Bespoke Cover Insurance Proposal Form – The GoJD Members' Portal

Member Insurance Policy Proposal Form for Bespoke Cover

A tailored policy for members with more in-depth requirements than simple PPL cover.

Your Details

Please enter your full details

* Title

* Your Name

Trading or Company Name (if applicable)

* Correspondence Address:

* Telephone No:

Mobile No:

* Email Address:

Website Address:

* Legal Status:

GoJD Membership No:

* Membership Level Silver (Free) Gold

* Please give a brief description of your business including details of materials and processes you commonly use: (1000 chars left)

Year Started

Current Insurer:

Renewal Premium Amount

* Date to Start Insurance

* Date Insurance ends (both dates inclusive)

Cover Required Section 1 - Work and Materials

* Is Cover Required For Work and Materials?

What is the maximum value of finished work, work in progress and materials in your premises at any one time (excluding specified materials below)? (See hint)

What is the maximum value of finished work, work in progress and materials in your premises at any one time including precious metals, precious stones and jewellery?

Maximum value of any single item of work?

* Do you want to extend cover to insure work and materials away from your premises (inc. whist in transit and at exhibitions worldwide)?

If yes, what is the maximum value of work and materials away from your premises at any one time?

Section 2 - Tools, Equipment and Other Property

* Is cover required for Tools, Equipment and Other Property?

Address of Studio Premises - See hint

Computer Equipment Cover Value Required?

Tools, Equipment and all Other Contents Value?

Goods Held in Trust Value? (Excluding precious metals, precious stones and jewellery) See hint

Goods Held in Trust Value? (Including precious metals, precious stones and jewellery) See hint

Studio Buildings Value? - See hint

Studio Improvements value? (See hint)

Portable Property Values Used Away From Your Studio

(A) Tools and Equipment UK/Europe Sum Assured

(B) Tools and Equipment Worldwide Sum Assured

(A) Portable Computer Equipment Value UK/Europe Sum Assured

(B) Portable Computer Equipment Value Worlwide Sum Assured

(A) Any Other Property Value? UK/Europe Sum Assured (See hint)

(B) Any Other Property Value? UK/Europe Sum Assured (See hint)

Business Interruption

Note: Cover under this section automatically applies if either Sections 1 or 2 have been selected, materials, tools, equipment and other property.

Do you require the annual gross profit cover increased from £50,000? (See hint)

Figure to increase to?

Increase Accounts Receivable figure from £5,000 - See hint

Figure to increase to?

Employers', Public and Products Liability

Employers Liability (See hint)

* Public/Products Liability

No. of Proprietors/Business Partners teaching, preparing and display of work excluding use of applied heat away from own premises, including open studios, open houses and exhibitions?

No. of Proprietors/Business Partners teaching, preparing and display of work including use of applied heat away from own premises, including open studios, open houses and exhibitions?

No. of Proprietors/Business Partners using fixed woodworking or metalworking machines?

No. of Directors and Permanent Employees (Inc Freelance Workers) teaching, preparing and display of static art excluding use of applied heat away from own premises, including open studios, open houses and exhibitions?

No. of Directors and Permanent Employees (Inc Freelance Workers) teaching, preparing and display of static art including use of applied heat away from own premises, including open studios, open houses and exhibitions?

No. of Directors and Permanent Employees (Inc Freelance Workers) using fixed woodworking or metalworking machines?

Do you engage employees or freelancers on a temporary basis? - See hint

If yes, please indicate the estimated total number of days worked per year. - See hint

Estimated Employment Costs

In respect of the Period of Insurance requested above, please provide estimates for the following estimated payments to:

Clerical, Managerial and Non-Manual Workers

Manual Workers (Inc Freelancers) on own premises?

Employees using fixed wood or metalworking machines on own premises?

Manual workers (Inc freelancers) away from own premises? Category 1

Manual workers (Inc freelancers) away from own premises? Category 2

Manual workers (Inc freelancers) away from own premises? Category 3

Manual workers (Inc freelancers) away from own premises? Category 4

Estimated Turnover

In respect of the Period of Insurance requested above, please provide estimates for the following:

Estimated Turnover (excluding turnover derived from activities in or work supplied to the USA or Canada)

Estimated Turnover derived from activities in or work supplied to the USA or Canada

Additional Information

Previous Claims/LossHistory

Please disclose any insurance claims made in connection with your artistic practice in the previous 5 years:

Please also include details of any incidents that would have formed a valid claim under this policy even if no claim was actually made.

Add details here, dates, details amount claimed and if settled. (1000 chars left)

I/We declare that to the best of my/our knowledge or belief, the particulars and statements given in this document and any additional information provided to Hencilla Canworth are true and complete.

* Full name:

* Date

Verification

Thank you for submitting this form to request a quotation for a bespoke insurance policy.

The details have been passed directly on to our broker who will contact you with your quotation.

If you have any questions, please do not hesitate to ask.