Application form for quotation for Nursery insurance

NurseryCare

Proposal form

Before you proceed with this application we strongly recommend that you read the Summary and Guide carefully. You should also read our Terms & Conditions for online application. These Terms and Condition form the basis of the legal agreement that you will be entering into with the underwriters, Sterling Insurance Company Limited.

Your attention is particularly drawn to the importance of the Declaration and signature on the Insurer's proposal forms. Any failure to disclose facts material to the insurance or any inaccuracies in your answers could invalidate your cover. Please do consult us if you are in doubt on any aspect.

Please note that we are not able to put you on cover online. You can either submit the form to us electronically (we will reply with a quote via email) or print out the proposal form, complete it, and return it to us for a quote. If you require more advice please call us on 08452 570119.

Please note that we only arrange cover in the UK.

I've read and accept your Terms & Conditions.
Insurance to commence from	for 12 months
Name of Nursery
Title
First Name
Surname
Address of Business premises
Post Code
Telephone
Fax
Email address
Website

Postal Address if different

Post Code

Telephone

Fax

Email address

Website

Are you a broker with a current Agency Agreement with Morton Michel?

YES NO

Do you have any existing insurances with Morton Michel?

YES NO

If Yes, please state policy number(s)

How did you hear about Morton Michel?

Full name and address of any other party with a financial interest in the property to be insured, such as a bank, mortgage company etc.

Company

Address

Postcode

The Nursery

1. Nursery Contents

a) Automatic cover is £20,000. Please state if you require a higher amount.
NOTE: All property must be insured for the full replacement cost.

Do you require All Risks cover on specified items of equipment?

YES NO

Description	Serial Number	Value
		£
		£
		£
		£
		£

2. Loss of Revenue?

The standard indemnity period (necessary for the business to recover) is 12 months. Please state if you require a longer period e.g. 18 months

months

Estimated gross revenue for the period selected:

3. Contents in transit

Automatic cover is £1000. Please state any higher amount required

4. Deterioration of Refrigerated/Frozen Food

Automatic cover is £2,500. Please state any higher amount required (to include food in all cabinets)

5. Loss of Registration Certificate

Automatic cover is £100,000. Please state any higher amount required

6. Buildings

If you wish to insure the buildings, please state the full rebuilding cost including all fixtures and fittings, outbuildings, annexes and walls, gates and fences plus an allowance for architects fees

Do you require subsidence cover on your buildings?

(Subsidence cover is not automatically included in the NurseryCare Policy and will not be given before acceptance by the Company of a satisfactory subsidence questionnaire.)

YES NO

7. Liability

Public, Products and Property owners liability automatic cover is £3,000,000.
Do you require the higher limit of £5,000,000?

(Employers' Liability automatic cover is £10,000,000 restricted to £5,000,000 if arising out of terrorism)

£5 million

8. Glass

Please give details and value of any armoured, bent or other special glass or of any lettering or designs on glass.

YES
NO

If YES, please give details.

9. Professional Indemnity

(See Summary and Guide for details of this optional cover)

If you wish to take out this cover please indicate which limit of indemnity you require.

£250,000

£500,000

10. Money

Money limits are as stated in the Summary and Guide. If you require higher limits, please contact Morton Michel.
Money on the premises outside of business hours is covered up to £1000 only. if contained in an approved locked safe.
Please provide full details of your safe(s).

Make of safe	Model	Age	Location and how fixed

If you need to keep more than £1000 in a safe,
please state amount required.

The Children

1. Please give full description of the business, facilities, and activities available at the nursery for pre-school age children.

2. How many children is the nursery registered for by OFSTED or other registering authority?

3 Do you care for school age children?

YES

4. If you care for school age children
a) please state

i) Maximum number
of children
in attendance

out of
school clubs

holiday play schemes

other meetings

ii) age range of
the children in attendance

out of
school clubs

holiday play schemes

other meetings

iii) number of supervisors in attendance

out of
school clubs

holiday play schemes

other meetings

b) Please give full details of 'other meetings' (if applicable) and full details of the activities available at each of the above facilities

c) If the meeting places for any of the above facilities are not the stated business premises, please provide the full address(es) of such meeting places.
Postcode

d) The following activities are automatically covered by your policy for school age children: Arts and Crafts,badge making,basketball,bat and ball,board games,bouncy castles(subject to policy conditions),card games, clay modelling,climbing frames,computer games,construction kits,cooking,dance(excludes break dancing),dance mats,dolls,drama,lego,mini golf,music,nature area,papier mache,parachute games,pedal go karts,play dough,playground games,races,reading corner,role play corner,roller skating(excludes roller blading and skate boarding), rounders,sand play,scooters,sewing,skipping,skittles,slides,snacks,space hoppers,swing ball,swings,table tennis,tennis,trampolines(subject to policy conditions),treasure hunts,watching television.

If you offer any other activities,please give full details, including the age range of the children involved:

General Questions

1 Date of opening nursery at this address
and at any previous location

2 Have you had continuous insurance since your business has been established? if Yes - please state Name and Address of current and previous insurer(s) and policy number(s) covering a period of five years.	YES NO
If No, please give reasons why insurance was discontinued:

3 Has any insurer ever
a. declined your proposal?	YES	NO
b. refused to renew or cancelled your policy?	YES	NO
c. imposed special terms or conditions for any of the risks proposed? If Yes to any of the above, please give full details	YES	NO

4 Have you, the proposer or any principal, director or partner under a current or any previous trading title
a. Been declared bankrupt or insolvent or been subject to a County Court Judgement of are any proceedings pending?	YES	NO
b. Been convicted of arson or any other criminal offence (other than motoring offences) or is any prosecution pending?	YES	NO
c. Been prosecuted under the Health & Safety at Work etc Act 1974, The Consumer Protection Act 1987 or the Food Safety Act 1990?	YES	NO
d. Been served with a Prohibition Notice under the Health and Safety at work etc Act 1974 or the food Safety Act 1990? if you have answered Yes to any of the above, please give full details	YES	NO

5 a) Do you obtain satisfactory and confirmed references in writing of prospective employees' integrity before engaging them?	YES	NO
b) Have you obtained the necessary Criminal Records Bureau Disclosures for all new and existing members of staff / voluntary helpers?	YES	NO
c) If you are awaiting Criminal Records Bureau Disclosures on members of staff/voluntary helpers,are all non - checked personnel fully supervised at all times by a suitable person with Criminal Records Bureau Clearance?	YES	NO
If NO to any of the above, please provide a full explanation

6 Do you hold a registration certificate?	YES	NO
if Yes:
a. Has there been opposition to renewal or transfer of the certificate within the last five years?	YES	NO
b. Has the renewal or transfer ever been refused?	YES	NO
c. Please state the name of the Registering Authority
d. Date of registration

7 Have you suffered any loss or damage or had any claims made against you in the last 5 years?

YES

If YES please give full details (continue in 'supplementary information' if necessary)

Date	Type of claim	Amount settled or outstanding

Failure to disclose previous claims could result in the invalidation of your policy

The Premises

1 What is the approximate age of the buildings?	Pre 1850 1850-1975 1976-1989 1990+
2 How many storeys has the building?

3 Are the buildings a) Built of brick, stone or concrete and roofed with slates, tiles, concrete, metal?	YES	NO
b) In an area unduly exposed to storm or impact damage? If you have answered yes to either of the red* answers above, please give full details*	YES	NO
(continue in 'supplementary information' if necessary)


4. Is more than 20% of your roof flat?	YES	NO
If YES a) what is the age of the flat roof?
b) what is the flat roof made of? (e.g. felt on timber, bitumen, asphalt etc)
c) what percentage of the total roof area is flat?

5 Have the premises ever been flooded; are they in a area liable to flooding or within ¼ mile from any river, watercourse or sea, or have you been informed that your premises are in a potential flood risk area?	YES	NO
If YES please give details

6 Are all the doors at your premises (internal and external) fitted with finger guards or finger shields?

YES

7 Do you have a written Assessment of Risk?

YES

8 Are the buildings used solely as a nursery?

YES

If NO, please give full details including the occupation of any other tenants and advise how the businesses are separated:

9 Are there any adjoining buildings?

YES

If Yes, please give full details of the trade(s) carried out therein and how they are separated from your building:

10 a) Has the fire authority inspected the premises?	YES	NO
b) If YES have you completed all the Fire Authority requirements?	YES	NO
If NO to either of the above, Please give full details
c) Are the premises protected by an automatic sprinkler installation?	YES	NO
If you have answered Yes, please give installers name and address

11 a) Are the premises protected by an intruder alarm which is in working order and subject to a maintenance contract?	YES	NO
If YES please give the installers' name and address
b) Are all the external doors to your premises protected in accordance with the Guide to Security?	YES	NO
c) Are all opening windows to your premises protected in accordance with the Guide to Security?	YES	NO
If NO please give details of other security fittings

12 Do you store any part of your equipment in:
a) timber sheds valued at more than £1,500?	YES NO
If YES please state
i) the replacement value of the shed	£
ii) the total value of the contents stored in the shed	£
b) metal sheds valued at more than £2,500?	YES NO
If YES please state
i) the replacement value of the shed	£
ii) the total value of the contents stored in the shed	£
c) any other type of garden shed?	YES NO
If YES please state
i) the replacement value of the shed	£
ii) the total value of the contents stored in the shed	£
iii) the nature of the construction of the shed (e.g. metal and plastic composite)
If you have answered YES to any of the above, are all doors and windows of each shed to be insured protected in accordance with the Guide to Security?	YES NO
If NO, please give full details of all security fittings on the shed:

13 Is any part of the premises occupied for residential purposes?	YES	NO
If Yes a) are the contents of that part also used in connection with the business?	YES	NO
b) do you wish to insure such contents through Morton Michel? NOTE complications can arise if jointly used property is insured with different insurers.	YES	NO

Supplementary Information

Indicate for which questions you are supplying extra information

Declaration

Please read the declaration carefully and check the answers you have given before signing the proposal form.

I/We (or in the case of a partnership or a limited company, any one of the partners or directors) hereby apply to Sterling Insurance Company Limited for NurseryCare insurance and

a) declare that to the best of my/our knowledge and belief the answers given are true and complete in every respect and all material
particulars which may affect the assessment of the risk have been disclosed. If any written answer has been made by another person,
such person shall for that purpose be deemed to be my/our agent and not the agent of the Sterling Insurance Company Limited. To the
extent that has been necessary, I/we have consulted relevant members of the organisation to verify answers stated in this form

b) understand that Sterling reserves the right to contact previous insurers to verify the information contained in this form

c) agree that this proposal and declaration shall be the basis of the contract between me/us and Sterling Insurance Company Limited and shall
be deemed incorporated into such contract

d) declare that all appropriate enquiries have been made to ensure that no principal, director, partner, employee or voluntary helper is, or is
obliged to be, listed on the Sex Offenders Register pursuant to the Sex Offenders Act 1997

Data Protection Act
I/we understand and agree that the personal information I/we provide (including sensitive personal details) may be used for insurance purposes by Sterling Insurance Company Limited, its connected companies, reinsures, agents and subcontractors; and also shared with other insurance companies as required for the purposes of my/our insurance. Where we have provided information about my/our spouse(s), partner(s) or another person/other persons (including their sensitive personal details) I/we confirm that I/we have their permission to provide this information for insurance purposes. I/we understand that I am/we are entitled to a copy of my/our personal information on payment of a fee.

From time to time, Morton Michel may wish to send you details of services and products, if you do not wish to receive such mailings, please tick this box

You have a duty to disclose all material facts and failure to do so could invalidate the insurance.
Cover does not commence until the proposal has been formally accepted by Morton Michel unless otherwise agreed by Morton Michel.
Morton Michel, Alhambra House, 9 St Michael's Road, Croydon CR9 3DD. Telephone: 08452 570119 Fax: 08452 570548 www.mortonmichel.com

SC 2180 04.03 Sterling Insurance Company Limited. Registered in London No 498605