pro-indemnity.co.uk Motor Trade Insurance Proposal Form   Please note that you may e-mail or fax your schedule of vehicles to us. You may e-mail to chris@pro-indemnity.co.uk or Fax to 029 2071 2919 1. Your Name:  Company Trading Title:  Type of Company: Sole TraderPartnershipLimited Company- 2. Address of your premises:  Post Code:            Telephone Number:  E-mail address:  Website address: 3. Description of Business: 4. Date Established: 5. Type of Premises: DealershipIndustrial UnitLock-upHomeMobile- 6. Does your premises have it's own lockable entrance:  Yes No 7. Do you have a health and safety policy?  Yes No  Is all training recorded?  Yes No 8. Do you have an Electrical Installation Certificate?  Yes No 9. Is your Portable Electrical Equipment tested?  Yes No 10. Do you have waste oil and/or tyres removed by registered contactors?  Yes No PART A - ROAD RISK Proposers involvement in Motor Trade (Please estimate percentage of activities in each group) Buying / Selling / Wholesale: % Car breaking / Scrap: % Valeting Steam Cleaning: % Repairing and Mechanical: % Vehicle deliveries: % Breakdown / Recovery: % Other Specify: % Cover Required: Third PartyThird Party Fire and TheftComprehensive- Maximum capacity in cars: Average number of vehicles handled per year: Annual Turnover: £ Registered for VAT:  Yes No Maximum value of any own vehicle: £ Maximum value of any one customer vehicle: £ Total value of own vehicles: £ No claims discount years earned on: CarCommercial VehicleMotor Trade-  Number of years no-claims discount Do you mainly deal in -  Sports or high performance vehicles?:  Yes No  Imported modified kit cars?:  Yes No Commercial vehicles in excess of 3.5 tons GVW:  Yes No If "Yes" state capacity of vehicles: Do you require demonstration cover?:  Yes No Do you require customer loan vehicle cover:  Yes No Do you require breakdown recovery? Yes No Do you require motorcycle recovery? Yes No  If "Yes" state max: capacity (cc) cc  and state value: £ Authorised driving: Policyholder onlyAny DriversAny Drivers Aged 21 & overAny Drivers Aged 25 & overAny Drivers Aged 30 & overNamed Drivers- OWN VEHICLES Vehicle Schedule - Please list below details of all vehicles to be insured, or alternatively, you may e-mail or fax your schedule of vehicles to us. If you need to list more than 5 vehicles, extra forms are available by clicking here Please indicate the total number of vehicles you wish to list : Make and Model Cubic / Carrying Weight (CCW) Registration Number (RegNo) Type of body and number of seats Gross Vehicle Weight (GVW) Value Cover required Year of manufacture (YoM) Class of use Where is vehicle kept at night? Postcode where kept at night CCW RegNo 1 GVW Value ComprehensiveThird party Fire & TheftThird party onlyFire & Theft (laid up cover)- YoM Carriage of own goods for hire/rewardCarriage of goods for hire/rewardPrivate hirePublic hire- RoadHardstandingLocked BuildingLocked Compound- Postcode CCW RegNo 2 GVW Value ComprehensiveThird party Fire & TheftThird party onlyFire & Theft (laid up cover)- YoM Carriage of own goods for hire/rewardCarriage of goods for hire/rewardPrivate hirePublic hire- RoadHardstandingLocked BuildingLocked Compound- Postcode CCW RegNo 3 GVW Value ComprehensiveThird party Fire & TheftThird party onlyFire & Theft (laid up cover)- YoM Carriage of own goods for hire/rewardCarriage of goods for hire/rewardPrivate hirePublic hire- RoadHardstandingLocked BuildingLocked Compound- Postcode CCW RegNo 4 GVW Value ComprehensiveThird party Fire & TheftThird party onlyFire & Theft (laid up cover)- YoM Carriage of own goods for hire/rewardCarriage of goods for hire/rewardPrivate hirePublic hire- RoadHardstandingLocked BuildingLocked Compound- Postcode CCW RegNo 5 GVW Value ComprehensiveThird party Fire & TheftThird party onlyFire & Theft (laid up cover)- YoM Carriage of own goods for hire/rewardCarriage of goods for hire/rewardPrivate hirePublic hire- RoadHardstandingLocked BuildingLocked Compound- Postcode

NAMED DRIVERS You may enter the details for up to five drivers here. If you need to list more drivers, there are additional forms available by clicking here. Please specify the total number of drivers you wish to list : Notes Age - of driver, in years, if under (eg) 21 do you want date of birth? Occupation - typically Motortrade or Driver, but for more casual users, please specify Relationship - of driver to you - typically Business Partner, Employee, or Family   Driver Details Details of any convictions, disabilities, accidents or claims. If none state none. Driver 1 Name Age Occupation if not full-time MT Relationship Date UK driving test passed Usage Motor TradeSocial Domestic & PleasurePrivate Business Uses- Driver 2 Name Age Occupation if not full-time MT Relationship Date UK driving test passed Usage Motor TradeSocial Domestic & PleasurePrivate Business Uses- Driver 3 Name Age Occupation if not full-time MT Relationship Date UK driving test passed Usage Motor TradeSocial Domestic & PleasurePrivate Business Uses- Driver 4 Name Age Occupation if not full-time MT Relationship Date UK driving test passed Usage Motor TradeSocial Domestic & PleasurePrivate Business Uses- Driver 5 Name Age Occupation if not full-time MT Relationship Date UK driving test passed Usage Motor TradeSocial Domestic & PleasurePrivate Business Uses- PART B - NON MOTOR RISKS / INTERNAL RISKS TRADE PREMISES COVER Yes No Give details of Construction of Premises. If your premises are not self contained, please give details. Give brief details of physical protections and perimeter security. Is there a burglar alarm under your sole control Yes No  If "Yes" type of the alarm: to Police Stationto Central Monitoring StationPrivate line to keyholderBells only- Are ALL vehicles secured at night within a locked building? Yes No  If NO what percentage remain in the open? %  And how are such vehicles protected from theft and vandalism? Are any vehicles parked on the road outside the trade premises at night?  Yes No MATERIAL DAMAGE   Total value of own vehicles £ Total value of customer's vehicles £ Buildings / tenant's improvements and decorations £ Fixed plant and equipment £ Stock excluding radios/tobacco/video/wine & spirits £ Stock other specify £ Portable hand tools (employees and company tools) £ Gross Profit (per year) £ Indemnity Period 12 Months24 Months36 Months- MONEY Annual cash carryings £ Limit any one carrying £ Safe limit - out of hours £ Limit during business hours £ GLASS External glass £ Signs / canopies £ Goods in Transit (maximum per vehicle) £ Number of vehicles LIABLITIES   Annual Turnover (ex VAT)           £ Annual wages paid to manual employees £ PA Self employed labour / casual labour £ PA Principal / Directors / Partners drawings and salaries £ PA All other non manual employees £ PA Total Wages £ ADDITIONAL INFORMATION AND DETAILS OF ALL LOSSES SUSTAINED UNDER ABOVE SECTIONS. If none - state NONE. PART C - PUBLIC AND PRODUCT LIABILITY This covers your legal liability to customers and members of the public for injury to them or damage to their property arising from your declared activities at your premises or whilst working away Public Liability cover required: £ 1M2M3M5MNone Products Liability cover required: £ 1M2M3M5MNone Service Indemnity cover required: £ 250,0001M2M3M5MNone Sales Indemnity cover required: £ 1M2M3M5MNone What is your projected annual turnover £ Do you weld or cut on your own premises?  Yes No Do you weld or cut away from your premises?  Yes No Do you spray on your own premises?  Yes No Do you spray away from your premises?  Yes No EMPLOYER'S LIABILITY    Do you require cover for Employer's Liability? (Standard indemnity is £10,000,000)  Yes No Have you ever been prosecuted under the Factories Act, the Health & Safety at Work Acts or other Statutory Regulations  Yes No Have you previously been insured for Employer's Liability cover?  Yes No ENGINEERING PLANT Cover Required Statutory InspectionStatutory Inspection and Insurance CoverStatutory Inspection and Insurance and Breakdown Cover- Air Receiver (quantity of) Mechanical Winch (quantity of) Electrical Winch (quantity of) Lifting Table (quantity of) Trolley Jacks (quantity of) Lifting Tackle (quantity of) Welding Sets (quantity of) Do you have an MOT inspection licence?  Yes No  If yes, annual MOT fee income, and £  income from repairs following MOT failure £ CURRENT INSURERS  Name of current insurers (so that we don't approach them!)  Expiry date of current insurance  Current premium (if known) £   You may e-mail or fax your schedule of vehicles to us. You may e-mail to chris@pro-indemnity.co.uk or Fax to 029 2071 2919 If you need to list more than 5 vehicles, extra forms are available by clicking here If you need to list more than 5 drivers, there are additional forms available by clicking here. Please supply me with an estimate within 105 working days. (We will attempt to meet the target, but please be aware that it does require our insurers to respond quickly as well!) Done