Osprey Jewellers Block Proposal Form

Step 1 of 14

Instagram

This field is for validation purposes and should be left unchanged.

Please read the following questions carefully and answer them all, providing additional information where required. Please ensure ALL questions are answered. If a question is Not Applicable, please explain why this is so.

If you need more space, please provide answers on a separate sheet of paper, clearly highlighting the question number. If you have any queries, please speak to your insurance agent.

Proposer Name

Address

Floor Number

Time In Business

Elsewhere in the country in which the Proposer’s premises are situated

What is the nature of your business:

% Retail:

% Wholesale:

% Manufacturing:

Number Of Employees

Minimum Number Of Employees

Basis of Valuation

NB Unless otherwise agreed on, the Policy claims in respect of your own stock will be settled on the basis of COST price. All figures completed in this Proposal must reflect the basis of valuation required.

Stock Values

What was the average total value during the last 12 months of:

Stock Values

(The stock figure is to be declared on the basis of cost price or on the basis per question above)

The total under (a), (b) & (c) comprises approximately of:

a. Jewellery, gold and platinum goods, bullion

b. Precious stones and pearls

c. Watches

d. Clocks, silverware, plateware, and other similar goods

Maximum Value

Value Out Of Safe

What will be the maximum value of all watches, jewellery, gold, bullion and platinum goods, precious stones and pearls (including those in windows) out of safe or strongroom?

a. Value outside business hours

b. Value during temporary closing eg. lunch time (if applicable)

Window Display

How many of the below do you have?

a. Windows

b. Outside Showcases

Give the maximum values which will not be exceed of:

a. Any one window during business hours:

b. Any one window outside business hours:

c. Any one ‘outside-showcase’ during business hours:

d. Any one ‘outside-showcase’ outside business hours:

e. Any one article during business hours:

f. Any one article outside business hours

g. Any one pad or tray of articles during business hours:

h. Any one pad or tray of articles outside business hours

i. In all windows and outside showcases during business hours:

j. In all windows and outside showcases outside business hours:

Outdoor Risk

Give the following information in respect of all insured property (inclusive of amounts carried to and from Bank or Safe Deposit) carried outside the Proposer’s Premises stated in Question 1 (b) by yourselves, your representatives, travellers, agents, messengers and delivery hands NOT Brokers during the last 12 months

In the City or Town in which the Proposer’s premises are situated

a. Names of all principals, representatives, travellers and agents:

Principals, Representatives, Travellers And Agents

Number Of Days Of Each Person Per Annum

Average Amount Each

Maximum Amount Each

1. Principals, Representatives, Travellers And Agents

1. Number Of Days Of Each Principal, Representative, Traveller And Agent Per Annum

1. Average Amount Each Principal, Representative, Traveller And Agent

1. Maximum Amount Each Principal, Representative, Traveller And Agent

2. Principals, Representatives, Travellers And Agents

2. Number Of Days Of Each Principal, Representative, Traveller And Agent Per Annum

2. Average Amount Each Principal, Representative, Traveller And Agent

2. Maximum Amount Each Principal, Representative, Traveller And Agent

3. Principals, Representatives, Travellers And Agents

3. Number Of Days Of Each Principal, Representative, Traveller And Agent Per Annum

3. Average Amount Each Principal, Representative, Traveller And Agent

3. Maximum Amount Each Principal, Representative, Traveller And Agent

4. Principals, Representatives, Travellers And Agents

4. Number Of Days Of Each Principal, Representative, Traveller And Agent Per Annum

4. Average Amount Each Principal, Representative, Traveller And Agent

4. Maximum Amount Each Principal, Representative, Traveller And Agent

b. Number of messengers and delivery hands:

Messengers And Delivery Hands

Number of days of each person per annum

Average Amount Each

Maximum Amount Each

1. Messengers And Delivery Hands

1. Number Of Days Of Each Messenger And Delivery Hand Per Annum

1. Average Amount Each Messenger And Delivery Hand

1. Maximum Amount Each Messenger And Delivery Hand

2. Messengers And Delivery Hands

2. Number Of Days Of Each Messenger And Delivery Hand Per Annum

2. Average Amount Each Messenger And Delivery Hand

2. Maximum Amount Each Messenger And Delivery Hand

3. Messengers And Delivery Hands

3. Number Of Days Of Each Messenger And Delivery Hand Per Annum

3. Average Amount Each Messenger And Delivery Hand

3. Maximum Amount Each Messenger And Delivery Hand

4. Messengers And Delivery Hands

4. Number Of Days Of Each Messenger And Delivery Hand Per Annum

4. Average Amount Each Messenger And Delivery Hand

4. Maximum Amount Each Messenger And Delivery Hand

Elsewhere (state Countries in each case)

c. Names of all principals, representatives, travellers and agents:

Principals, Representatives, Travellers Agents

Number Of Days Of Each Person Per Annum

Average Amount Each

Maximum Amount Each

1. Principals, Representatives, Travellers And Agents In Other Countries

1. Number Of Days Of Each Principal, Representative, Traveller And Agent Per Annum In Other Countries

1. Average Amount Each Principal, Representative, Traveller And Agent In Other Countries

1. Maximum Amount Each Principal, Representative, Traveller And Agent In Other Countries