Within the last 5 years have you or any of your partners or directors in connection with any business which you/they have been involved had any losses whether Insured or not or had any claims made against you, other than rent guarantee?
Previous No Claims Discount
1. Years claim free for buildings claims:
2. Years claim free for contents claims:
Have you or any of your partners or directors either personally or in connection with any business which you/they have been involved, or has any business with which you or any of your partners or director have been involved, ever:
3. Been convicted of or charged with (but not yet tried) a criminal offence other than a motoring offence or a spent conviction in accordance with the “Rehabilitation of Offences Act 1974”?
4. Been disqualified from being a company director?
5. Been declared bankrupt or are the subject of any bankruptcy proceeding, liquidation, administration, IVA, any voluntary or mandatory insolvency or winding up procedures?
6. Had any County Court judgement or a Sheriff Court decree?
7. Been prosecuted or have prosecution proceedings under the Health and Safety Work Act or any other statute or regulation?
8. Had any insurance proposal declined, renewal refused, a policy cancelled mid-term by underwriters, a policy declared void, a claim repudiated, or had any special or increased terms applied?
9. During the last 5 years have you been prosecuted or has any enforcement action, including any requirements for clean up or environmental restoration, been taken against you for contravention of any standard regulations or law relating to the release of any substance from any location into sewers, rivers, sea or onto land?
10. At the time of making this insurance application are you aware of any incident or circumstance that could reasonably be expected to have given rise to a claim, prosecution or enforcement action?
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Property Address (inc. PostCode)
Type of Building & Age
1. Building Type:
2. Is there a basement or underground parking?
3. What propotion of the roof is flat?
4. What is the lowest level the premises is situated on?
5. Approx what year was the building built ?
6. Are the premises Grade I,II III or A ,B or C or have any special historic importance?
7. Amount of Buildings Cover Required (Enter Building Declared Value):*
8. Amount of Landlords Contents Cover Required:*
9. Amount of Loss of Rent Cover Required for a 12-month period:*
10. Accidental Damage Cover Required?
11. Subsidence coverd required?
12. Employers Liability Cover Required?
13. Property Owners Liability Cover Amount (£2m included as standard):
14. Tenancy Type:
15. Do you have short term tenancy arrangements at the premises (less than 6 months) ?
16. Are the premises only occupied by tenants who have signed the tenancy agreement (family members, partners or someone the tenant is legally liable for to be covered by the signature of the main tenant) ?
17. To the best of your knowledge do any of your tenants undertake any work that would involve client or public visits to the insured premises ?
18. Is the building sub-let ?
19. Are the premises constructed of brick, stone or concrete, with a roof of slate, concrete, felt or metal ?
20. Does the property have any internal or external composite panels ?
21. Are the premises maintained and kept in a good state of repair ?
22. Are the premises due to undergo any structural alterations / conversions or due to be demolished ?
23. Are the premises due to undergo any non-structural alterations or refurbishment works ?
24. Are any parts of the premises currently unoccupied or due to be unoccupied for a period greater than 30 days during the policy period ?
54. What is the construction of the floors ?
26. Do the premises have a purpose built kitchen area / areas ?
Heating & Secuity
27. Are the premises heated only by either hot water central heating systems, mains electricity or mains gas ?
28. Are the premises protected by at least a Mortice lock on all external entry / exit doors ?
29. What fire protections are fitted within the premises ?
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Cover-4-Less is a trading name of Maintenance Direct Insurance Services Ltd Authorised & Regulated By The Financial Conduct Authority Financial Services Registration Number: 707133 Registered In England No: 03152770. Registered office: Citibase Suite 538, The Atrium, 1 Harefield Road, Uxbridge, UB8 1PH
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