Commercial & Contractor s Combined Risk Presentation General Details Once completed, save form and email to your local BDM or a member of the Commercial Combined team. Insured/Company name ERN Risk address Full business description Current insurer Inception date Target/Current premium Material Facts Year company established Max height Limit Max depth limit Any spraying on site Is full health & safety policy in force Are risk assessments undertaken Any work at hazardous locations Any previous company liquidised Any criminal conviction of directors Any previous insurance cancelled Premises Details (see back page for second premises) Premises number & address Age of premises Type of heating Construction/Composite panels in use Registered in England. 5604278 Authorised and regulated by the Financial Conduct Authority FCA Register number 460209
Floor construction Flat roof % Electrical certificate in force Security Details Alarm details (model/maintained) Metal roller shutter Metal bars CCTV Sums Insured - Property Damage Buildings DV Subsidence cover required Contents (machinery/plant/fixtures & fittings Stock Stock-in-open n-ferrous metals Computers All risks cover - other All risks - portable computers Stock - high risk Other Sums Insured - Business Interruption Indemnity period (12/24/36 months) Gross profit Increased cost of working Book debts Loss of rent Registered in England. 5604278 Authorised and regulated by the Financial Conduct Authority FCA Register number 460209
Sums Insured - Money During business hours (safe/transit) After business hours (locked safe) Sums Insured - Goods in Transit Annual carryings (own vehicles) Max one load (own vehicles) Annual carryings (hauliers) Max on load (hauliers) Annual carryings (post) Max one load (post) Employees Liability Wage Split Number of Staff Total Wage Roll Clerical staff Manual premises workers Woodworkers (premises) Heat work (premises) Manual work away UK Manual work overseas (please detail) Is heat used away from the premises (%) Public/Products Liability Limit of indemnity (1m/2m/5m/10m) Turnover UK Turnover USA Turnover Asia Turnover Rest of the World Registered in England. 5604278 Authorised and regulated by the Financial Conduct Authority FCA Register number 460209
Payments to bona fide contractors Contract All Risks Contract works value Own plant sums insured Hired in plant/hire charges Tools & business equipment Employees personal effects/tools Claims Please provide details and particulars of any loss, damage or injury sustained by you or others whether claimed for or not during the past five years in connection with the risk(s) to be insured (if none state NONE ) Date (specify premises) Brief Details Amount Paid Amount Outstanding Material Facts You have a duty to make a fair presentation of the risk which is covered by this policy. Therefore you should ensure that any information you have provided to us, and the content, is accurate and complete. If you do not comply with your duty to make a fair presentation of the risk, the policy may be voided. Declaration We declare that the information and statements provided above gives an accurate account of the risk in question, to the best of our knowledge. Broker s name Broker s position Registered in England. 5604278 Authorised and regulated by the Financial Conduct Authority FCA Register number 460209
Second Premises Details Premises number & address Age of premises Type of heating Construction/Composite panels in use Floor construction Flat roof % Electrical certificate in force Security Details Alarm details (model/maintained) Metal roller shutter Metal bars CCTV Sums Insured - Property Damage Buildings DV Subsidence cover required Contents (machinery/plant/fixtures & fittings Stock Stock-in-open n-ferrous metals Computers All risks cover - other All risks - portable computers Stock - high risk Other Registered in England. 5604278 Authorised and regulated by the Financial Conduct Authority FCA Register number 460209
Sums Insured - Business Interruption Indemnity period (12/24/36 months) Gross profit Increased cost of working Book debts Loss of rent Sums Insured - Money During business hours (safe/transit) After business hours (locked safe) Registered in England. 5604278 Authorised and regulated by the Financial Conduct Authority FCA Register number 460209