Address of the premises to which the Policy is to apply
N.B. Unless otherwise agreed on the Policy Claims in respect of your own stock will be settled on the basis of Cost Price. All figures completed in this proposal must reflect the basis of valuation required.
5.STOCK VALUES (a) What was the average total value during the last twelve months of:
The total under (i) and (ii) comprises approximately:
7.WINDOWS DISPLAY (A) How many of these are there?
(B) Give MAXIMUM values which will not be exceeded of: (a) Any one
8.EXHIBITIONS & DISPLAYS (a) (i) Did you during the past 12 months exhibit any portion of your stock at any exhibition other than one promoted or financially assisted by any public authority or by any Trade Association or entrusts goods for any display or performance? YesNo
(ii) If so, give full particulars including values
(b) (i) Do you exhibit goods, in any showcase in any hotel, club or elsewhere away from your premises? YesNo
(ii) If so, give full particulars including values and details of protections (i.e. type of glass, locks and the likes)
(c) Outside Limit (which also includes Sendings) What limit is required for any one loss for property elsewhere than at the Proposer's premises stated in question 1 (b) (This limit will not apply to property in any safe)
9.Are the premises occupied at night by any of the following: ProposerEmployeeCaretakerNone
10.Are there any openings leading to cellar or basement from outside the shop? YesNo If so, please give details and protection measures
11.Give details of the following and how they are protected
12.DISPLAY WINDOW & SHOWCASE PROTECTIONS (a) Give full details of the type of glass in all your display windows
(b) (i) Are all sections of the windows containing jewellery, gold, silver, platinum, pearls and precious stones and watches substantially partitioned off from the remainder of the display? YesNo
(ii) What precautions do you take to protect the rear of your display windows?
(iii) Are they kept permanently locked and keys removed? YesNo
(iv) Are interior showcases similarly locked and keys removed? YesNo
(c) AT NIGHT and at all other times when premises are not open for business (i) Are all display windows and/or outside showcases protected externally by shutters or a grill? YesNo
(ii) Give full particulars of such protections and state how they are secured
(iii) Does this protection cover the entire front of your premises? YesNo
(iv) If not give details
(d) During Business Hours: Are all your display windows and/or outside show cases containing jewellery, gold, silver, platinum, pearls, precious stones and watches protected internally either by:
(i) Fixed grilles covering the whole of the display? YesNo
If YES, give specification of these grilles
(ii) Hanging Glass suspended between the window glass and the display
(iii) Can the internal grills or the suspended glass be reached from under? YesNo
(a) Is there a Burglar Alarm? YesNo
(b) If so, give full details with name and a copy of maker's specification to underwriters
(c) Are hold-up/panic buttons incorporated in the system? YesNo
(d) Is the system maintained under contract? YesNo
14.MONITORING SYSTEMS Are the premises monitored by IC TVs? YesNo Are the premises monitored by Motion Detectors? YesNo Are the premises monitored by Seismic Detectors? YesNo Are the premises monitored by Recording System? YesNo If YES, please provide details
15.SAFES Was the safe new or second hand when purchased? NewSecond Hand
Is the Safe illuminated and visible from the street at night? YesNo
16.STRONG ROOMS Are ALL the keys (including Alarms, Safe & Strong Room) removed from the premises outside business hours? YesNo Are there any other special means of protection? YesNo If YES, please give details
Do you keep proper records of all sales purchases and transactions? YesNo
18.LOSSES Have you ever sustained a loss of or losses? YesNo If YES, give statement covering the past five years with particulars including the amount of each loss and if insured whether paid in full or otherwise
19.RECEIPTS Is it your practice to give receipts for goods left with you by non-trade customers for repair, valuation, sale or any other purpose and to require surrender of such receipts before goods are returned to the customer? YesNo Do you use entrustment / approbiation notes in respect of all entrustments? YesNo
20.CONTENTS FIRE RATE
21.SUMS TO BE INSURED
B) Carrying outside premises Within City Please ATTACH a file specifying names of all items and individual limits in the following format: Item No. | Name of Item | Limit Name of file should be " Carrying outside premises Within City " Only PDF, Excel & Word files accepted.
Carrying outside premises Within UAE (Not Applicable) Please ATTACH a file specifying names of all items and individual limits in the following format: Item No. | Name of Item | Limit Name of file should be " Carrying outside premises Within UAE " Only PDF, Excel & Word files accepted.
Carrying outside premises Outside UAE (Not Applicable) Please ATTACH a file specifying names of all items and individual limits in the following format: Item No. | Name of Item | Limit Name of file should be " Carrying outside premises Outside UAE " Only PDF, Excel & Word files accepted.
C) Sendings (Not Applicable)
D) Home Risk
F) Infidelity of Employees Please ATTACH a file with names of all specified employees in the following format: Sr. No. | Name | Nationality | Maximum Limit (AED) . Please add Total Aggregate Limit at bottom. Name of file should be " Infidelity of Employees " Only PDF, Excel & Word files accepted.
22.REFERENCES Unless proposing for renewal, give two references from your trade.
23.OTHER INSURANCE Have Llyods or any other insurer ever cancelled or refused to issue or to continue any insurance for you? YesNo Have you previously been insured? If so, state with whom, risks covered
24.OTHERS Are there any other circumstances or information within your knowledge or opinion that you would like to state?
I/We have read the above and agree that to the best of my/our knowledge and belief it represents a full and complete statement. I/We agree that if this insurance is completed the protections and or safeguards mentioned above shall not be withdrawan or varied to the detriment of the interests of the underwriters without their consent. We agree to the terms and conditions of the above declaration.