Dealers Proposal Form
Proposer Details
Full Name
*
Address
*
Address Line 1
Address Line 2
City
County
Postcode
Telephone Number - Landline
*
-
Area Code
Landline Number
Telephone Number - Mobile
*
-
Area Code
Mobile Number
Email Address
*
example@example.com
Occupation
*
Date of Birth
*
/
Day
/
Month
Year
Date
Trading Name
*
Trading Style
Is the stock kept at the above address?
*
Yes
No
Please state address where it is kept:
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Cover Required
Total stock at premises (£)
*
Total stock at Bank Vault (£)
*
Total stock at exhibitions, stamp fairs & shows (£)
*
Total number of exhibitions etc. anticipated in one year
*
Total stock at any other premises in the UK (£)
*
Total stock while in transit anywhere in the world (£)
*
Estimated total value of annual sendings to the UK (£)
*
Estimated total value of annual sendings Overseas (£)
*
By whom was the last evaluation conducted?
Date of last evaluation
-
Day
-
Month
Year
Date
On what basis was the value of the collection determined?
Is a complete record of collection maintained?
*
Yes
No
Please state how exact amount of loss would be calculated?
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Premises Details
Is the address of where the stock is kept:
Self-contained and under sole control?
*
Yes
No
In good state of repair?
*
Yes
No
Built of brick, stone or concrete and roofed with slate, tiles, metal, asbestos or concrete?
*
Yes
No
Please provide details of construction
Are all external doors fitted with deadlocks to British Standard 3621?
*
Yes
No
I'm not sure
Please give details of locks:
Are all accessible windows fitted with window locks having removable keys?
*
Yes
No
Do you have a fire alarm maintained under contract?
*
Yes
No
Do you have an intruder alarm?
*
Yes
No
Please provide details
Is the stock kept in a safe, locked cabinet, locked showcase or fireproof cabinet?
*
Yes
No
Please provide details
Please provide details of the value which is stored OUTSIDE the safe, if applicable (£)
Please provide details of where it is stored
Do you have any other forms of protection i.e. Security guards, CCTV, strong rooms?
*
Yes
No
Please provide details:
*
Year property was built?
*
If applicable, which floor do you occupy?
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Insurance History
Have you sustained a loss for any of the risks now to be insured against?
*
Yes
No
Please provide details:
Is the stock presently insured?
*
Yes
No
Please state name of insurer
Have you ever had your insurance cancelled?
*
Yes
No
Have you ever had your renewal refused?
*
Yes
No
Have you ever had your premium increased?
*
Yes
No
Has your insurance ever been revised with addition Terms & Increased rates?
*
Yes
No
Have you ever had any losses by any of the risks to be covered within the last five years?
*
Yes
No
Please give details:
Optional cover:
Please complete where required
Office Contents - Value of office contents (£):
Declaration
*
To the best of my knowledge and belief the sums insured above represent the full value of the property to be insured. The information provided in connection with this proposal application, whether in my hand or not, is true and I have not withheld any material facts. I understand that non-disclosure or misrepresentation will entitle the insurers to void the insurance. I understand that the signing of the proposal/ application does not bind me to complete the insurance but agree that should a contract of insurance be concluded, this proposal/application and the statements made therein shall form the basis of the contract.
Form Consent
*
This information will be stored and processed for the purpose of this enquiry and will not be shared, transferred or sold without consent.
Signature
Date
*
/
Day
/
Month
Year
Date
Submit
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