Non-motor Quote Form (Business)

Non Motor Quote Form (business)

Please use the form below to get a quote for...

Choose the insurance cover you require a quote for

Proposer's Details (Whether business or individual)

Full Name of Proposer
Full Name of Proposer

Contact Details.

Please provide the period for which the insurance is required


Does any law or regulation governing the conduct or maintenance of premises apply to your premises?
Have you carried out all obligations imposed on you by such laws and regulations?
Have you carried out all obligations imposed on you by such laws and regulations?
Do you have any boilers?
Are your ways, works and plant properly fenced and guarded and otherwise in good order and condition?
Do you use acids, gases, chemicals or explosives?
Do you handle or use radio isotopes radioactive substances or other sources of ionizing radiations?
Are you at present insured or have you ever proposed for a Workmen's Compensation Policy or a Work Injury Benefits Policy?
Have such proposals or renewals ever been declined or withdrawn?
Have increased rates been required for such proposals or renewals?
Do you have any employee with pre-existing medical condition?
Do you have any employees who are apprentices or trainees in your organization?

Employers Liability Insurance

Do have any circular saw or other machinery driven by steam, gas water, electricity or other mechanical power?
Have you any boilers?
Are your ways, works and plant properly fenced and guarder and in good order and condition?
Are you at present insured or have you ever proposed for work injury benefits policy?
Are you at present insured or have you ever proposed for any insurance in respect of your legal liability under common low to your employees?
Have such proposals or renewals ever been declined or withdrawn?
Have increased rated been required for such proposals or renewals?

Estimated Annual Wages Salaries and other Earnings

Please note that it is a condition of this policy that the estimated annual wages, salaries and other earnings is required to be certified by your auditors within three months of the expiry date of the period of insurance.

Give the following information in respect of the past three years.

Limits of liability select any one of the following options below

Any one person
Any one occurrence
Any one year

Group Personal Accident

Benefit Required (capital benefits)

Public Liability

Whether accommodation facilities are offered
Whether car park facilities are provided
Do you own the premises?
Are you the sole occupier?
Do you wish to cover your liability in connection with your car park?
Do you wish to cover liability in respect of guests personal effects rising from fire, theft or accidental damage

Marine Cargo Insurance

Plate Glass Insurance

This additional cover can be obtained at a premium of 5% on the declared value of the wood work
Is the glass insured at preset?
Has any company declined to acceptor renew the insurance
Has any company imposed a special condition?

Fire & Peril Insurance

Representing the annual NET TRADING PROFIT added to the annual amount of the following STANDING CHARGES OF THE BUSINESS
Deleted charges not to be covered. Interest on debentures, Mortgages, Loans, Bank overdrafts and other borrowed capital, Rent Rates and taxes, Director's fees, Auditors fees, insurance premiums, advertising charges, travelling expenses, Salaries to permanent staff, wages to skilled Employees.

Money Insurance

Do you require cover for cash contained in a lock safe or strong room?
Describe how your money is conveyed.
Do you have a Fidelity Guarantee Policy?

Fidelity Guarantee

Is there a system to obtain references from previous employers?
Has any of your employees been dismissed in the last 12 months?
Do you have a current policy?
Has any Company in respect of any infidelity guarantee insurance:
Declined your proposal?
Cancelled or refused to renew policy?
Accepted your proposal on special terms and conditions?

Goods in Transit

If cover is required on specified vehicles, please complete the following schedule;



Burglary Insurance

Do you require the following extensions to your policy?
Hold up your cover
Riot and strike

Industrial All Risks Proposal

Machinery Breakdown Insurance

Fire Insurance

Whether pipe is carried into brick flue
Whether pipe is within nine inches of unprotected wood work
Does the building have a fire alarm
Does the building have a fire extinguisher / hose reels
Do you keep a set of books showing a complete record of business transacted including all purchases and sales for cash and credit, together with the last inventory to the business?
Are the books securely locked in a fireproof safe at night and at all times when the warehouse or store is not actually open for business?
Limit of cover required:(single combined limit each and every loss and in the aggregate during the period of insurance for physical damage and business interruption)
Are there any of the following within 500 meters of the location?
Building Location Details
Is there a guard force?
Is the perimeter fence?
Is there a parking area?

Products Liability Insurance

Explain what your business entails:
Note: Brochures or leaflets describing the product can be enclosed if available.
Are the products used as a component?
Are any of your products assembled by another firm (or persons)?
Note: This cover excludes exports to the USA and Canada.
Are any of the products supplied for use in connection with:
Aircraft, aerospace equipment or aerial devices of ant kind?
Offshore platforms and rigs?
Do you enter into any agreement or undertaking to indemnify or compensate supplier of materials or components or subcontractors or processors in respect of any injury or damage?
If so, please provide a copy of such agreement or undertaking.
Do you manufacture the packaging materials?

Contractors Plant & Machinery

Electronic Equipment Insurance

Is there a risk of flooding or water damage?
Condition of the equipment
Is the Equipment new?
Was the equipment obtained ex works, that is, were all costs from the sellers premises borne by you?
Is the air conditioner
Is the equipment maintained in accordance with the manufacturers instructions?
Is there a valid maintenance contract in place?
Maximum upload size: 104.86MB

Carriers Legal Liability Insurance

Please indicate whether you operate as a :
Indicate whether the vehicles are :
Do you subcontract any carriage?
If yes do you have written contracts with the subcontractors?
Do you maintain a detail register of all vehicles that are used for carriage of goods?

Security of Vehicles

Are the vehicles fitted with:

Tracking Devices ?
Radio Communication?
Engine immobilizers?
Overloading Devices?
Any other Devices (please specify:)

Limits of Liability Required

State the limits of liability required:

Contractors All Risk Insurance

Details of subsoil: (Tick where applicable)
Do geological faults exist in the vicinity?
Is third party liability to be included?
Has the contractor concluded a separate policy for TPL?
Have you either alone or in partnership or jointly with any other party or office holders:
Incurred legal costs in a contractual dispute in the last 3 years?

Contractual Legal Liability Proposal

Been charged with or convicted of any criminal offence?
Been declared bankrupt, insolvent, had a liquidator appointed or been a defendant in any civil court case?
Insurance Cover (Please tick):

Limits of Liability

Had an insurer decline any claim, cancel any insurance policy or impose special tersm to any insurance policy?