BLOCK POLICY PROPOSAL FORM A separate Proposal Form must be completed for each premises. STATEMENT PURSUANT TO SECTION 16/4 OF THE INSURANCE ACT, You are to disclose in this proposal form, fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder may be void. Please reply fully to ALL the following questions. QUESTIONS ANSWERS 1. (a) Name of Proposer and Subsidiary and/or Affiliated Companies (in full) (a) (b) State address of the premises to which the Policy is to apply (b) (c) State the floor on which your premises are situated. (c) (d) How long have you carried on business? (d) 2. NATURE of your BUSINESS Retail % Wholesale % 3. EMPLOYEES (a) How many employees have you? (a) (b) What is the minimum number of employees including principals (b) in the sales section of your premises at any time during business hours, including lunch time? 4. VALUATION BASIS On what basis do you require claims to be settled? N.B. : Unless otherwise agreed on the Policy claims in respect of your own stock will be settled on the basis of COST price. All figures completed in this Proposal must reflect the basis of valuation required. 5. STOCK VALUES (i) What was the AVERAGE total value during the last twelve months of (i) (a) Your own stock? (a) (the stock figure is to be declared on the basis as in question 4 above) (b) Goods in trust (other than for safe custody) goods on approval, repairs and the like? TOTAL (b) The total under (a) and (b) comprises approximately Jewellery, gold and platinum goods, bullion, precious stones and pearls -1-

2 Watches Clocks, silverware, plateware, and other similar goods (ii) What was the MAXIMUM value of your own stock and goods in trust (ii) (other than for safe custody) at any time during the last twelve months? 6. VALUES OUT OF SAFE During temporary What will be the MAXIMUM VALUES of all watches, jewellery, gold, bullion Outside business closing e.g. and platinum goods, precious stones and pearls hours Lunch Time (INCLUDING THOSE IN WINDOWS) (if applicable) OUT OF LOCKED SAFE OR STRONGROOM? 7. WINDOW DISPLAY (A) How many (a) Windows facing thoroughfare? (a) (b) Inside windows? (b) (c) Inside showcases? (c) have you (B) Give MAXIMUM values which will not be exceeded of During business Outside business (i) Any one Hours Hours (a) window facing thoroughfare? (b) inside window (c) inside showcases (ii) Any one article (iii) Any one pad or tray of articles (iv) In all windows and showcases 8. OUTDOOR RISK (I) Give the following information in respect of all insured property (inclusive of amounts carried to and from Bank or Safe Deposit) carried outside the Proposer's premises stated in Question 1 (b) by yourselves, your representatives, travellers agents, messengers and delivery hands but NOT Brokers during the last 12 months. (a) In the City or Town in which the Proposer's No. of days Average Maximum properties are situated: each person Amount Amount per annum each each (b) Names of all principals, respresentatives, travellers and agents. (a) Number of Messengers and delivery hands.... (b) Elsewhere (state Countries in each case): No. of days Average Maximum Singapore each person Amount Amount Names of all principals, representatives, travellers per annum each each and agents. -2-

3 (II) HOME RISK Does any Principal, Employee, Traveller or Agent take Stock to his private residence for any purpose? If so, please give following information:- Name Address Maximum value Full details of Is the property ever taken Safe or any other left unattended at the protection Private Dwelling House (III) ENTRUSTMENTS What was the estimated value entrusted to dealers, customers, repairers cutters and brokers during the past 12 months? (a) (b) (IV) SENDINGS What was the AGGREGATE By Registered By Registered By Other Air By Ordinary TOTAL value of all insured Post Air Mail Conveyances Post, Rail, Steamer property sent during the past and other 12 months? Conveyances (a) (b) in the country in which the Proposer's premises are situated? elsewhere (state countries and values sent to each)? N.B. : The Policy contains a condition that postal sendings containing jewellery, precious stones, precious metals and/or watches and/or bank notes and/or coins exceeding any one package are sent by registered letter post or equivalent airmail service. (V) EXHIBITIONS and DISPLAYS (a) Did you during the past 12 months exhibit any portion of your stock at (a) any Exhibition, other than one promoted or financially assisted by any Public Authority or by any Trade Association, or entrust goods for any display or performance? If so, give full particulars including values. (b) Do you exhibit goods, in any showcase in any hotel, club or elsewhere (b) away from your premises? If so, give full particulars including values and details of protections (i.e. type fo glass, locks and the like) (c) OUTSIDE LIMIT (which also includes Sendings) What limit is required for any one loss for property elsewhere than at the Proposer's premises stated in Question 1 (b)? (This limit will NOT apply to property in any safe deposit vault or bank vault). GENERAL PROTECTIONS OF THE PREMISES PROTECTIONS 9. Are the premises occupied at night (a) by Proposer (a) (b) by employee or caretaker (b) -3-

4 10. Are there any openings leading to cellar or basement from outside the shop? If so, please give the details and protections. 11. Give details of the following and how they are protected: (a) each outer door (a) (b) each inner door (b) (c) all windows other than Display Windows (c) - (d) all skylights or fanlights or roof openings (d) DISPLAY WINDOW AND SHOWCASE PROTECTIONS (a) Give full details of the type of glass in all your (i) Display windows facing thoroughfare (a) (i) (ii) lnside windows (ii) (iii) Inside showcases (iii) (b) (i) What procedures do you take to protect the rear of your display (b) (i) windows facing thoroughfare? (ii) Are they kept permanently locked and keys removed? (ii) (iii) What precautions do you take to protect the opening of your (iii) inside windows? (iv) Are inside windows similarly locked and keys removed? (iv) (v) What precautions do you take to protect the opening of your (v) inside showcases? (vi) Are inside showcases similarly locked and keys removed? (vi) (c) AT NIGHT and at all other times when premises are not open for business. (i) Are all display windows facing thoroughfare protected externally (c) (i) by either shutters or by a grille? (ii) Give full particualrs of such protections and state how they are secured. (ii) (iii) Does this protection cover the entire front of your premises? (iii) (iv) If not, give details. (iv) (d) DURING BUSINESS HOURS Are all your display windows facing thoroughfare, inside windows, and/or inside showcases containing jewellery, gold, silver, platium, pearls and precious stones and watches protected internally either by:- (i) Fixed grilles covering the whole of the display? (d) (i) Give specifications details or (ii) Any other form of recognised protection? If so give specification (ii) details -4-

5 13. BURGLAR ALARMS (a) Is there a Burglar Alarm? (a) (b) If so, state name and forward copy of maker's specification to the (b) Company (or if not available give full details). (c) Are holdup/panic buttons incorporated in the system? (c) (d) Is the system maintained under contract? (d) 14. SAFES (a) Give the maker's name of safe, cost when purchased (state whether (a) new of second-hand) and give details f any descriptive markings on the door. (b) Approximate size and weight. (b) Size Weight (c) Approximate age. (c) (d) Whether illuminated and visible from the street at night? (d) 15. STRONG ROOMS (a) Is there a Strong Room? (a) (b) If so, give full details. (b) 16. Are all the keys (including your Alarm, Safe and Strong Room keys) removed from the premises outside business hours? 17. Are there any other special means of protection? If so, give details. 18. STOCK RECORDS (a) When was your last annual stocktaking? (a) (b) Do you keep proper records of all sales purchases and (b) transactions? 19. LOSSES Has the proposer, or any other person where property is to be insured hereunder, sustained any loss or damage during the last five years which would have been covered by this type of insurance had it been in force? If yes, state (a) Approximate date of each loss or damage (a) (b) Circumstances and amount thereof, and (b) (c) With whom the property was insured (c) (d) If insured, whether claim was paid in full or otherwise (d) 20. RECEIPTS (a) (b) Is it your practice to give receipts for goods left with you by non-trace customers, for repair, valuation, sale, or any other purpose and to require surrender of such receipts before goods are returned to the customer? Do you use entrustment/approbation notes in respect of all entrustments making the recipient responsible for the goods until return to you? 21. CONTENTS FIRE RATE (a) What is the Fire insurance rate on the contents of your premises? (b) By whom was this quoted? -5-

6 22. SUM INSURED For what amount is Policy required? (a) On Stock (including goods in trust) (a) (b) On Trade and Office Furniture, Fixtures and Fittings, Machinery, (b) Plant, Safes, Alarm Systems, Tenants decoration and improvements and all other Contents (except your stock and goods in trust) at your premises against the risks of Fire, Lightning, Explosion, Aircraft, Burglary or Theft or any attempt thereat, Storm, Tempest, Flood or bursting or Overflowing or Leakage of Water Pipes of Apparatus, or Impact by any road vehicle, horse or cattle not belonging to or under your control. TOTAL 23. REFERENCES Unless proposing for renewal, give two reference FROM YOUR TRADE. 24. OTHER INSURANCE (a) Has any Insurer ever cancelled or refused to issue or to continue (a) any Insurance for you? (b) Have you previously been insured? If so, state with whom, risks (b) covered and for what amount. 25. Are there any other circumstances within your knowledge or opinion not already disclosed, affecting or likely to affect the proposed insurance? -6-

7 To the best of my/our knowledge and belief the information provided in connection with this proposal, whether in my/our own hand or not, is true and I/we have not withheld any material facts. I/we understand that non-disclosure or misrepresentation of a material fact will entitle the Company to void the insurance. (N.B. A material fact is one likely to influence acceptance or a assessment of this proposal by the Company. If you are in any doubt as to what constitutes a material fact you should consult your Broker/Agent). I/we understand that the signing of this proposal does not bind me/us to complete the insurance but agree that, should a contract of insurance be concluded, this proposal and the statements made therein shall form the basis of the contract. I/we agree that if this insurance is completed the protection and/or safeguards mentined above shall not be withdrawn or varied to the detriment of the interests of the Company without their consent. Date: Signature of Proposer Name and Position STATEMENT PURSUANT TO SECTION 16(4) OF THE INSURANCE ACT 1966 Your are to disclose in this proposal form, fully and faithfully all the facts which you know or ought to know othewise the policy issued hereunder may be void. For Office Use Only: -7-

8 Jewellers Block Insurance SUPPLEMENTARY PROPOSAL FORM 1 Watches In addition to the information supplied in the main proposal form, what is the maximum value of the watches during the last 12 months (a) Please give details of the make of watches stocked? (b) What was the maximum value of any one watch stocked? 2 Security Protections (a) Is the alarm system connected to a 24 hour manned control room? Yes No (b) Are the internal showcases fitted with protective screens restricting access to one hand only Yes No (c) Are the premises covered with cctv with a video recording facility Yes No (d) Is there a separate office where staff can oversee the shop without being exposed to offenders and could safely activate the alarm system and/or summon the police? Yes No (e) How close are the premises to the nearest police station? minutes (f) Do the display windows allow passers-by a view of the shop interior? Yes No (g) Please indicate how access to the premises is controlled during business hours by choosing the option which most accurately reflects your protection No door/open fronted shop Door with no entry control Single leaf door with buzzer or other entry control Double door interlocking system Proposer's name Date: Signature: