Business Combined Insurance for Miscellaneous
Manufacturing Companies
Proposer's Name
Contact Name
Address
Postcode
Telephone
Email
Business Description
Please describe any goods manufactured, supplied,
installed, erected, repaired, altered or treated by you.
No
of Years In Business
Number of Employees
Renewal Date
Renewal Premium
Premises Information and Cover
Number of properties
One
Two
Three
Four
Address of Property if different
Construction of the premises.
-Walls -
Brick
Brick/Steel
Steel
Wood
Concrete
Other
- Roof -
Slate
Steel
Concrete
Timber/Felt
Other
- Floors -
Concrete
Stone
Wood
Other
- Heating -
Gas CH
Electric
Oil
Portable Heaters
None
- Electrics Checked -
Less than 12 months
Less than 3 years
Less than 5 Years
Other
- Intruder Alarm -
BT Redcare
Digital
Commmunicator
Bells Only
None
- Alarm Maintained -
Yes
No
- Other Occupants -
Yes
No
Other occupants
No
Yes
if yes
Approved Alarm
No
NACOSS
SSAIB
Alarm Signaling
None
Bells Only
Digicom
Redcare
Property Sums Insured
Buildings
£
Loss of rent
£
Stock (ex non ferrous metals)
£
Stock of non-ferrous metals
£
Contents (ex Computers)
£
Computer Equipment
£
Tenants Improvements
£
Deterioration of Frozen Stock
£
Residual Computer Breakdown (additional costs)
£
Nil
£20,000
£30,000
£40,000
£50,000
£100,000
Non Specific Cover Detail and Sums Insured
Business Interruption (Automatic Cover Twice Trade
Contents)
£
Business Interruption Indemnity Period
Book Debts
£
Description (please complete in all cases)
£
Wage roll (at premises)
Wage roll (away from premises)
No
of Employees
Clerical, commercial travellers and managerial employees
who do not engage in manual labour
All
other employees
Labour gangers, labour only sub-contractors and
self-employed hired or borrowed persons
All
other sub-contractors
Proposer’s own annual remuneration if working
manually in the business
(Total payments must include overtime and board and
lodging without deductions such as National Insurance,
Income Tax etc.)
Turnover
UK
Only
EU
and Europe
Rest of World
USA/Canada
Goods in Transit - Limit any one conveyance
£
All Risks
Description of Items
Europe or Worldwide
Sum
Insured
Europe
Worldwide
Europe
Worldwide
Europe
Worldwide
Europe
Worldwide
Europe
Worldwide
Legal Expenses
No
Yes
Contract Cover
No
Yes
Claims Experience
Date
Cause
Amount
Has a Formal Risk Assessment Undertaken?
-Please Choose-
Yes
No
Is there a Written Health and Safety Policy in force?
-Please Choose-
Yes
No
Is
there a system for the inspection of all parts of the
workplace on a regular basis in order to identify
defects and hazards and to ensure any corrective actions
is taken?
-Please Choose-
Yes
No
Is
there work involving use of heat away from the premises?
-Please Choose-
Yes
No
Details
Percentage of Work Away from the premises involving
the use of heat.
0%
1%
2%
3%
4%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
%
Work involving the use of woodworking machinery
0%
1%
2%
3%
4%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
%
Details
Maximum height/number of storeys worked at by any
manual employees externally.
Details
Workers exposed to noise levels above 85db?
-Please Choose-
Yes
No
Details
Employees exposed to chemicals which are known to be
associated with conditions such as dermatitis, cancer or
respiratory problems etc.?
-Please Choose-
Yes
No
Details
Please use this space to tell us about any other factors
that you may feel are important or may affect the
opinion of underwriters in assessing the risks
associated with the insurance proposed.
