Jewellers/Pawnbrokers Declaration For Insurance - Primassure Specialist Insurance Broker

Jewellers/Pawnbrokers' Declaration For Insurance

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/Insurers).
If you are in any doubt concerning the answer to any question or to a material fact please contact us on 01702 544 972

Name of Proposer

All Trading names/Subsidiary Co's

Website

Type of Business - percentage split

Retail

Pawnbroking

Wholesale

Manufacturing

Cheque Cashing

Gold Buying

Any other business, please give details here

Address to which this Insurance is to apply

Telephone Nos.

Email Address

What Basis of Value do you wish claims to be settled on in respect of your own stock?

Replacement Cost Price

Cost Price+

Cost Price

Other

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 the 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 InsuredYesNo

limit required

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 (up to maximum of 25%)

Pledge & Deposit – Private Treaty Goods

Uplift for Private Treaty (up to maximum of 75%)

Do you operate BUYBACK?YesNo

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

Do you hold Money for:

Cheque cashingYes

Telegraphic TransferYes

Foreign ExchangeYes

N/AYes

What is your estimated Annual Turnover for the stated operation/s

MAXIMUM LIMIT required for money on Premises

MAXIMUM LIMIT of money in Transit

OUT OF SAFE LIMIT

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

This being the total value of the above in your Showroom, counters and windows at close of business). Note: It is a condition that such items in Pawn are required to be in Safe/Strongroom when closed.

WINDOW DISPLAY

How many Display Windows do you have

What will be the MAXIMUM value of all stock in display windows at any one time

Any one Window

In all Windows

Any one item

During Business Hours

Outside Business Hours

TRAVEL Outside your premises please provide the following information:

a) In the UK

Names of all principals, representatives, travellers & agents

Number of days p.a.

Average Amount carried

Maximum value carried

b) Overseas, please specify Countries

Names of all principals, representatives, travellers & agents

Number of days p.a.

Average Amount carried

Maximum value carried

c) 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 Sale/Alarm/other

Is stock left unattended?

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

UK Sendings

Overseas Sendings(Specify countries below)

Inward Sendings

Parcel Limit

Next Day Special Delivery

Registered Airmail/ Insured Airmail

Within UK aggregate

Ordinary Post

Airfreight

Outside UK aggregate

Courier(name)

ENTRUSTMENTS

What was the Average value of property entrusted to any one Dealer,Repairer, Cutter, Setter, Polisher or similar?

What was the maximum entrusted to any one person/company?

Are Trade Approval notes used making the Third Party responsible?YesNo

What was the Average entrusted to the Assay Office at any one time?

What was the Maximum entrusted to the Assay Office at any one time?

Do you STORE OR DISPLAY STOCK at any other premises on a permanent/semi permanent basis?YesNo

Please give amount and details

Do you take stock to Trade organised EXHIBITIONS OR FAIRS?YesNo

a)Please list exhibitions/fairs planned over the next twelve months (use a separate page if required)

Name & Location

Approximate Date

Limit

Method of Conveyance to/from

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 VEHICLEYesNo

Petrol Station Forecourt OnlyYes

All DayYes

Limit

Please provide details of the vehicle/s and protections.

Vehicle Registration

Make & Body

Body Type

Thatcham Approved Alarm

Any Additional Security

Do you require additional WEARING cover over the £5,000?YesNo

What limit do you require?

Do you require additional WORKING UPON cover over the £5,000 limit(subject to Coinsurance)?YesNo

What limit do you require?

Do you require DEFECTIVE TITLE cover?YesNo

What limit do you require?

Do you require FIDELITY cover?YesNo

What limit do you require?

Do you require BUSINESS INTERRUPTION cover?Providing coverage against Accidental Loss, Destruction or Damage, including Theft from premisesYesNo

a)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 affected12 Months18 Months24 Months36 Months

Do you require RENT (PAYABLE) cover?(Do not complete if Business Interruption covered)YesNo

What will be your RENT for the next 12 months?

If you require a longer Indemnity Period please specify18 Months24 Months36 Months

Do you require PERSONAL ACCIDENT/ASSAULT cover?YesNo

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?(Providing coverage against Accidental Loss, Destruction or Damage, as per Wording.)YesNo

How old are your premises?

Are they in a good state of repair?YesNo

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?(NOTE: If the answer is yes and this is a first proposal through Towergate London Market Limited an additional Subsidence questionnaire may be requested.)YesNo

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.)YesNo

Please provide your Employer Reference Number (Employer PAYE Ref)(this being for the Employers Liability Tracing Office and is compulsory)

Give details of wages per annum paid to:

Directors, Managerial and Clerical Staff, Shop Assistants and Travellers

Any Other Employees (to be specified)

Do you require cover for PUBLIC AND PRODUCTS LIABILITY?YesNo

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?YesNo

The following limits are available please specify£10,000£20,000

Do you require cover for TERRORISM?YesNo

DISPLAY WINDOWS:

Is all the glazing laminated glass (state thickness)YesNo

Thickness

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 closedYesNo

Is there an internal grille permanently fitted or hanging glassYesNo

Please provide details

Are all window backs and showcases fitted with Locks and kept locked with keys removed?YesNo

SAFE OR STRONGROOM please provide details of the make and model

Make

Model/Serial No.

Cash Rating £

Additional Security i.e. Time lock / Limpet

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)

How long have you traded from your premises?

How long elsewhere (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:

CLAIMS HISTORY

Have you suffered any LOSSES(whether insured or not in the last five years?)YesNo

If you answered YES please provide details including circumstances, amount of settlement, any unpaid amounts

Please detail steps taken to prevent similar losses.

Do you store or display stock in the Basement?YesNo

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?)YesNo

If YES, please give details:

Are there any other factors that might affect this insurance?

ADDITIONAL INFORMATION

Please complete where not room in above answers or there is additional material information.

DATA PROTECTION

Note Where Insurer is mentioned this shall mean Insurer/Underwriters

The defined terms used in this section shall have the meaning given to those terms in the Data Protection Act 1998 (as may be amended from time to time).

In the course of providing insurance services to you, the insurer may have access to Personal Data. You warrant that you shall have obtained all necessary authorisations and approvals from Data Subjects prior to disclosing any Personal Data to the insurer (whether such disclosure is made directly by you to the insurer or indirectly by you to any agent acting on behalf of the you or the insurer). The insurer shall be the Data Controller of any Personal Data provided to it.

The insurer undertakes that it shall only use any Personal Data provided to it for the purposes of performing its services in connection with its contract of insurance with you. This will include the processes of underwriting, administration and claims assessment as well as any necessary services ancillary thereto.

The insurer will hold all Personal Data provided to it securely and shall limit access to such Personal Data to those who have a need to see it. You hereby consent to the insurer sharing any Personal Data provided to it with its group companies, agents, reinsurers, claims handlers, loss adjusters, medical professionals and other professional advisors, healthcare management companies and any other necessary service providers with whom the insurer contracts in connection with the proposed contract/contract of insurance between you and the insurer

You acknowledge that the insurer may be required as a matter of law or regulation to disclose Personal Data provided to it to a Court of law or regulatory body such as the Financial Services Authority or any other public body or authority of competent jurisdiction and you hereby consent to any such disclosure.

You acknowledge that the insurance industry maintains certain registers for the purposes of fraud prevention and hereby consents to the insurer sharing Personal Data provided to it with fraud prevention agencies and other insurance companies for the purposes of fraud prevention and to validate your claims history.

DECLARATION

In completing this declaration, whether in my own hand or not, I have read and understood the questions and have checked the answers/information therein and confirm the answers are correct and complete. I understand that this is my responsibility and that any inclusion of incorrect information or the omission of material facts may entitle Underwriters/Insurers to void any insurance issued and/or repudiate claims.

Signature of Proposer

Name of Proposer

Date