Kennel and Cattery

Duty of disclosure of Material Facts (Duty of Presentation)

A material fact is an important fact about you or your circumstances. Fair presentation means that you must have disclosed all material facts, matters and circumstances which you know, which could influence an insurer's or underwriter's decision to accept your insurance. This also applies to facts that you ought to know. You must disclose sufficient information to make the insurers aware that they need to make further enquiries. They can then choose to accept or decline your insurance. If they accept, they may apply certain terms. The duty of fair presentation is a significant obligation placed upon you under the contract of insurance. If you fail to meet this obligation, insurers can take various actions in accordance with the Insurance Act 2015.
Section 1 - Proposer Details
Title*
Name*

First nameLast name
Trading/Limited company name: *
What is your position? *
Date of Birth*

DayMonthYear
Address to be insured:*

Address line 1

Address line 2

City

Postcode
Telephone*
Please enter a valid phone number.
Email*

Confirmation EmailConfirm email
Is the address to be insured the same as your postal address?*

YesNo
Postal Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is a joint policy required?*

YesNo
Title*
Name*

First nameLast name
Date of birth*

DayMonthYear
Are you a member of the Pet Industry Federation (PIF) or Licenced Kennel & Cattery Association (LiKCA)?*

YesNo
If yes, please provide your membership number: *
Do you, or your directors or partners within your business, have any formal qualifications relating to this business?*

YesNo
If yes, please provide details below. *
Have you or any director, partner or other board member involved with the business ever been disqualified from acting as a director of a limited company or member of a limited liability partnership?*

YesNo
If yes, please provide details:
Have you or any director, partner or other board member involved with the business ever had an insurance proposal cancelled, withdrawn, declined or made subject to special terms?*

YesNo
If yes, please provide full details:
Have you or any director, partner or other board member involved with the business ever had a licence revoked, been refused a licence request or had a licence renewal application rejected?*

YesNo
If yes, please provide full details:
Have you or any director, partner or other board member involved with the business ever been convicted of or charged with a criminal offence, other than a conviction spent under the Rehabilitation of Offenders Act 1974 or any successor legislation?*

YesNo
If yes, please provide full details:
Have you, or any director, partner or other board member within the business ever been the subject of any insolvency process, including county court judgement, bankruptcy, individual or company arrangement?*

YesNo
If yes, please provide full details:
Have you or any director, partner or other board member involved with the business ever had any prosecution or notification of a prosecution or receipt of prohibition or improvement notices for breaches of health and safety or fire safety?*

YesNo
If yes, please provide full details:
Have you or any director, partner, or other board member involved with the business ever been prosecuted by the Environment Agency, been subject to Civil Sanctions or been required to pay clean-up costs following a pollution incident?*

YesNo
If yes, please provide full details:
Have you or any director, partner or other board member involved with the business ever worked with, contracted with or made any payments to, any person, entity or organisation that is domiciled in or operates in any way from; or travel to the following countries: Cuba, Iran, Non-Government Controlled areas of Ukraine, North Korea, Syria, Afghanistan, Belarus, Myanmar, Russia or Venezuela?*

YesNo
If yes, please provide full details:
Licence Details
Do you have a current licence, issued by your local authority under the Animal Boarding Establishment Act?*

YesNo
Name of your licencing authority: *
Licence holder (as shown on your boarding licence):*
Licence start date:*

DayMonthYear
Date
Licence end date:*

DayMonthYear
Date
Licence star rating: *
Length of time licence has been held:*
Insurance and Claims History
If applicable, who is your current insurer? Please note we cannot quote for a business already insured with Aviva.
Expiry date of your previous/current policy:

DayMonthYear
Date
Date new policy should start:

DayMonthYear
Have you, or your directors or partners within your business, had any incidents in the last 5 years which have resulted in a claim in respect of covers now granted?*

YesNo
Loss date:*

DayMonthYear
Date
Loss details:*
Amount paid or outstanding:*
Settled date:

DayMonthYear
Date
Add another incident?*

YesNo
Loss date:*

DayMonthYear
Date
Loss details:*
Amount paid or outstanding:*
Settled date:

DayMonthYear
Date
Your Insurance Requirements
Please provide a full description of the activities to be carried out at the business: Only those activities described below will be considered for insurance. *
Public and Products Liability
What level of public liability cover do you require?*

£5m£10m
How many animals are you licenced to board? *
What is the maximum number of animals boarded at any one time? Please state the total number of dogs, cats and small domestic animals excluding rescues, council strays or police seized dogs. *
Do you board small domestic pets? (i.e. rabbit, hamster, guinea pigs etc.)*

YesNo
If you board small domestic pets, please list the type of pets that you board. Please note, cover cannot be provided for birds and reptiles.*
Do you board any council stray animals?*

YesNo
Do you undertake any dog warden activities?*

YesNo
Do you undertake any animal rescue activities?*

YesNo
Do you board any police seized dogs that may include banned breeds?*

YesNo

Please declare your annual turnover from the following activities. If you do not undertake an activity, please leave blank. *

	Turnover
Commercial boarding (this should include overnight and day boarding)
Grooming on non-boarded animals
Home visits or home boarding
Microchipping
Dog walking (including hiring of secure dog walking facilities at the premises)
Hydrotherapy
Non-invasive therapies
Training activities
Breeding activities (you may require a separate licence for this)
Pet crematorium facilities
Retail sale of pet related products (all feedstuffs must be sold in the manufacturer's original packaging)
Quarantine facilities

Do you offer any pet photography or pet wedding services?*

YesNo
Do you hold or attend any shows or events? (maximum number of 150 attendees for on-site shows)*

YesNo
Non-negligent Cover
Do you require cover for non-negligent related incidents? (cover up to £5,000 per claim, subject to a minimum £50 excess)*

YesNo
Employers' Liability

Limit of indemnity £10,000,000
Do you have anybody working for your business? (i.e. employed, self-employed, sub-contracted, voluntary)*

YesNo
Please state your total annual wage roll paid to staff:*
Do you take on work experience placements?*

YesNo
If yes, how many at any one time? *
Property - Buildings
Is buildings cover required?*

YesNo

If you have answered No to any of the above, please provide full details below:
Please give details of construction, including roofing materials and the rebuild value of each building you require cover for. *
Is the property a Grade I or Grade II listed building? (or Category A if in Scotland)*

YesNo
Please describe, in as much detail as possible, the construction of each building for which cover is required. Please include information about any flat roof areas or basements and the amount it would cost to rebuild each building. Note: If there has not been an inspection of flat roof areas carried out in the last two years, you will be required to have one completed within 45 days of the start date of the policy and any defects remedied as soon as possible. *
Property - Contents
Is contents cover required?*

YesNo

Are all external doors (other than any designated fire exit) secured by a key operated lock which engages with the door frame and can be engaged from both sides or a security hasp and locking bar secured by a 5 level close shackle padlock?*

YesNo
Are all designated fire exits secured by a panic bar locking system incorporating bolts which engage both the head and sill of the door frame or a mortice lock having specific application for emergency exit doors and which is operated from the inside by means of a conventional handle or thumb turn mechanism?*

YesNo
Are all windows and skylights which are accessible from the ground or easily reached by climbing, secured by means of a key-operated locking device or permanently screwed shut or protected by solid steel bars (less than 10cm apart) or metal grilles?*

YesNo
Are all contents kept in a locked building when out of use?*

YesNo
If you have answered No to any of the above, please provide details below:
Has there been an inspection of the electrical installations at the premises in the last 5 years? Note: If there has not, you will need to have an electrical inspection carried out by a suitably qualified electrician with 90 days of the start of the policy and any defects remedied as soon as possible.*

YesNo
Do you have an intruder alarm?*

YesNo
If yes, was it installed by a National Security Inspectorate (NSI) or the Security Systems and Alarms Inspection Board (SSAIB) registered company?*

YesNo
If yes, is it connected to a central station by means of BT RedCare or equivalent?*

YesNo
Property - Away and in transit
Is cover required away from the business premises or while in transit? (Within the United Kingdom, The Isla of Man or The Channel Islands)*

YesNo

Money and assult
Is cover required for money and assult?*

YesNo
Loss of licence
Is cover required for loss of licence?*

YesNo
Section 9 - Business Interruption
Is cover required for loss of revenue?*

YesNo
The required indemnity period:*

12 months24 months36 months
Total annual turnover from all business activities:*
Professional Indemnity

Professional Indemnity covers you for claims made for costs and expenses that arise from your business activities as a direct result of the advice you give and / or work supplied.
Is Professional Indemnity cover required?*

YesNo
If yes, do you belong to any trade professionals associations?*

YesNo
If yes, please provide details:
How many years have you been in practice?*
How many years of experience do you have prior to setting up your own business?
Do you or any employees give professional advice for a fee?*

YesNo
If yes, please provide details:
Have there been any claims or complaints against you or your business in respect of animals in your care during the last 3 years?*

YesNo
If yes, please provide details:
Are you aware of any events which may lead to a claim being made against you or your business?*

YesNo
If yes, please provide details:
Personal Accident

Personal Accident covers an injury sustained during the course or in connection with your business activities (as described in the policy business description). All people to be covered must be aged between 16 and 75 and live in the UK.
The benefits are as follows:

Capital benefit amount: Up to £10,000

Weekly benefit amount: Up to £100

Total event limit: £1,000,000

Maximum absence period: 104 weeks

Minimum absence period: 2 weeks

Additional covers (in addition to the overall limit of indemnity stated above)

Recruitment expenses: £10,000

Retraining expenses: £10,000

Funeral expenses: £5,000

Medical expenses: £10,000

Physiotherapy treatment expenses: £5,000

Workplace alteration expenses: £5,000

Counselling expenses: £5,000
Is Personal Accident cover required?*

YesNo
Is Personal Accident cover required for all staff members?*

YesNo
If yes, how many members of staff have you have in total?

Is each person to be insured, to the best of your knowledge and belief, in good health and free from physical and mental defect?*

YesNo
If no, please provide full details:
Other policies available to you
We are able to provide specialist home insurance for those who are using their home for business purposes, as most insurers will not cover this. Would you like to to contact you regarding a quote?*

YesNo
If yes, please provide your renewal date below:

MonthDayYear
Date
Legal Expenses & Business support

We are able to provide a commercial Legal Expenses policy & business support package at the cost of £57.04 for the year. A copy of the policy wording is available if you require full details of the terms and conditions of this policy.
Would you like us to provide details of the Legal Expenses policy?*

YesNo
Declaration

By signing this document you are confirming that all the information provided is correct and true. If any of the information within the documents provided is incorrect, you must advise us as soon as possible. We reserve the right to change the terms and conditions, premium, or withdraw this quotation if any information changes or is found to be incorrect.
Name*

First NameLast Name
Signature*

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How would you prefer to be contacted by Cliverton?*

PhoneEmail
Where did you hear about Cliverton? *
If 'other', please state where: *
Would you like to receive news and updates from Cliverton?*

YesNo
Data Protection Act

By accepting your insurance policy, you consent to us using the information we hold about you for the purposes of providing insurance and handling claims. This may involve processing sensitive personal data about you where it is necessary (for example health information or criminal convictions). This may mean we have to give some details to third parties involved in providing insurance cover. These may include insurance carriers, third party claims adjusters, fraud detection and prevention services, reinsurance companies and insurance regulatory authorities. Where such personal information relates to anyone other than you, you must obtain the explicit consent of the person to whom the information relates. This consent must cover both the disclosure of such information to us and its use by us as set out above. The information provided will be treated in accordance with the UK Data Protection Act 2018. You have the right to apply for a copy of your information (for which we may charge a small fee) and to have any inaccuracies corrected.
Should be Empty:

	Yes	No
a. in a good state of repair?
b. detached from neighbouring properties?
c. heated by fixed oil, electric or gas fittings?
d. in an area free from any history of flooding?
e. free from any signs of damage by subsidence, ground heave or landslip?

	Sum insured
General contents (to include all small tools and electronic equipment kept permanently at the business address)
Stock, Bedding & Feedstuff (to include all retail stock and frozen or refrigerated stock)
Machinery & Implements (to include all static hydrotherapy equipment)
Trailers (at own premises only)

	Sum insured
General property in transit
Mobile phones, laptops & computers
Trailers (away from premises)
Hired-in property
Hired-out property
Portable tools (including hydrotherapy or ultrasounds equipment to be used away from the business premises)

	Name	Date of Birth
1.
2.
3.
4.

Duty of disclosure of Material Facts (Duty of Presentation)

Section 1 - Proposer Details

Licence Details

Insurance and Claims History

Your Insurance Requirements

Public and Products Liability

Non-negligent Cover

Employers' Liability

Property - Buildings

Property - Contents

Property - Away and in transit

Money and assult

Loss of licence

Section 9 - Business Interruption

Professional Indemnity

Personal Accident

Other policies available to you

Legal Expenses & Business support

Declaration

Data Protection Act