Risk Presentation

Please consult with senior colleagues and management in the completion of this form.

Who is completing this Form: Job Title:
Business Name: Trading Name:
Phone number: Email:
Mobile: Correspondence Address:
Risk Address (if different): Registration Number (if applicable):
Employee PAYE Reference Number (if applicable): From which date would you like the cover to start from:

In which sector/industry is your business based:

Please provide some details:

Do you require a package policy concerning loss or damage to buildings owned by This Business/You including loss of rent and property owners liablity?YesNo A package policy covering loss of or damage to property occupied as tenant by the business in:

Please provide some details:

What type of insurance do you would you require:

Let us know what your business does to help you find the right insurance coverages:

What is the Legal Status of this business:
From whom are we permitted to accept instructions in relation to the proposed insurance:Partners/DirectorsProfessionalAdvisorsStaffBanks/Lenders

Trading History
How long Approximately has the business traded: Years at this Risk Address?: Years at another Address?: Is the Business Muti Location:YesNo

Cancellations, Refusals & Declined Past Policies
Has any insurer declined to accept, cancelled or refused to continue any insurance of this nature with the proposer:YesNo

Please Provide Details:

Has the Business ever been prosecuted under the Factories Act 1961, Health & Safety at Work Act 1974, the Consumer Protection Act 1987 or any other statutory regulations?:YesNo

Please provide details:

Insurance Current / History
Do you have a current insurance Policy:YesNo

Insurer: Renewal Date:

Have you had any insurance claims or incidents that would give rise to a potential claim:YesNo

If you have had any insurance claims or incidents that would give rise to a potential claim, please list them below (Excluding Motor Claims):

Date Type Circumstances Settlement Outstanding


Has any Principal, Partner or Director or any senior management within the last 5 years made an insurance claim, had an insurance proposal declined or been charged with a criminal conviction:YesNo

These questions are about the people who own manage or run the business.

Has any Principal, Partner or Director or any senior management ever been made bankrupt, or been in a business that has been sequestrated, liquidated or placed into administration?:YesNo

If Yes, Please Provide Details:

Claims History for Principal, Partner, Director or senior management .

Please note the following question is about the insurance history of the individuals owning, controlling or running the business either in their personal capacity for other business interests (i.e. other directorships, past or present).

Has any Principal, Partner or Director or any senior management sustained any insurable/ physical loss or damage during the last five years in a personal or business capacity in excess of £25,000.?YesNo

If Yes, Please Provide Details:

Have the people of the business made any insurance claims within the last five years:YesNo

Please provide details of Claims Experience of people over the last 5 years:

Date Insurer Circumstance Settlement Outstanding Amount

Has any insurer refused to continue, cancel or decline insurance cover for any Principal, Partner or Directors or senior management of the Business?YesNo

Please provide details:

Criminal Convictions
Some convictions are regarded as ‘spent’ under the terms of the Rehabilitation of Offenders Act 1974 and need not to be disclosed in applying for insurance.

"If you are in doubt about whether a conviction is ‘spent’ please consult with your legal advisors.” Has any Principal, Partner or Director or Senior Management ever been convicted of or charged (but not yet tried) with arson or any offence involving dishonesty of any kind (e.g. fraud, robbery, theft or handling stolen goods)?YesNo

If Yes, Please Provide Details:

The Next Twelve Months

Do you have annual wages, salaries and payments to be made either in a Full or Part Time Capacity:YesNo

Please Provide Estimated annual wages, salaries and all other payments for the next twelve months Full time/ Part Time:

Working Premises Working Away
Activity Number Wageroll Number Wageroll
Clerical, Non Manual & Managerial
Delivery Drivers
Woodworking Machinists
Working at Height
Working at Depth
Working with Hazardous Substances (e.g. Asbestos)
Naked Flame & Heat Work
Power Driven Machinery
Other Manual labour
Payments to Bona Fide Sub Contractors
Payments to Labour Only Sub Contractors

If you use Labour Only Subcontractors - what do they do?:

Other Manual Workers - what do they do?:


Do you wish to insure property with your insurances?YesNo

What is the property used for? Are you the sole Occupier of this risk address?YesNo Are Adjoining Properties surrounding the premises Occupied?YesNoUnknown In the premises are there occupants above or below you?YesNoUnknown Are there any unoccupied areas at the risk address?YesNoUnknown If there are operational businesses surrounding/ above or below your premises please list the trades these businesses operate in:
Fire Prevention
Are you aware if a Fire Risk Assessment has been carried out on your premises?YesNoUnknown

If so, when was it carried out?

Can you confirm the premises have appropriate Fire Extinguishers?YesNo Are these are subject to an annual maintenance contract?YesNo Do you have a kitchen Fire Risk Assessment in place?YesNo Do the premises have a sprinkler system?YesNo Do the premises have a Fire Alarm system?YesNo If Yes, Is this linked to remote alarm signalling?YesNo Do the premises have a smoke detection system and is this linked to remote alarm signalling?YesNo Is a thorough inspection conducted at the close of the business to allow for smoldering matches, tobacco or other material as part of a closing procedure?YesNo

Is the building in a recognised Flood Area?YesNoDon't know Have there been any cases of Flood at the premises or in the vicinity?YesNoDon't know Please provide details:

Construction of the Premises Roof type: Please provide details: Is any part of the roof flat?YesNo What %? What are the Walls made of? What is the Floor made of?

State of repair:Excellent (Constant maintenance programs)Adequate (As and when required)Don’t know Age of premises? No of stories in total? Stories occupied by you? Is the building listed?YesNo Is there Composite Panelling?YesNo What (%)?

Are there any subsidence Issues at the property or in the area that you are aware of or have been reported?YesNoDon't know

Further Details:

Is there is a basement?YesNo

Is the Basement Used?YesNo

Is stock kept in the basement?YesNo If so, Is stock kept at least 10cm off the floor?YesNo Do security measures extend to the basement?YesNo Please provide info about stock and usage of basement:

Electrical Installation
When was the electrical system installed?

When was it last inspected?

Do you have a valid PAT Test Certificate for your premises?YesNo

When was the Certificate issued?:

*Please provide certificates when submitting your Risk Presentation

How is the premises heated?

Are there any gas, paraffin portable heaters on the premises?YesNo

If there are gas or paraffin portable heaters, please provide details:

Physical Security
Please complete the following questions, soley in relation to security directly and completely under your control. Please advise how each of the following are protected:

Alarm Contact Locks Grills Bars Bolts Shutters
Final Exit Door Yes Yes Yes Yes Yes Yes
Rear Exit Doors Yes Yes Yes Yes Yes Yes
Fire Door Yes Yes Yes Yes Yes Yes
Windows Yes Yes Yes Yes Yes Yes

Is there a fire resistant cabinet in the premises?YesNo

Passive Security Systems
Alarm System Is there a burglar alarm installed on your premises?YesNo Is the Alarm Installer registered with NICEICYesNo Does the alarm system communicate externally?YesNo Method of Signalling:Bells OnlyRedCareOther

Please specify other:

System Is there a CCTV system fitted to the premises?YesNo Is there an external local authority CCTV system monitoring the vicinity?YesNo Please advise of any other security measures not under your direct control (e.g. security patrols, guard dogs etc):

Is waste removed from the premises:YesNo

How often is waste removed from the premises?MonthlyFortnightlyWeeklyDaily How far from the premises is the waste stored? Is the waste removed kept in metal containers?YesNo

If not kept in metal containers how is waste stored?

Frozen Food
Are all refrigerated units subject to an annual insurance maintenance contract?YesNo

Is Cash kept on the Premises:YesNo

How much Cash is kept at the premises? Is Money moved between your Premises and the Bank?:YesNo

How much is usually moved? How often? By how many people? Do you take cash home?YesNo *Please be aware only monies directly moved between your premises and the bank will be covered by your insurances.

Safe details
Do you have a safe?YesNo

Make/ Model: Insurance Rating (if known): How much money is kept in the safe (at peak trading overnight)?

Do you use forklifts:YesNo

How many forklifts are in operation:

Are your forklifts used on public highways:YesNo

Are forklifts:

If you have charging stations for forklifts are they charged overnight:YesNo

Are the charging stations at least 5m from any combustible materials:YesNo


Business Activities
Please provide a full description of Business Activities: Are there any manufacturing processes carried out on the premises?YesNo

If Yes, What manufacturing processes are carried out

Are there any flammable oils or other hazardous goods stored or used on the premises?YesNo

If yes, please provide details

Does your business involve the use of Frying and Cooking Equipment:YesNo Is the Frying Range/Cooking Range annually serviced by a professional specialist contractor including the servicing of the extraction fan and motor?YesNo

If so, who cleans it?

Do you have a valid Duct Cleaning Certificate:YesNo

Date of Last Certified Clean: *Please provide certificates when submitting your Risk Presentation

Alcohol License
Is an Alcohol License involved in your business operations:YesNo

Do you hold an alcohol license?YesNo To your knowledge, have there been any objections to the license during the last five years?YesNo Have the present owner(s) or manager(s) been refused a license at any time?YesNo Are there any circumstances known to the proposer that might prejudice the continued holding of a license?YesNo Please provide details:

Contractors & Turnover

Do you ensure that all subcontractors engaged have at least the same level of Liability insurance in force as you and do the limits match those of the proposed insurance?YesNo

How often do you check this is the case?AnnuallyAt Project Start

Goods Transported within the United Kingdom
Do you collect or deliver stock?YesNo

If so, do you use your own vehicles?YesNo

If so, how many vehicles do you own?

Do you use couriers?YesNo

If so, how frequently are couriers used?DailyWeeklyBi-WeeklyMonthlyQuarterlyYearly

What is the maximum value in transit in any one vehicle?

What is the maximum value in transit in any one consignment?

Business Process & Employee Exposure

Do your activities expose your employees to any of the following: Excessive noise, Working at Height or Depth, Power Driven Machinery or Heat Work? YesNo

Does Your Process Involve Yes / No % of Turnover
Turnover Excessive noise (higher than 80db): YesNo
Working at height: YesNo
Working at depth: YesNo
Working with naked flame (away from premises): YesNo
Heat work away from your premises: YesNo
Power Driven Machinery: YesNo
* High Risk Locations: YesNo

* High Risk Locations Include Airports, Offshore Installations, Dams, Quarries, Railways, Nuclear Power Stations

Importing / Exporting
Does your Business:Not Import nor ExportImport & Export

If so, do you Import DirectlyIndirectlyBoth
Please provide information on the turnover generated by the business in the following geographic locations.

Area % Turnover
European Union
North America
United States
Rest of World

What are your sending methods for Goods: When Importing do you have legal recourse against manufacturers?YesNo

Do you have any representation outside the United Kingdom?YesNo Have you supplied any goods or services for the nuclear, aerospace, marine or offshore industries?YesNo

If so, please provide details:

Does your business involve the use of toxic and/or hazardous goods, materials, substances and/or waste?YesNo

If so, please provide details:

Does your business result in any impairment of the environment e.g. chemical effluents, fumes etc?YesNo

If yes, please explain:

Have you ever been fined/ cautioned/ prosecuted by any environmental agency?YesNo

If yes, please explain:

Computers & Data
Do you have Security controls in place (Antivirus/Malware Protection, Firewalls, Network Access Controls): YesNo Do you have Backup and recovery procedures in place for all mission critical systems, data and information assets:YesNo Do you have processes in place for managing and installing patches on all systems and assets:YesNo Do you have processes in place to ensure that all confidential data is encrypted on all portable devices:YesNo Do you store more than 100,000 records containing personally identifiable information:YesNo Do you have any knowledge of any security failure, operational failure or data breach that would otherwise have been the subject of a claim or loss under a Cyber policy:YesNo

Assets & Liabilities

Item Sums Insured (£)
Tennants Improvements
Loss of rent cover 12 months24 months36 month
Stock of Alcohol
Stock of Tobacco
Stock in the Open
Stock of Alcohol
High Value attractive Stock
All other Stock
Chilled & Frozen Foods
External and Illuminated Signs
Fixtures & Fittings
Machinery, Plant & Equipment
Electrical Equipment
Portable Devices

Sums Insured
Money in the Premises outside Business Hours: (Not contained in locked safes or strongrooms): Private residence: In the Premises outside Business Hours (Contained in locked safes or strongrooms): On the Premises During Business Hours: In Transit: In a gaming, amusement or vending machine:

Goods In Transit within the United Kingdom
In Transit (any one conveyance):
Business Interruption
Annual Gross Profit: Indemnity period:6 Months12 Months24 Months36 Months Annual Increased Cost of Working: Indemnity period:6 Months12 Months24 Months

Annual Turnover and/or fee income of the business in the last 12 months: Employers Liability Cover:£10 Million Public Liability Cover:£5 Million£10 Million Products Liability Cover:£5 Million£10 Million Management Liability Cover:£100k£250k£500k£1million Cyber Liability Cover:£250k£500k£1million£5million Professional Indemnity Cover:£250k£500k£1million£5million

Material Facts & Declaration

Are there any other material facts (see proposal introduction and declaration below) not already disclosed affecting or likely to influence acceptance or assessment of this proposal by underwriters?


I have read and checked this proposal for completeness and accuracy. To the best of my knowledge and belief, I confirm that the information given, whether in my own hand or not is complete and accurate.

I understand that this proposal does not bind the Proposer to complete the insurance but, if accepted, this proposal will form the basis of the contract between the Proposer and the Underwriters.

I understand that any material misrepresentation or non-disclosure may lead to avoidance of the insurance by the Underwriters. I understand that any information provided to the Underwriters regarding the Proposer will be processed by the Underwriters, in compliance with the provisions of the Data Protection Act 1988, for the purpose of providing insurance and handling claims which may necessitate providing such information to third parties.

Have Colleagues contributed to the completion of this Risk Presentation Proposal:Yes

Please Provide Details of Colleagues who contributed to this Risk Presentation:

Name Position

I confirm that I am duly authorised by the Proposer to make this declaration.

Printed Name: