Commercial Property Proposal

    1

    Proposer Details

    2

    General Questions

    3

    Property Situations

    4

    Fire Events & BI

    5

    Covers - Security - Declaration

    1) Your Details

    2) Interested Parties

    3) Period of Insurance Requested

    Cover is not in force until the insurer has accepted the proposal.

    4) General Questions

    If more than one person, director, company or entity comprises the insured, all questions apply to all persons.

    Loss or Damage History - last 5 years

    Date of LossCause and DescriptionAmount $Applicable Excess $Insurer

    5) Situation(s) of Property to be Insured

    6) Property Details

    Occupancy and construction details for each situation.

    Situation 1Situation 2Situation 3
    Occupancy
    Construction
    Walls
    Frame
    Roof
    Floors - Ground
    Floors - Other
    No. of storeys
    Approx. age

    7) Fire and Defined Events

    If No you will be insured for reinstatement or replacement value. Enter sums below.

    Situation 1Situation 2Situation 3
    Building including fixtures and fittings$ $ $
    Plant - Machinery - Leasehold improvements - other Trade Contents$ $ $
    Stock - Merchandise$ $ $
    Removal of Debris$ $ $
    Extra Cost of Reinstatement$ $ $
    Other (Please specify)
    $
    $
    $
    Total sum insured$ $ $
    Situation 1Situation 2Situation 3
    Sum insured$ $ $

    8) Business Interruption

    Situation 1Situation 2Situation 3
    Indemnity Period
    Insured - Gross Profit or Gross Revenue$ $ $
    Payroll 100 percent (where insured separately)$ $ $
    Payroll (Dual Basis)$ $ $
    Additional increased cost of working$ $ $
    Professional fees and claims preparation costs$ $ $
    Loss of Rent for months
    $
    $
    $
    Other (Please specify)
    $
    $
    $
    Total sum insured$ $ $

    9) Theft - Burglary Cover

    Situation 1Situation 2Situation 3
    Stock (excluding tobacco products)$ $ $
    Tobacco - Cigars - Cigarettes$ $ $
    Trade Contents (other than Stock in Trade)$ $ $
    Theft without forcible and violent entry$ $ $
    Other (Please specify)
    $
    $
    $
    Total sum insured$ $ $

    10) Money Cover

    Situation 1Situation 2Situation 3
    Money in Transit$ $ $
    Money on the Premises - During Business Hours$ $ $
    Money on the Premises - Outside Business Hours (not in safe)$ $ $
    In locked safe or strongroom$ $ $
    Money in Private Residence$ $ $
    Damage to Safes or Strongroom$ $ $
    Total sum insured$ $ $

    11) Accidental Breakage of Glass

    Situation 1Situation 2Situation 3
    External Glass
    Internal Glass
    Cost of temporary shuttering$ $ $
    Cost of sign writing or ornamentation on glass$ $ $
    Damage to stock from breakage of glass$ $ $

    12) Fire Protection

    Situation 1Situation 2Situation 3
    Are the premises sprinkler protected
    If Yes, maintained under a service contract
    What type of supply
    Fire hydrants located throughout the premises
    Fire blankets
    Hoses and reels
    Fire extinguishers
    Hard wired thermal - smoke detectors


    Area coverage percent
    Fire alarm installed
    If Yes, Local - Connected to Fire Brigade - Connected to Security Company
    Name of Monitoring Company
    Area Coverage percent
    Are premises on town water supply
    If No, provide full details of water source
    Distance km to nearest Fire Brigade
    Is Fire Brigade permanently staffed
    If Yes, how are they protected

    13) Security

    Situation 1Situation 2Situation 3
    All perimeter doors deadlocked
    All perimeter windows protected by bars or grills
    Any skylights in the roof
    Random visit Security night patrols


    PIR - Motion Detectors
    Local sounding alarm only
    Alarm connected to monitoring company
    If Yes, what type of system
    Who is notified when the alarm is activated
    Monitoring company has access to investigate alarm activation
    Other security measures

    14) Cooking

    Refer to the Cooking Questionnaire at www.penunderwriting.com.au/property-policy-proposals

    15) Woodworking

    Refer to the Woodworking Questionnaire at www.penunderwriting.com.au/property-policy-proposals

    Declaration

    I declare that:

    • I am authorised by each of the Applicant(s) to sign this Proposal.
    • The statements in this Proposal are true and complete and no material information has been withheld.
    • I have read and understood the Important Notices accompanying this Proposal.
    • I have diligently made all necessary enquiries in order to comply with the duty of disclosure.
    • I have read the Pen Underwriting Privacy Statement on this Proposal and consent to the use, disclosure and obtaining of personal information for the purposes shown in the Privacy Statement.
    • Where I have provided information about another individual, that individual has been made aware of that fact and of the Privacy Statement.
    • I acknowledge Pen Underwriting relies on the information and representations in this Proposal.
    • Except where indicated to the contrary, any statement made in this Proposal will be treated as a statement made by all persons to be insured.
    • I will notify Pen Underwriting of any material alteration prior to inception of the proposed insurance.
    • I understand that no insurance is in place until acceptance is confirmed by Pen Underwriting.