Antiques & Fine Art Policy Proposal Form...Antique & Fine Art Dealers Policy Proposal Form How we...

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Antiques & Fine Art Policy Proposal Form

Transcript of Antiques & Fine Art Policy Proposal Form...Antique & Fine Art Dealers Policy Proposal Form How we...

Page 1: Antiques & Fine Art Policy Proposal Form...Antique & Fine Art Dealers Policy Proposal Form How we use your information The personal information, provided by you, is collected by or

Antiques & Fine Art Policy Proposal Form

Page 2: Antiques & Fine Art Policy Proposal Form...Antique & Fine Art Dealers Policy Proposal Form How we use your information The personal information, provided by you, is collected by or

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

Page 3: Antiques & Fine Art Policy Proposal Form...Antique & Fine Art Dealers Policy Proposal Form How we use your information The personal information, provided by you, is collected by or

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*

Page 4: Antiques & Fine Art Policy Proposal Form...Antique & Fine Art Dealers Policy Proposal Form How we use your information The personal information, provided by you, is collected by or

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

Page 5: Antiques & Fine Art Policy Proposal Form...Antique & Fine Art Dealers Policy Proposal Form How we use your information The personal information, provided by you, is collected by or

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

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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

Page 7: Antiques & Fine Art Policy Proposal Form...Antique & Fine Art Dealers Policy Proposal Form How we use your information The personal information, provided by you, is collected by or

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 partners and directors.

If answer the is NO to any of the questions above please give details below

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

I/we confirm that no insurer has ever declined my / our proposal or refused to renew or cancelled my / our policy or imposed special terms or conditions for any of the risks proposed.

I/We confirm the business and employees are domiciled in Great Britain, Northern Ireland, the Channel Islands or Isle of Man.

I/we have not been convicted of or charged with (but not tried) or received a police caution in connection with arson or any other criminal offence (other than motoring offences).

I/We have not been prosecuted or received notice of intended prosecution, issued with a simple caution or been served with a prohibition or improvement notice in connection with a breach of any health and safety legislation.

I/we have not been declared insolvent or bankrupt or been the subject of bankruptcy proceedings or an Individual Voluntary Arrangement.

I/we have not been a director or partner in any business which is or has been the subject of a winding up or administrative order, or receivership proceedings or a Company Voluntary Arrangement

I/We have not been the subject of a Debt Relief Order nor are there any applications pending

I/we do not supply products to any country which is subject to sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America.

I/we have not been the subject of a County Court Judgement (or Scottish equivalent) or are any proceedings pending.

Note: Convictions regarded as spent under the Rehabilitation of Offenders Act do not need to be disclosed

Yes No

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

Antique & Fine Art Dealers Policy Proposal Form

How we use your information

The personal information, provided by you, is collected by or on behalf of Covea Insurance plc and may be used by us, our employees, agents and service providers acting under our instruction for the purposes of insurance administration, underwriting, claims handling and for research, or statistical purposes. We may also share your information with reinsurers and regulators, as required by law.

From time to time we may need to undertake some of the processing of your data in countries outside of the European Economic Area, and in such cases we will ensure that there is an agreement in place which gives equivalent assurances as found in the Data Protection Act 1998.

We will not use your information or pass it on to any other person for the purposes of marketing further products or services to you.

We will collect sensitive information when dealing with your policy, we will however only collect information that is relevant to your policy, its administration or claims handling.

Your personal information will be kept secure at all times.

Fraud Prevention and detectionIn order to prevent or detect fraud we will check your details with various fraud prevention agencies, who may record a search. Searches may also be made against other insurers’ databases. If fraud is suspected, information will be shared with those insurers. Other users of the fraud prevention agencies may use this information in their own decision making processes. We may also conduct credit reference checks in certain circumstances. You can find out further details explaining how the information held by fraud prevention agencies may be used or in which circumstances we conduct credit reference checks and how these checks might affect your credit rating by contacting Covea Insurance plc.

Disclosure of other people’s personal informationYou should show this notice to anyone whose personal information you provide to us. You must ensure that any such information you supply relating to anyone else is accurate and that you have obtained their consent to the use of their data for the purposes set out above.

Your RightsUnder the Data Protection Act 1998 you have the right of access to the personal information held about you by Covea Insurance plc. You can exercise this right by contacting us. We will make a charge of £10 for dealing with these requests.

You have the right to request that we correct any inaccuracies in the personal information we hold about you. Please contact your insurance broker, or Covea Insurance plc, if your personal information needs updating.

ConsentBy providing us with information, you also provide us with your consent and that of any other person whose information you provide to the personal information being used for the purposes set out above.

How to contact UsPlease visit www.coveainsurance.co.uk/dataprotection if you would like some more detailed information on how we share your personal information.

If you have any concerns about our use of your information please write to Customer Relations, Covea Insurance plc, 50 Kings Hill Avenue, Kings Hill, West Malling, Kent ME19 4JX.

Telephone: 0330 134 8194.

If you contact Covea Insurance plc by telephone your call may be recorded for training and evidential purposes.

Choice of LawThe parties to an insurance contract are free to choose the law that will apply. Unless we agree in writing with you otherwise, this insurance shall be subject to the law applying in the part of the United Kingdom, Channel Islands or Isle of Man where you have your principal place of business. If there is any dispute, the law of England and Wales shall apply.

Registration and Regulatory InformationCovea Insurance plc. Registered in England and Wales No. 613259. Registered office: Norman Place, Reading, Berkshire. RG1 8DA.

Covea Insurance plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Our Financial Services Register number is 202277. You can check this on the Financial Services Register by visiting the FCA’s website www.fca.org.uk/register or by contacting the FCA on 0800 111 6768.

Declaration- continued

Your Personal Information

Dated*

Signature of Proposer*

* required for submission

Page 9: Antiques & Fine Art Policy Proposal Form...Antique & Fine Art Dealers Policy Proposal Form How we use your information The personal information, provided by you, is collected by or
Page 10: Antiques & Fine Art Policy Proposal Form...Antique & Fine Art Dealers Policy Proposal Form How we use your information The personal information, provided by you, is collected by or

South House, 21 - 37 South Street, Dorking, Surrey RH4 2JZTel: 01306 740 555connoisseurunderwriting.com

Antiques & Fine Art Dealers Policy - Proposal Form from Covéa Insurance

In association with Connoisseur Underwriting