Before any question is answered, read carefully the declaration at the end of this proposal, which you are required to sign. Please answer all questions in full. 1. Contact Name: 2. Trading Name: 3. Postal Address:... 4. Risk Address (if different to the above): 5. Telephone:..Facsimile:... 6. Business Type and Activity:.. 7. How long has the business been established? 8. What cover do you require? Theft Restricted Perils All Risks of Mortality (Death) 9. For what type of animal is cover required, please state species and breed? 10. What is the maximum value of any one animal in stock?... 11. What is the minimum value of any one animal in stock?... 12. What is the average value of any one animal in stock?... 13. What is the total stock value?... 14. Please describe the premises, facilities and construction of buildings. 15. Is this property occupied at all times, or do staff live on the premises? 16. Are there any public access routes through / to the side / rear of your property, e.g. footpaths, garage blocks or parkland? Page 1 of 6
17. Please describe the aviaries/cages in which the birds are kept, including details of dimensions, age and construction and whether man-made or manufactured. 18. Where are they kept at night (if different to the above)? 19. Are the birds allowed to fly free outside their aviaries/cages? 20. If the birds are taken outdoors, what precautions are taken to prevent their loss? 21. Do you have an alarm system? If yes, please answer the following; What is the make and model? Does the alarm give an audible signal to a pager/mobile phone of a member of staff or police in case of intruders after business hours? Was the alarm professionally installed? What was the date of installation? 22. Do you have CCTV in operation? If, does this record 24hrs a day? What are the make and type of locks used on the avaries? 23. Do you have operational security lighting? Page 2 of 6
24. Do you have a guard dog and/or security guards patrolling the premises after business hours? 25. Do all your birds have ID (i.e. rings/microchips)? 26. Have you ever had a theft or attempted theft from the premises? If Yes please give details. 27. Do you keep a breeding log? 28. Do you have a receipt /proof of purchase for all your birds? 29. Do you keep an up-dated stock Register at all times? 30. Should the underwriters so require, do you have any objections to a representative viewing your collection/security for insurance purposes? 31. Please give details of any other security measures in place. 32. Are the animals sound and healthy? 33. Please give full particulars of defects or ailments, illness or disease, during last twelve months. 34. Please give date and reason of last veterinary treatment or advice. 35. Is there any contagious or infectious disease on the premises now? 36. Has there been any during the past twelve months? Page 3 of 6
37. Is there any, to your knowledge, in the neighborhood now? If yes, to 35, 36, or 37, please give details 38. From where do you source your bird stock? If imported into the country please state from where. 39. Are the animals now insured or have they been insured previously? If please give details including the names of Insures. 40. Has any Insurer ever declined or refused to renew your Livestock Insurance, or imposed special terms when offering renewal? If please give details:.... 41. Has the business, its Directors or Partners ever been the subject of bankruptcy, a petition for winding up, or a county court proceedings for debt recovery? If yes please give full details:. 42. Have any of the Directors or Partners in the business ever been convicted or charged (but not yet tried) with a criminal offence other than a motoring offence? If yes please give full details: 43. Have any of the Directors or Partners in the business ever been prosecuted in connection with health and safety legislation? If yes please give full details:. Page 4 of 6
44. How many animals of like category have you lost by death/theft/during the last two years, irrespective of class, type or species? Please state cause and date of death in each case, and give further details if theft. 45. Have you been paid claims on livestock at any time? If please state how many, causes of loss, amount(s) and name(s) of Insurer(s) and date(s) 46. Name and full address and telephone number of your Veterinary Surgeon. 47. What is his distance from where the animals are normally located? 48. Are you a member of the NCA or other bird association? If yes please state which. 49. Are there any other circumstance within your knowledge or opinion note already disclosed, affecting or likely to affect the proposed insurance? 50. Are these animals subject to the DANGEROUS WILD ANIMALS ACT (D.W.A.A.) 1976? Or AS AMENDED BY 1984 ACT? Page 5 of 6
DECLARATION I declare that the information given in this Insurance Proposal is to the best of my knowledge and belief and is correct and complete in every detail and will form the basis of the contract Signature of Owner. Dated.. Please Print Name.. N.B. You are reminded of the need to disclose any facts which the insurer would take into account in the assessment and acceptance of the proposal. If you have any doubts as to whether certain facts are relevant, please consult Crowe Livestock Underwriting Limited. Failure to disclose all relevant facts may invalidate your policy or may result in your policy not operating fully. DATA PROTECTION ACT 1998 - PROPOSER S CONSENT CLAUSE I/We hereby consent to any information you may have about me/us being processed by you for the purposes of providing insurance and claims handling, which may necessitate your providing such information to third parties. Signed: 22/6/00 NMA2866 Page 6 of 6