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CI

CRAFTSINSURE PROPOSAL FORM

Full Name of Proposer: ..........................................................................................

Address: .................................................................................................................

................................................................................................................................

Tel No.(Business): ............................................................ (Home): .......................

Goods Made: .........................................................................................................

NO

YES

Have you or any person directly connected with the ownership or management of the Business ever been convicted or accused of arson, fraud, theft, receiving stolen goods or other acts of dishonesty? Disclosure. You are not required to disclose convictions as ‘spent’ by virtue of the Rehabilitation of Offenders Act 1974.

1

D SUM INSURED

£10,000

Recovery under Section 1 (iv) of the policy will not exceed 50% of the Sum Insured (unless Transit One or Two selected)

}}}}

C SUM INSURED

£7,500

PLAN

B SUM INSURED

£5,000

A SUM INSURED

£2,500

SUMMARY OF STANDARD COVER SECTION 1

PROPERTY

Property meaning stock and materials in trade, machinery and tools of trade and display stand tables, etc, will be covered against loss by:

Fire, Lighting, Explosion, Earthquake, Aircraft, Riot, Strikers, Civil Commotion, Malicious Damage, and Impact:

(i)

during business hours whilst on display and during transit anywhere in U.K. between 05.00 hrs. and 22.00 hrs.

a)

b)

Fire, Lighting, Explosion, Earthquake, Aircraft, Riot, Strikers, Civil Commotion, Malicious Damage, Impact, Storm, Flood and Burst Pipes whilst contained in your private dwelling or any other building used in the course of your business.

(ii)

(iii) Theft following forcible and violent entry to or exit from any building (including your private dwelling) whilst not trading, day or night. (iv) Theft following forcible and violent entry to or exit from a vehicle whilst in transit between 05.00 hrs. and 22.00 hrs. anywhere in the U.K. subject to any loss shared equally with your Insurer, (i.e 50% Co-Insurance).

NO

NO

YES

YES

If “Yes”, give full details on a separate sheet.

(a) Has any insurer ever declined or refused to renew your Insurance, Increased the premium, modified the cover or made special stipulations?

(b) In respect of any risk to be covered by this insurance, have you ever suffered loss or incurred liability?

2

£10,000

£7,500

£5,000

£2,500

SECTION 2

BUSINESS INTERRUPTION Loss of trading profit will be covered for up to 3 months during the Period of Insurance if the Business is interfered with or interrupted as a result of a loss insured under Section 1 occurring at your private dwelling or any other location where you are trading or whilst in transit, including denial of access and public utilities extensions.

SECTION 3

If “Yes”, give details including the name of any Insurer concerned on a separate sheet.

Please circle the plan/extension you require: ABCD

TRANSIT ONE / TWO / OVERNIGHT THEFT FROM MARQUEES / ROBBERY NOTE: The plan selected must represent the full value at risk.

is enclosed

The annual premium of £

Cheques should be made payable to G.M. Imber Limited

£10,000

£7,500

£5,000

£2,500

£5,000,000 any one occurrence and unlimited in any one Period of Insurance

Limit of Indemnity:

PERSONAL ACCIDENT The Benefits shown will be paid in the event of accident causing death or permanent loss or permanent total loss or use of one or two limbs or the total and final loss of sight of one or both eyes within 12 months of the accident. Cover applied to first named proposer only covered 24 hours per day, 365(6)

days per annum. Benefits:

SECTION 4

PUBLIC LIABILITY Covers your legal liability to third parties for personal injury or damage to property. You will be responsible for the first £250 each claim for Third Party Property Damage, EU only.

DECLARATION I declare that all the statements and particulars made with regard to this proposal, which I have read and checked, are true. I have not suppressed, omitted, misrepresented or mis-stated any material fact and I agree that this declaration shall be the basis of the contract between me and the Insurer. (Note: A material fact is one likely to influence acceptance or assessment of this proposal by the Insurer: if you are in any doubt as to what constitutes a material fact you should consult G M Imber Ltd)

£5,000,000 any one occurrence and in all in any one Period of Insurance

£10,000,000 any one occurrence (including costs and expenses) and unlimited in any one Period of Insurance

Limit of Indemnity:

Limit of Indemnity:

SECTION 5

PRODUCTS LIABILITY INCLUDING FOOD AND DRINK POISONING Covers your legal liability from the sale or supply of products including food and drink. You will be responsible for the first £250 each claim for Third Party Property Damage, EU only.

SECTION 6

EMPLOYERS’ LIABILITY Covers your legal liability for injury, death or disease sustained by employees at work.

Signature: ....................................................................... Date: ............................

£330

£180 £255

£119

ANNUAL PREMIUM (PER TRADER) INCLUDING INSURANCE PREMIUM TAX AT 5%

Date insurance to commence: .............................................................................. Please separate and return this completed proposal with your payment to:-

HIGHER SUM INSURED ? 020 7231 5005

G.M. Imber Limited Grange House, Grange Walk, London SE1 3DT

ADDITIONAL PREMIUMS including Insurance Premium Tax at 5%

£26 £52 £78 £104

£520

£390

£260

£130

£208

£156

£104

£52

OPTIONAL EXTENSIONS

EXTENSION: “TRANSIT ONE” Extends Section 1 (iv) by removing the 50% Co-Insurance provision.

(1) Clothing and Leather goods OR

(2) All Other (ex that normally excluded - see overleaf)

EXTENSION: “TRANSIT TWO”

Extends Section 1 (iv) by removing the 50% Co Insurance provision AND providing 24 HOURS All Risks cover whilst in transit (see summary of cover overleaf).

IMPORTANT NOTICE

£100

£75

£50

£25

You will be responsible for the first 10% of each and every loss

Theft of Craft Stock between the hours of 22:00 hrs and 05:00 hrs.

EXTENSION: “OVERNIGHT THEFT FROM MARQUEES” (see summary of cover overleaf).

The liability of the Insurer does not commence until this proposal has been accepted by the Insurer and the premium payment cleared. The term Insurer in this prospectus and proposal refers to Brit Insurance Limited.

1.

2.

£1000

£30

£500

£15

£250

£10

Cover (Circle limit required)

Additional Premium incl IPT @5%

Loss of Business Money by Robbery between 05.00 hrs and 22.00 hrs

EXTENSION “ROBBERY”

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