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  • Antiques & Fine Art Policy Proposal Form

  • Connoisseur Underwriting - Fine Art & Antiques Insurance Policy - Proposal Form – July 2016 (KH4070 07.16)

    First Name:* Title

    Last Name:*

    Trading As:*

    Yes No

    Yes No

    Are you currently insured for the proposed risks?*

    Have you ever traded under a different name*

    How long have you been in the trade?

    If YES, please provide details:

    Telephone:* Fax:

    Email:*

    Address:*

    Nature of Your Business?

    Date Cover is Required From:

    Insurer Name:

    ERN (Employer Reference Number):

    Current Policy renewal date:

    Present Address:

    Elsewhere:

    Postcode:*

    * information required for proposal submission

    Antique & Fine Art Dealers Policy Proposal Form

    1. Your Details

  • Connoisseur Underwriting - Fine Art & Antiques Insurance Policy - Proposal Form – July 2016 (KH4070 07.16)

    If you have ticked a shaded box, please give details:

    * information required for proposal submission

    Antique & Fine Art Dealers Policy Proposal Form

    2. Premises

    Address*

    Postcode*

    Yes No

    Yes No

    Yes No

    Yes No

    Yes No

    Yes No

    Yes No

    Are Buildings constructed of brick, stone, concrete and roofed with slates, tiles, asbestos, metal, concrete or asphalt?*

    Alarm Company Protecting the Premises

    Signalling Method

    Any other Protections?

    What is your main stock?

    Approximate percentage of Jewellery, Gold and / or Plate

    Are Buildings in a good state of repair?*

    Are the premises solely occupied by you for the purpose of the business?*

    The premises are not in an area liable to flooding or within 1/4 mile from any river, watercourse or the sea?*

    The premises have never been flooded to my knowledge*

    I/we have not been informed or are aware that the premises are in a potential flood risk area*

    Are the protections in good working order and activated when the premises are closed for business*

  • Connoisseur Underwriting - Fine Art & Antiques Insurance Policy - Proposal Form – July 2016 (KH4070 07.16)

    Buildings

    Trade Contents and Stock - State your sums insured for the following items:

    Trade Contents

    Pictures/Paintings

    Furniture

    Ceramics, Porcelain, Glass, Mirrors and other items of brittle nature

    Clocks/Mechanical Art

    Jewellery/Watches**

    Gold, Silver and Other Precious Metals

    Maximum value of any single article, pair or group or articles

    Carpets/Tapestries

    Computer Equipment

    Stock in the open (e.g. statues)

    Portable Electronic Equipment

    Stock at Exhibitions and Trade Fairs

    Goods in Transit

    Number of Exhibitions and Trade Fairs

    Total Amounts insured

    When was you last annual stock taking?

    **If jewellery and watches are to be insured state the maximum value out of a locked safe or strongroom when you premises are closed for business

    Any other stock (please specify below)

    If NO state basis of stock records

    Antique & Fine Art Dealers Policy Proposal Form

    3. Property Damage Section - See Key Facts and Summary for details

    Yes No

    Yes No

    Yes No

    Yes No

    Do you require Buildings cover? (optional)

    Do you keep stockbooks recording every purchase and sale?

    Do you include in your records details of all entrusted to you or entrustments out? (e.g. Sale or Return items)

    Do you require Subsidence cover? (optional) If YES we will require you to complete a supplementary questionnaire

    If YES, state declared value GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

  • Connoisseur Underwriting - Fine Art & Antiques Insurance Policy - Proposal Form – July 2016 (KH4070 07.16)

    Money in Premises

    Money in Transit

    Money in a safe

    Name

    Name

    Name

    Name

    Date of birth

    Date of birth

    Date of birth

    Date of birth

    Antique & Fine Art Dealers Policy Proposal Form

    4. Glass & Sanitaryware

    5. Business Interruption

    6. Terrorism

    7. Money

    8. Personal Accident

    Yes No

    Yes No

    Yes No

    Yes No

    Yes No

    Yes No

    Yes No

    Do you require cover for Glass & Sanitaryware?

    Do you require Terrorism cover for Property Damage?

    Do you require Personal Accident cover for you or your employees whilst operating on behalf of the business?

    See Key Facts and Summary for details

    Your policy cover standard limits as per the Key Facts and Summary, do you require higher limits for Money or Personal Accident Assault?

    If YES please state below

    Do you require Terrorism cover for Business Interruption?

    Do you require cover for Loss of Income or cover for Increase in Cost of Working only?

    a) For income

    b) is the standard Maximum Indemnity Period of 12 months sufficient for your requirements?

    c) if NO please choose the Maximum Indemnity Period you require

    d) If Increase in Cost of Working cover only is required please state limit required

    NOTE: The Sum Insured should be adequate to cover the full cost of replacing all exterior and interior glass (including any lettering or decoration), frames, framework, fittings and displays and sanitaryware and, in the event of damage, the cost of boarding up and removing/replacing window display fittings, alarm protections and other obstructions.

    (Business Interruption is not available without Property Damage) - See Key Facts and Summary for details

    If YES state the Sum Insured required - see Key Facts and Summary for details

    If YES, state Sum required GBP

    GBP

    GBP

    GBP

    GBP

    GBP

    GBP

  • Connoisseur Underwriting - Fine Art & Antiques Insurance Policy - Proposal Form – July 2016 (KH4070 07.16)

    See Key Facts and Summary for details

    See Key Facts and Summary for details

    If YES please supply details below:

    If none write “none”

    If none write “none”

    State estimated annual turnover of your business

    See Key Facts and Summary for details

    In the last 5 years have you, any director or partner (in this or any other name under which you may have been trading) or any other person proposed for insurance suffered any loss or had any claims made against any of you in respect of the covers for which you are now applying?

    Ex USA/Canada

    USA/Canada

    Antique & Fine Art Dealers Policy Proposal Form

    9. Employers’ Liability - See Key Facts and Summary for details

    10. Public Liability

    11. Products Liability

    12. Claims History

    Yes No

    Yes No

    Yes No

    Yes No

    Do you require Employers’ Liability cover for a limit of indemnity of GBP 10,000,000

    Do you require Public Liability cover for a limit of indemnity of GBP 2,000,000?

    Do you require Products Liability cover for a limit of indemnity of GBP 2,000,000?

    GBP

    GBP

  • Connoisseur Underwriting - Fine Art & Antiques Insurance Policy - Proposal Form – July 2016 (KH4070 07.16)

    Antique & Fine Art Dealers Policy Proposal Form

    Declaration

    Fair Presentation of the Risk

    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. Where you have provided us with information which relates to matters of your expectation or belief, it does not matter if such information turns out to be inaccurate provided that you acted in good faith when you provided us with such information.

    If you do not comply with your duty to make a fair presentation of the risk, including failing to disclose or misrepresenting a material fact, or disclosing material facts to us in a way which is not clear and accessible your policy may not be valid or the policy may not cover you fully or at all.

    A material fact is any fact which could influence our assessment or acceptance of your application for insurance.

    You must also tell us about any facts or changes which affect your insurance and which have occurred either since the policy started or since the last renewal date.

    If you are not sure whether certain facts are relevant please ask your insurance broker. If you do not tell us about relevant changes, your policy may not be valid or the policy may not cover you fully or at all.

    You must check all the information contained within this document immediately and tell us if any details are incorrect.

    You should keep a written record (including copies of letters) of any information you give us or your insurance broker.

    Insurance cover does not commence until confirmed by us or Anthony Wakefield &/or Connoisseur Underwriting.

    A Prospectus & Key Facts Summary or a specimen copy of the Policy wording is available on request.

    This Proposal form is a record of information supplied by you or on your behalf or assumptions we have made, about you, your business and your business partne