Commercial Property, Fire & Perils Proposal Commercial Property Insurance Standard Fire & Perils Proposal Form
Commercial Fire Insurance PLEASE ANSWER ALL QUESTIONS FULLY AND ACCURATELY AS FAILURE TO DO SO MAY RENDER YOUR POLICY VOID. Proposal Form 1. Name of Proposer: 2. Postal Address: 3. Address of Property to be insured, if different from above ( the premises ): 4. Occupation, Trade, Business (Describe fully): 5. Currency in which policy to be issued: EUR IR STG 6. Date on which cover is to commence: General Details 1. How long have you been in business (a) (b) at the premises elsewhere. 2. Have you been previously insured in respect of any of the risks to which this proposal relates at the premises or elsewhere? If yes, give details including Name of Insurer and policy number, if known. 3. Has any Insurer in respect of any risk to which this proposal relates at the premises or elsewhere ever declined a proposal, refused renewal, terminated an Insurance or imposed special terms? If yes give details. 08 PRO 03.08
General Details continued 4. Have any losses or claims arisen in respect of any risk to which this proposal relates at the premises or elsewhere whether Insured or not? If yes, give details of them below: Year Cause of Loss Was Loss Insured / Number Amount 5. Please give details of the building s: (a) Construction: Walls Roof Floors (b) (c) Heating Fire Extinguishing Appliances. 6. In what year were the premises concerned built? Year 7. Are the premises occupied solely by you? If no please give details of occupations by other tenants 8. Are the Premises occupied at Night? If yes please give details. 9. Should the policy note the interest in the property of any parties other than the Proposer? If yes please give details, including address. 10.Name and address of your Auditors?
A. Property Property to be insured A separate sum must be given for each building and its contents (Use separate sheet if necessary). Item 1. The Building including Landlords fixtures and fittings together with boundary walls, gates and fences. See te 1 Property Damage. 2. Decorations and improvements for which the Proposer is responsible as tenant. 3. Months rent on the Buildings. 4. Machinery Plant & All Other Contents the Proposers own and those held in trust for which he is responsible other than separately specified. See te 3 Property Damage. 5. Stock and Materials in trade the Proposers own and those held in trust for which he is responsible. 6. Stock Debris Removal. TOTAL Sum Insured For Fire & Other Damage (full reinstatement value) See te 2 Property Damage B. Business Interruption Item 1 Earnings of the Business including Payroll (Salaries and Wages) See tes 1 & 2 Business Interruption. Please select definition of Earnings to be used See te 3 Business Interruption. A B C D E F If definition A chosen, please list Specified Working Expenses: Item 2 Additional Expenses: Please indemnity period required See te 2 Financial Loss. 12 months 18 months 24 months Please additional extensions required. Suppliers Premises Electrical, Gas or Water Supplies Denial of Access Key Customers Premises Transit Infectious Diseases, Murder, Suicide & Food Poisoning
C. Book Debts Sum to be insured on Outstanding Debit Balance: Are records stored in Fire Resisting safes, strongroom or cabinets If yes please give details. Are Duplicate Records maintained? If yes please detail where located. Perils to be Insured Against (Please your requirements) A. Property will be covered for loss or damage by the perils selected B. Business Interruption and C. Loss of Book Debts will be covered if due to loss or damage by the same selected perils to Property at the premises. If you wish more restricted perils to apply to B or C please advise us. Fire & Lightning only Storm, Tempest, Flood ( 317/ 250 excess) Aircraft, Explosion & Earthquake Burst Pipes ( 317/ 250 excess) Riot and Malicious Damage ( 317/ 250 Excess) Impact ( 317/ 250 excess) All Risks (excluding Theft and Glass) Sprinkler Leakage ( 317/ 250 excess) ( 317/ 250 excess) Each claim for loss or damage to Property will be subject to the deduction of the Excess amount stated above, unless we advise otherwise. If Theft or Glass Breakage cover is required please complete the additional Proposal Form.
Important tice Failure to disclose material facts could result in your Policy being invalidated. Material facts are those facts which may influence the acceptance or assessment of your Proposal. If you are in any doubt as to whether a fact is material you should disclose it. Before you complete the declaration, please check that (a) you have selected the necessary covers. (b) if you are registered for VAT any claim for loss or damage to property will be paid exclusive of VAT, and you are advised to arrange your sums insured accordingly. Allowances should be made to include an amount for VAT in the sum insured if you are not registered. (c) The sums insured, values and limits requested are adequate. Declaration Please read the following declaration very carefully, especially if the proposal has not been completed in your own hand. I/We declare that the statements and particulars contained in this proposal and any supplementary statements and particulars supplied by me/us in connection with this proposal are to the best of my/our belief and knowledge true and that no material facts concerning the insurance have been withheld. I/We agree that this proposal and declaration shall be the basis of the contract between me/us and Allianz p.l.c., and I/We agree to accept a Policy in the Company s usual form for these classes of Insurance and to provide at the end of each period of insurance information as required by the Company concerning those Insurances which are on an adjustable basis and to pay such additional premiums as may be required. I/We understand that no cover will apply until this proposal has been accepted by the Company and cover confirmed. te: Each Policy is subject to Exclusions and Conditions and a specimen policy is available on request. Proposers Signature Date The Insurance will not be in force until the Proposal has been accepted by the Company and the Premium paid, except to the extent of any official Cover te issued by the Company. Agency Town
tes Property Damage 1. The cover provided under items 1, 2 and 4 will include Architects, Surveyors and other professional fees incurred in the reinstatement of the Buildings and Machinery together with the cost of removing debris, and also the cost of compliance with Local Authority requirements and the sums to be insured should be increased accordingly. 2. Sums Insured and Inflation In setting sums insured you should allow for the full cost of reinstatement, allowing for inflation which may occur up to the time when the rebuilding/repair work can be completed. To fully cater for this aspect you may require a policy on a Day One or Escalator basis full details are available on request. Stock sums insured should reflect the maximum stock held at any time of year. Where stock amounts are variable you may require a policy on a Stock Declaration basis full details are available on request. You may need to allow for Value Added Tax in setting sums insured. Property in the UK may be affected by the Finance Act 1989 which widens the circumstances in which VAT may need to be included. Consult your professional advisors if in doubt. 3. All Other Contents It is agreed that the term All Other Contents is understood to include: (a) Money and Stamps (other than the National Insurance Stamps) for an amount not exceeding 127/ 100. (b) (c) Documents, Manuscripts, and Business Books but only for the value of the materials as stationery together with the cost of clerical labour expended in writing up and not for the value to the Insured of the information contained therein for an amount not exceeding 635/ 500. Computer System Records, but only for the value of materials together with the cost of clerical labour and computer time expended in reproducing such records (excluding any expense in connection with the production of information to be recorded therein) and not for the value to the Insured of the information contained therein, for an amount not exceeding 1,270/ 1,000. (d) Patterns, Models, Moulds, Plans and Designs, for an amount not exceeding 635/ 500. (e) In so far as they are not otherwise insured: Director s, Visitor s, and Employee s Pedal Cycles, Tools and other Personal Effects up to 191/ 150 in respect of any one Pedal Cycle and 191/ 150 in respect of other Personal Effects of any one person and 191/ 150 for any one person s instruments and tools. The policy will be subject to an underinsurance clause (Average Clause) the effect of which is that if the sum insured specified for an item is less than its actual value, the insured will bear a proportionate amount of any loss.
Business Interruption 1. Provision for Professional Accountants charges for producing and certifying any particulars or details required in connection with a claim should be included in Item 1. 2. For Indemnity periods in excess of 12 months the Sum Insured should be increased proportionately, e.g. Indemnity 24 months the Sum Insured should be twice the amount. 3. Definition of Earnings, as follows: A B C D E F Gross Profit, defined as the amount by which the sum of the amount of the Turnover (as defined below) and the amount of the Closing Stock and Work in Progress shall exceed the sum of the amount of the Opening Stock and Work in Progress and the amount of the specified Working Expenses. Gross Profit, defined as the money (less discount allowed) paid or payable to the Insured for goods sold and delivered (less the net purchase price of such goods) and for services rendered in course of the Business at the Premises. Gross Rentals, defined as Monies paid or payable to the Insured by Tenants, Lessees, or other Occupants of the Insured s premises under lease or tenancy agreements. Tax Relief, defined as the statutory relief from or reduction in the standard rate of Corporation Tax to which the Insured is entitled in course of the Business at the Premises. Gross Revenue, defined as the money paid or payable to the Insured in respect of services rendered in course of the Business at the Premises. Gross Fees, defined as the money paid or payable to the Insured in respect of work done and services rendered in course of the Business at the Premises. Definition of Turnover: The money (less discounts allowed) paid or payable to the Insured for goods sold and delivered, and for services rendered in course of the Business at the Premises. 4. Where your business is liable to fluctuation, a policy on an Adjustable or Declaration basis may better meet your requirements full details are available on request.
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Allianz p.l.c., Allianz House, Elmpark, Merrion Road, Dublin 4. Telephone: (01) 613 3000 Fax: (01) 613 4444 Email: info@allianz.ie Website: www.allianz.ie Allianz p.l.c. is regulated by the Financial Regulator. Registered in Ireland,. 143108 08 PRO 03.08 TF