Jewellers Proposal Form

NOTES FOR COMPLETION OF THIS FORM

• Please answer all questions to the best of your knowledge. If a question is not relevant to your business, please answer ‘N/A’.

• All material facts must be disclosed as failure to do so may nullify any insurance issued. (A material fact is one that is likely to influence the acceptance or assessment of this Declaration by Underwriters).

• If you are in any doubt concerning the answer to any question or to a material fact please contact Warrings Insurance Brokers on 0844 209 0566


Name of Proposer
All Trading names
Type of Business
Retail			%
Wholesale			%
Manufacturing			%
Pawnbroking			%
Cheque Cashing or Other (detail)

Address to which this Insurance is to apply:


What Basis of Value do you wish claims to be settled on in respect of your own stock?	Cost +	%
NB All own stock figures in this Declaration must reflect the Basis of Value selected.

During the last twelve months what was the AVERAGE TOTAL VALUE of:
Your own stock (at the Basis of Value selected on Question 3) and money (excluding money used for Cheque Cashing) as used in the conduct of your business?	£
Property entrusted to you and entered in your Stock records?	£

How is the total Stock declared in Question 4 SPLIT between the following
Jewellery, Gold Precious Stones and Watches, Platinum Goods, Pearls & the like		%
Clocks Silver, Silver plate and Gold plate		%
Brittle/fragile items such as Pottery, China, Glass, etc		%
Please specify maximum amount of money on your premises within the sum insured	£

What SUM INSURED is required in respect of:
Your own stock, money and property entrusted to you and entered into your stock records (other than for safe custody)	£
Do you require a seasonal increase in your Stock Sum insured. Please indicate the amount and the period for the increase	£
All Other Contents including trade and office furnishings, fixtures and fittings, machinery, plant and security equipment etc	£
Glass fixed in display and other windows and doors of buildings for which you are responsible	£

PLEDGE STOCK (if applicable) The amount loaned for:
Jewellery Gold and Platinum goods Bullion Precious Stones Pearls and Watches	£
Non Precious Pledge Goods (Electrical Equipment etc)	£
Uplift to allow for interest (normally 25%)	£
Pledge & Deposit – Private Treaty Goods	£
Uplift for Private Treaty (normally 75%)	£

Do you operate BUYBACK,

Yes No


If you hold Money for CHEQUE CASHING or Telegraphic Transfer or Foreign exchange (state which)
Please state the estimated Annual Turnover for the stated operation/s			£
MAXIMUM LIMIT of money on Premises			£
MAXIMUM LIMIT of money in Transit			£
*Note 1: Money must be placed in Safe/Strongroom outside business hours and during business hours the amount out of safe must be strictly controlled. Note 2: Money in transit excess of £5,000.00 must be accompanied by two of your staff and transits excess of £10,000.00 must be by Security Company. Note 3*: The above limits do not apply to cheques where up to the limit in the Cheque Cashing Extension applies.


OUT OF SAFE – If you leave Jewellery, Gold, Watches, Platinum goods, Bullion, Unset Precious Stones and Pearls out of safe when your premises are unattended please advise

The MAXIMUM AMOUNT of such stock out of locked safe outside business hours including temporary closing*			£
And, the MAXIMUM SINGLE ITEM VALUE			£

Note: It is a condition that such items in Pawn are required to be in Safe/Strongroom when closed.


How many Display Windows have you

What will be the maximum value of all stock in all display windows which will not be exceeded

	During Business Hours	Outside Business Hours
Any one Window	£	£
In all Windows	£	£
Any one item	£	£

TRAVEL Outside your premises please provide the following information:

In the UK

Names of all principals, representatives, travellers & agents	Number of days p.a.	Average Amount carried (£)	Maximum value carried(£)




Overseas TRAVEL, please specify Countries

Names of all principals, representatives, travellers & agents	Number of days p.a.	Countries Travelled to	Maximum value carried(£)

If any Principal, Employee, Traveller, Representative or Agent takes stock to his PRIVATE RESIDENCE for any purpose please give following information:

Name	Address	Maximum Value	Full details of Safe/ Alarm/other	Is the stock left unattended

What was the aggregate total value of property sent during the last 12 months?

	Next Day Special Delivery	Ordinary Post	Courier
UK sendings	£	£	£ Name
Overseas sendings Specify countries	Registered Airmail/ Insured Airmail	Airfreight	Other, Specify –


Inward sendings	Within UK	Outside UK
	£	£


What was the Average value of property entrusted to any one Restorer, Restorer, Repairer, Framer or Customer during the last twelve months?	£
What was the maximum entrusted to any one person/company?	£
Please confirm trade Approval notes are used Making the Third Party responsible?	Yes No
What was the Average entrusted to the Assay Office at any one time during the last twelve months?	£
What was the Maximum entrusted to the Assay Office at any one time during the last twelve months?	£

Do you STORE OR DISPLAY STOCK at any other premises on a permanent/semi permanent basis?	Yes No
Amount	£
Details

Do you take stock to Trade organised EXHIBITIONS OR FAIRS?	Yes No
Please state the maximum limit you require	£
Please list exhibitions/fairs planned over the next twelve months (list separately if necessary)

What OUTSIDE LIMIT do you require for any one loss away from your premises (not including Exhibitions)?	£

Do you require cover for stock in an UNATTENDED VEHICLE (normally excluded)	Yes No
What limit do you require?	£
Details of the vehicle/s and protections.

Do you require additional WEARING cover over the £5,000 limit included in our Wording?	Yes No
What limit do you require?	£

Do you require additional WORKING UPON cover over the £5,000 limit (subject to Coinsurance) in our wording?	Yes No
What limit do you require?	£

Do you require DEFECTIVE TITLE cover?	Yes No
What limit do you require?	£

Do you require FIDELITY COVER?	Yes No
What limit do you require?	£

Do you require BUSINESS INTERRUPTION cover?	Yes No
Providing coverage against Accidental Loss, destruction or Damage, including Theft from premises, as per Wording.
What is your ESTIMATED GROSS PROFIT (EGP) for the next 12 months? (Note: The Sum Insured will be 133.33% of the EGP)	£
What INDEMNITY PERIOD do you require? That is the period following damage during which your Revenue would be affected (minimum 12 months)	12 / 18 / 24 / 36 Months


Do you require RENT (PAYABLE) cover? (Do not complete if Business Interruption covered)	Yes No
What will be your RENT for the next 12 months?	£
If you require a longer Indemnity Period please specify	12 / 18 / 24 / 36 Months
If you require a longer Indemnity Period please specify

Do you require PERSONAL ACCIDENT/ASSAULT cover?	Yes No
Providing Compensation for Death or Injury by Assault with intent to steal property as defined in Section 1 Stock & Money and/or keys giving access to such property.
State number of employees (including Principals)
What Capital Sum Insured do you require for each person? NOTE: Persons over 70 or under 16 years of age are not eligible for certain Benefits	£

Do you require cover for BUILDINGS?	Yes No
Providing coverage against Accidental Loss, Destruction or Damage, as per Wording.
How old are your premises? (in years)
Are they in a good state of repair?	Yes No
What is the Sum Insured required which adequately reflects the cost of reinstatement of the Buildings, including the costs of Professional, Legal and Other Fees and Debris Removal, following a Claim?	£
Do you require cover for subsidence, landslip or heave?	Yes No

Do you require EMPLOYERS LIABILITY cover? NOTE: Cover is compulsory under the terms of the Employers Liability (Compulsory Insurance) Act 1969 when you employ staff.	Yes No
Give details of wages per annum paid to:
Directors, Managerial and Clerical Staff, Shop Assistants and Travellers	£
Any employees engaged in Manufacturing or Industrial Processes	£
Any Other Employees (to be specified)	£
Any Other Employees (amount)	£

Do you require cover for PUBLIC AND PRODUCTS LIABILITY?	Yes No
What Limit of Indemnity do you require? (Minimum £1million)	£
Please provide your Estimated Turnover for the coming twelve months.	£

Do you require PROFESSIONAL INDEMNITY insurance against wrongful valuations?	Yes No
Limit of £10,000.00 or £20,000.00 is available please specify	£

Do you require cover for TERRORISM?	Yes No


Is all the glazing laminated glass	Yes No
Please state thickness (mm)
If you have more than one window and the glazing varies please detail
Is there an external shutter covering all of the front of your premises at night and when closed	Yes No
Is there an internal grille permanently fitted or hanging glass	Yes No
Please provide details
Are all window backs and showcases fitted with Locks and kept locked with keys removed?	Yes No

Please attach the installed Alarm specification or state
The installing company
The signalling method (indicate) Audible / Digital Comm / Redcare CS / Dualcomm
Are the following included (indicate) Panic Buttons / CCTV / Verification
Is it maintained under contract	Yes No

SAFE OR STRONGROOM please provide details of the make and model or the dimensions, any serial numbers and weight if known.

Please detail PROTECTIONS (other than Alarms) on the following:
All external doors giving access to your portion of the premises
All internal doors giving access to your portion of the premises
All windows skylights etc (not display)

Are there any SPECIAL SECURITY MEASURES incorporated? (For example, smokecloak, smart water, airlock etc)


How long have you traded from your premises?
How long elsewhere?
Please state address

How many EMPLOYEES have you?
What is the minimum number of Employees/principals, in the sales area of your premises during your opening hours?

Please provide the names and addresses of two references from your trade:
1.
2.


Have you suffered any LOSSES (whether insured or not) in the last five years?	Yes No

Please provide details
Please detail steps taken to prevent similar losses.

Has any Insurer ever cancelled or refused to insure or imposed special terms, or declined to continue any insurance for you?	Yes No
Please provide details

Have you or your partners been a) declared Bankrupt or b) been convicted of arson or any dishonesty offence e.g. Fraud, Theft, Handling stolen goods?	a)	Yes No
	b)	Yes No
If YES to either please provide details

Please state your last Insurer:

Do you keep detailed records of all sales, purchases and other transactions?	Yes No

Do you keep a record of all property entrusted to you?	Yes No

Do you carry out full annual stocktaking?	Yes No
Please state date of your last stock take

Do you occupy your premises at night?	Yes No

Do you store or display stock in the Basement?	Yes No
If YES, please give details: Note: All Stock and vulnerable Contents in basements should be on raised storage at least 15cm (6in) high.

Are any parts of your premises of light construction? (Not using brick/stone/slate/tile or similar?)	Yes No
Please provide details

Are there any other factors that might affect this insurance?

Jeweller's declaration for insurance

General details

Display windows

Travel

Sendings

Entrustments

Business Interruption

Display windows

BURGLAR ALARM

Your business

Claims history

Other material facts

Contact details

Declaration


If YES please specify a Maximum limit inclusive of up to 30% uplift.	£

Please be aware that it is essential that all material facts be disclosed at inception or during currency of the insurance. A material fact is information that may affect the insurers decision to provide cover, such as previous losses, convictions, vehicle modifications, occupancy of property, etc. If you are in any doubt please give further details regarding what may be a material fact here.

So that we may readily discuss or clarify any aspects of the proposal form with you, please supply your relevant contact details below:

	Your name
	Daytime telephone number
	Mobile telephone number
	email address
	Correspondence address (if different to risk address above)


I/We declare that: i) to the best of my/our knowledge and belief, the answers given are true and that all material facts have been disclosed; ii) this proposal and declaration shall form the basis of the contract between me/us and the Underwriters and when I/we accept a policy on the standard form issued by the Underwriters will be bound by the terms and conditions thereof;