Commercial Specialists’ Insurance

(Jewellers, Fine Art Galleries, Museums, Auctioneers, Pawnbrokers)

Proposal Form - Addendum

Keystone recommends that the proposed Insured keep a record of all information supplied for the purpose of entering into an insurance contract. Please answer all questions in full. If there is insufficient space, please provide further details on a separate sheet. All attached documents form part of this Proposal.

General Details

Proposed Insured Name (list all names to be covered by the policy):

Location (Situation) Details

Address:

Does the proposed Insured or any principals of the proposed Insured own the premises?	Yes ☐	No ☐
Is the premises:
at street front in a main street or thoroughfare?	Yes ☐	No ☐
at street front in a pedestrian mall (restricted or no vehicular access)?	Yes ☐	No ☐
within an arcade?	Yes ☐	No ☐
within a shopping centre?	Yes ☐	No ☐
If yes to (c) or (d), is the arcade or centre closed to the public at night?	Yes ☐	No ☐
Does the proposed Insured or any principals of the proposed Insured, an employee or a caretaker occupy the premises at night?	Yes ☐	No ☐

Please confirm details of the building construction for the Situation:

Walls	Brick ☐	Concrete ☐	Stone ☐	Steel ☐	Timber ☐	Other ☐
Roof	Tile ☐	Concrete ☐	Slate ☐	Metal ☐	Other ☐
Is the Situation on the ground floor?	No ☐	Yes ☐
If no, please provide details

Business Activity

How long has the business operated at the above premises?
How many people work in the business at the above location (including Principal(s)/Director(s))?
What will be the minimum number of employees (including Principal(s)/Director(s)) in the sales area of the business at the above location during opening hours, including lunchtimes?

Security

Locks

Is the public entrance protected by electronic buzzer entry/exit?	Yes ☐	No ☐
Is the public entrance protected by a double door interlocking mantrap?	Yes ☐	No ☐
If no to both above questions, please detail type of locks (standard/deadlocks/mortice) on all external doors:

Closed Circuit TV

Is CCTV used to monitor the business?	Yes ☐	No ☐
If yes, how many cameras are used?
Cameras record with:
Time-lapse video	Yes ☐	No ☐
Digital recording	Yes ☐	No ☐
How long are tapes/digital records kept?

Other details:

Alarm

Is an alarm installed at the premises?	Yes ☐	No ☐
If yes, type of alarm installed:
☐ Dedicated landline ☐ Mobile system ☐ Dialler system ☐ Other (describe below)
Is the alarm system monitored? (NB: If the alarm is not monitored by a security company, it is likely that we will not be able to quote.)	Yes ☐	No ☐
If yes, name of monitoring company:
Is the alarm system maintained under a regular servicing and testing contract?	Yes ☐	No ☐
If yes, how often is it serviced and tested?
Does the alarm system have line security?	Yes ☐	No ☐
If yes, type of system:
☐ GSM	☐ GPRS
What type of detectors are installed (tick all that apply)? ☐ passive infra-red ☐ break-glass detection ☐ door contacts ☐ window contacts
Doe the alarm system have hold-up/panic buttons?	Yes ☐	No ☐
If yes: What type? ☐ Portable (how many ) ☐ Under counter (how many )

Safe(s)

Is a safe installed at the premises?	Yes ☐	No ☐
If yes, how many? (if more than 2, add details on Additional Information page.)
Safe 1	Safe 2
Make: Model: Locking mechanism (dial, digital keypad, biometric): Estimated: Size Weight Year made Cash rating	Make: Model: Locking mechanism (dial, digital keypad, biometric): Estimated: Size Weight Year made Cash rating
Safe connected to alarm?	Yes ☐	No ☐	Safe connected to alarm?	Yes ☐	No ☐
Door contacts?	Yes ☐	No ☐	Door contacts?	Yes ☐	No ☐
Vibration/seismic sensors?	Yes ☐	No ☐	Vibration/seismic sensors?	Yes ☐	No ☐
Time locks installed?	Yes ☐	No ☐	Time locks installed?	Yes ☐	No ☐
Torch and drill resistant?	Yes ☐	No ☐	Torch and drill resistant?	Yes ☐	No ☐
Illuminated and seen from the street at night?	Yes ☐	No ☐	Illuminated and seen from the street at night?	Yes ☐	No ☐

Strongroom/s

Is there a strongroom at the premises?	Yes ☐	No ☐
If yes, please give the specification/construction of: Door Walls
If yes, is the strongroom equipped with time locks?	Yes ☐	No ☐

Display Window/s

Are there display windows at the premises?	Yes ☐	No ☐
If yes, how many?
Type of glass:
☐ Plate ☐ Laminated ☐ Bandit-proof ☐ Other (describe below) Glass thickness: mm
Rear of display windows protected by locked doors/shutters/grilles?	Yes ☐	No ☐
If yes, are they kept always locked with keys removed?	Yes ☐	No ☐
After hours are the front of display windows secured?	Yes ☐	No ☐
If yes, protected by:
Shutters/grilles	Yes ☐	No ☐
Roller door	Yes ☐	No ☐
Other:
Does this protection cover the entire front of the premises?	Yes ☐	No ☐

Other details:

Showcase/s

Is stock displayed in showcases at or away from the premises?	Yes ☐	No ☐
If yes: How many showcases inside the premises? How many showcases outside the premises?
Type of showcase glass:
☐ Plate ☐ Laminated ☐ Bandit-proof ☐ Other (describe below) Glass thickness: mm
Are showcases always locked with keys removed, except when items are being taken out or returned?	Yes ☐	No ☐
Is stock displayed in showcases away from the premises (eg. clubs, hotels, shopping centre mall)? (Note: these are any display cases/windows which physically cannot be stocked from inside the premises.)	Yes ☐	No ☐
If yes, for each outside showcase:
Address
Type of glass and thickness
Locks on showcase
Who has access
Additional details:

Other details:

Fire Protection

Extinguishers	Yes ☐	No ☐
Smoke detectors	Yes ☐	No ☐
Fire alarm (bells only)	Yes ☐	No ☐
Fire alarm (connected to central station)	Yes ☐	No ☐

Insurance Needs

General Cover

Stock and Goods in Trust

This comprises the business’ stock and merchandise. It also includes customers’ good held for repair/alteration and valuation, and goods on approval of consignment from third parties.

Stock Sum insured required:	$

Historical Stock (during the last 12 months):	Average	Maximum
Your own stock and merchandise	$	$
Goods in trust (other than for safe custody), on approval or consignment, or for repair etc.	$	$
Totals	$	$

The totals above are estimated to consist of:

Paintings	%
Non-fragile artworks/sculptures	%
Fragiles	%
Furniture	%
Stock in the Open Air	%
Jewellery, gold and platinum goods, precious stones and pearls	%
Watches	%
Clocks, silverware, plateware, giftware and crystal	%
Other goods (please describe)	%
100%

Seasonal Increase for Stock

Is extra stock cover required for peak seasons?	Yes ☐	No ☐
If yes, Additional sum insured required: $
Please tick months required:
☐ January	☐ February	☐ March	☐ April	☐ May	☐ June
☐ July	☐ August	☐ September	☐ October	☐ November	☐ December

Contents

This includes trade and office furniture, fixtures and fittings, machinery, plant, safes, alarm systems, tenant decorations and improvements, reference library, and other contents.

Sum insured required:	$

Cover 1 – Property Damage Extensions

Fire Extinguishment Costs	$
Removal of Debris	$

Cover 2 – Theft

Display Windows and Outside Showcases

Please give maximum values displayed (these limits cannot be exceeded when stocking)

Inside Premises	Outside Premises
Business Hours	After Hours	Business Hours	After Hours
Any one display window or showcase	$	$	$	$
All display windows or showcases	$	$	$	$

Values Out of Safe

Values out of safe relate to precious stock only (ie this does not include clocks, plateware, crystal, giftware and non-jewellery silverware). Please give the maximum total value of all jewellery, watches, gold and platinum, precious stones and pearls (including those in display windows, inside and outside showcases) out of a locked safe or strong room:

After Hours	During temporary closings (eg. lunchtimes)
Limit any one item	$	$
Limit all items (maximum value)	$	$

Cover 3 – Money

Money in Transit:	$

Money on Premises during business hours:	$

Money in locked safe or strongroom outside business hours:	$

Money in Custody:	$

Cover 4 – Glass

Do you require cover for internal and external glass?	Yes ☐	No ☐

Additional Information