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

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 ☐

Other details:

Closed Circuit TV

Is CCTV used to monitor the business?	Yes ☐	No ☐
If yes, how many cameras are used?
Cameras use:
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:
What type of alarm is installed? ☐ Dedicated landline ☐ Mobile system ☐ Dialler system ☐ Other (describe below)
Is the alarm system monitored?	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:
Is it a GSM system?	Yes ☐	No ☐
Is it a GPRS system?	No ☐
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 ☐
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: Estimated: Size Weight Year made	Make: Model: Estimated: Size Weight Year made
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

Internal and External Glass:	$

Cover 5 – Business Interruption

Gross Profit	$
Additional Increased Cost of Working	$
Accounts Receivable	$
Claim Preparation and Proving Expenses	$
Uninsured Working Expenses	$
Indemnity Period	months

Cover 6 – Sendings and Transit

Sendings (Jewellery and Valuables only)

Australia (domestic)

Method of Sending	Annual Total	Ave. Value per Parcel	Max. Value per Parcel
Australia Post - Parcel Post / Express Post (without signature)	$	$	$
Australia Post – Express Post / Platinum Post (with signature)	$	$	$
Australia Post – Courier Post	$	$	$
Commercial Couriers	$	$	$
Failsafe / Fast Couriers / Toll Secure / Star Track Security / Express TNT Secure	$	$	$
Armoured Car	$	$	$

Overseas (international)

Method of Sending	Annual Total	Ave. Value per Parcel	Max. Value per Parcel
Australia Post - Express Courier International / Registered Airmail / EMS	$	$	$
Commercial Couriers	$	$	$
Airfreight Shipped as Valuable Cargo	$	$	$
Armoured Car	$	$	$
Please state all countries where items sent:

Stock Away from Premises – Personal Transit

Please give the following information in respect of all insured property (excluding money) carried outside the premises by the proposed insured, the proposed insured’s representatives, travellers, agents and/or messengers (but not brokers) in the last 12 months:

Within State (local/inside proposed insured’s state)

Name of Each Person	No. of days per year	Average Amount	Maximum Amount
$	$
$	$
$	$
$	$

Australia-wide (interstate)

Name of Each Person	No. of days per year	Average Amount	Maximum Amount
$	$
$	$
$	$

Overseas

Name of Each Person	No. of days per year	Average Amount	Maximum Amount
$	$
$	$
Please state countries to be visited:

Stock Away from Premises – Professional Fine Art Transit

Please give the following information in respect of all insured property (excluding money) carried outside the premises by Professional Fine Art Carriers in the last 12 months:

Australia-wide transit:	$

Overseas transit:	$

Stock Away from Premises – Courier Transit

Please give the following information in respect of all insured property (excluding money) carried outside the premises by standard Couriers in the last 12 months:

Australia-wide transit:	$

Overseas transit:	$

Cover 7 – Exhibitions and Shows

Does the business wish to display stock at exhibitions/trade shows over the next 12 months?	Yes ☐	No ☐
If yes, please give details: Number of exhibitions/trade shows to be attended: Values displayed: $ Additional Information:

Optional Extensions

Sum Insured Required
Contents Away from Premises1	$
Damage to Premises by Thieves2	$
Directors’ and Employees’ Tools-of-Trade and Personal Effects	$
Employee Dishonesty	$
Entrustments in Trade3	Average amount at any one time:	$
Maximum amount at any one time:	$
Does the business use entrustment / approbation notes for all outwards entrustments?	Yes ☐	No ☐
Entrustments to Photographers	$
Fusion and Machinery Breakdown	$
Home Risk (please fill in section below)*	$
Media Loans	$
Processing Risk/Workmanship – Jewellery and Valuables	$
Replacement of Locks and Keys	$
Stock Away from Premises (not Exhibitions, Shows or Showcases)	$
Wearing Risk – Jewellery and Valuables	$

1.	May include covering laptops, mobile phones, presentation equipment, etc used while away from the business.

2.	Provides cover at the premises where the business operates and/or for landlord’s fixtures and fittings for which the business is legally responsible.

3.	What was the estimated value entrusted to dealers, customers, repairers, cutters, setters and brokers in the last 12 months?

*Home Risk (only applicable if Transit cover is taken)

Does any principal, employee, traveller or agent take stock to their private home for any other purpose than in connection with travel shown under Outdoor Risk?	Yes ☐	No ☐
If yes, please give the following information for each person (please use Additional Information page to show below details for more staff if required):

Person 1 Name: Maximum Value kept at home: $ Address: Full details of safes, alarms and any other protections at this location:
Is the stock ever left unattended at this home?	Yes ☐	No ☐

Person 2 Name Maximum Value kept at home: $ Address: Full details of safes, alarms and any other protections at this location:
Is the stock ever left unattended at this home?	Yes ☐	No ☐

Public and Products Liability

This covers liability to third parties for personal injury or property damage caused by an incident during the period of insurance which is as a result of the business’ activities and products.

Is public and products liability required?	Yes ☐	No ☐
If yes, limit of liability required:	☐ $5,000,000 ☐ $10,000,000 ☐ $20,000,000

Additional Information