bhib affinities quote form - media and entertainment · email: enquiries@bhibaffinities.co.uk...
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Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Media & Entertainment Media & Entertainment Media & Entertainment Media & Entertainment ---- Quotation FormQuotation FormQuotation FormQuotation Form
Product SelectionProduct SelectionProduct SelectionProduct Selection
Last Annual Turnover: £ ________________________
Select if Bespoke or Freelancers Package: Select if Bespoke or Freelancers Package: Select if Bespoke or Freelancers Package: Select if Bespoke or Freelancers Package:
Bespoke
The bespoke policy is designed for businesses with over 4 employees and more than 250,000
turnover.
Freelancers Package
The Freelancers Package is designed for Freelancers or small businesses with up to 3 employees and
no more than £250,000 turnover. Cover is selectable based on pre-defined options. This includes
Technical and Portable Equipment up to £50,000, Employers Liability (£10m), Public Liability (£5m),
Contents (up to £25K) and ICOW cover (up to £25K). Personal Accident and Professional Indemnity
covers can also be selected, and short period cover options are available.
Please fill out the relevant section dependent on which policy you have chosen above
Client Details
The Company
Company Status Limited Company ☐ Unlimited Freelancer ☐
Unincorporated Company ☐ Unincorporated Freelancer ☐
Trading name: ___________________________
Correspondence Address: __________________________
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Post code
County:
Business description:
Year Business established:
Contact Details
Salutation
Forename
Surname
Telephone
Occupation
Please fill out the relevant section dependent on which policy you
have chosen above
Bespoke Policy
Your Premises
Address:
Town:
County:
Post code:
Is the property a storage unit? Yes No
Is the storage unit secured with a closed shackle padlock within a recognised storage location (e.g.
Big Yellow, Safestore, Set a Side Storage) constructed with external walls of brick, stone or concrete
and roofed with slate, tiles or profile metal and staffed on a 24 hour basis?
Yes No
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Property Damage
Do you require Buildings or Tenants Improvements cover?
Occupancy status: Not occupied Yes – Buildings Yes – Tenants Improvements
Please fill in the relevant question set below, dependent on your answer to the question above
Buildings
Buildings Sum Insured: £
(Buildings can only be insured if Contents or Portable & Technical Equipment is insured)
Rent owed to you:£
(Rent Owed can only be insured if Contents or Portable & Technical Equipment is Insured)
Contents Sum Insured: £
Computers and
Ancillary Equipment: £
Tape Stock: £
Do Contents float over other premise Yes No
Money
Select cover required :
Money whilst the premises is open £2,500 £5,000
for business, whilst in a locked safe
or in transit? £7,500 £10,000
Technical & Portable Equipment
Sums insured
Permanently on the premises: £
Does this equipment float over Yes No
other premises occupied by
the insured?
Anywhere in the European Union £
(Excluding equipment used worldwide)
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Anywhere in the world £
Is cover required for Loss Yes No
of hire fees above £25,000?
Loss of Hire Fees sum insured £
(if yes)
Temporary Equipment Cover (if applicable)
Please enter only the increase in sum insured or extra cover required, excluding the annual sums
insured already in place.
Permanently on the premises £
Anywhere in the European Union
(Excluding equipment used worldwide) £
Anywhere in the world £
Cover Start Date: / /
Cover End Date: / /
Number of days:
If you require additional premises insurance, please use the space provided at the end of the
Bespoke policy section
Policy Cover
Additional Cover Terrorism
Do you require Terrorism Cover? Yes No
Public Liability Cover
Do you require Public Liability cover? Yes No
Please select limit of indemnity required
£2,000,000 ☐ £3,000,000 ☐ £5,000,000 ☐ £10,000,000 ☐
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Do you require Temporary Public Liability cover?
Temporary Limit Required?
Please select limit of Temporary Indemnity required
£2,000,000 ☐ £3,000,000 ☐ £5,000,000 ☐ £10,000,000 ☐
Cover Start Date: / /
Cover End Date: / /
Number of days:
Do you undertake manual work away from the premises? Yes ☐ No ☐
Clerical/Non Manual work away Wage Roll excluding bona fide sub-contractors £ _____________
Clerical/Non Manual payments to bona fide sub-contractors £________________
(Information : For the purposes of this insurance, bona fide sub-contractors are defined as
contractors who work without direction from the client, provide their own tools and materials and
hold their own General liability cover with a limit of indemnity of no less than £2,000,000)
Manual Work Away excluding bona fide sub-contractors £_________________
Manual Work Away - payments to bona fide sub-contractors £ _______________
(Information: For the purposes of this insurance, bona fide sub-contractors are defined as
contractors who work without direction from the client, provide their own tools and materials and
hold their own General liability cover with a limit of indemnity of no less than £2,000,000
Employers Liability Cover
Do you require Employers Liability cover? Yes No
Please provide your ERN / PAYE number if you have any Employees.
No Employees / Exempt --------------------------------------
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Clerical/Non manual wage roll: £____________
(Information: For the purposes of this insurance, cameramen (including cinematographers, stills
photographers and assistants) who do not work at height, with animals or at any hazardous
locations can be considered non-manual)
All other employees: £ _____________
(Information: For the purposes of this insurance, cameramen (including cinematographers, stills
photographers and assistants) who do not work at height, with animals or at any hazardous
locations can be considered non-manual).
Commercial Legal Protection
Do you require Commercial Legal Protection Cover? Yes☐ No ☐
(If yes note the standard limit of indemnity us £100,000)
Wage roll: £ ____________
Have you made any previous claims in respect of Commercial Legal Protection? Yes ☐ No ☐
If yes, please confirm details of claims?
Personal Accident
Do you require Personal Accident Cover? Yes☐ No ☐
Capital Benefit £10,000
Total Number of People covered
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Insured Details
Name
Pre-Existing Medical Conditions Yes ☐ No☐
If yes please state all conditions below:
Date of Birth date Month Year
Age
Add another person + (repeat as above if applicable )
Business Travel
Do you require Business Travel Cover? Yes No
If yes, please fill out the sections below
Destination: Select: UK only ☐☐☐☐ Europe only ☐☐☐☐ Worldwide ☐☐☐☐
Complete appropriate section:
UK trips only
Estimated number of Trips
0 – 4 :
5 – 10 :
11 – 18 :
19 – 31 :
Europe trips only
0 – 4 :
5 – 10 :
11 – 18 :
19 – 31 :
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Worldwide trips only
0 – 4 :
5 – 10 :
11 – 18 :
19 – 31 :
Business Travel continued
Any non-business travel, i.e. Yes No
for personal reasons?
Any person traveling over 71? Yes No
Individuals to be insured are all UK Yes No
nationals and domiciled in the UK?
Any trips with multiple destinations? Yes No
Any spouses or children travelling Yes No
with the insured person on
a business trip?
Any travel to or in Afghanistan, Chad, Yes No
Chechnya, Congo (Democratic Republic),
Iraq, Israel, Ivory Coast, Somalia or
Sudan or any other countries where
non-essential travel is advised against
by the Foreign and Commonwealth Office?
Any pre-existing medical conditions for Yes No
which treatment has been required within
the last two years or any trips taken against
medical advice, or taken in order
to receive medical treatment overseas?
Any winter or hazardous sports, e.g. Yes No
diving, mountaineering or climbing
Details of any previous Travel Claims:
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Directors & Offices
Do you require cover for Directors and Officers Cover? Yes ☐ No ☐
Limit of Indemnity is £50,000
The Business is a Limited Company Yes☐ No☐
Have you been trading for at least two years, made a profit Yes ☐ No☐
In the last year and declared a positive net worth in the
latest annual company?
Has your accountant qualified their opinion in the latest annual account. Yes ☐ No ☐
Do you have assets or derive turnover outside the United Kingdom Yes ☐ No ☐
Have there been any claims or investigations made against the company,
its directors, officers or employees in the last five years which may have
given rise to a claim under this policy had it been in force. Yes ☐ No ☐
Are you aware of any fact, circumstance, allegation or incident likely
to give rise to a claim Yes ☐ No ☐
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Professional Indemnity
Do you require Professional Indemnity Yes No
cover?
Limit of Indemnity? £100,000 £250,000
£500,000 £1,000,000
Select an excess? £0 £500 £1,000
£2,000 £2,500 £5,000
If prior to inception please enter any earlier Retroactive Date required? / /
Are there any contracts where Yes No
the total value exceeded £250,000?
Have you worked under any contracts Yes No
with applicable law outside of the EU?
Are all steps are taken to ensure third Yes No
party rights are not breached?
Are you aware after reasonable enquiry of any matter which may lead to a claim against you,
including but not limited to;
� A shortcoming or problem in your work which cannot reasonably be put right
� A complaint about your work or anything you have supplied which cannot immediately be resolved
� An escalating level of complaint on a particular project
� Any of your customers withholding payment to you after a complaint
Yes No
Notes
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Internet and Email
Do you require Internet and Email cover? Yes ☐ No ☐
Limit of Indemnity: Select limit ☐£100,000 ☐£250,000
You do not operate an interactive website? Yes ☐ No☐
(Information: For example, a website which contains a bulletin board, chat forum or newsgroup
facility or where financial transactions can be made).
You are fully compliant with the Data Protection Act Yes ☐ No☐
You have virus protection software operating on their network which is updated daily: Yes ☐No☐
You back up all electronic files on their system at least weekly and stores these off site: Yes ☐No ☐
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Freelancers Package
Do you require annual cover? Yes ☐ No ☐
If No please advise us of the cover From date / month/ year
start date and end date: To date / month / year
The Cover
Public Liability Limit: £5,000,000 Automatic
Do you require Technical and £5,000 £10,000 £15,000
Portable Equipment cover? £20,000 £30,000 £40,000
333 £50,000 No
Do you require Employers Yes No
Liability Cover?
Employers Liability Limit: £10,000,000 Automatic
Are there more than 3 employees? Yes No
Please provide your ERN/ PAYE number is you have employees ________________
Personal Accident Benefit: £10,000 Automatic
Do you require Property Contents £2,500 £5,000 £10,000
& Increased Cost of Working cover? £15,000 £25,000 No
This relates to Contents (excluding Technical & Portable Equipment) at your premises and used in
connection with the business. An equivalent limit will also be provided for the economical costs
incurred in minimizing the reduction in income to your business.
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Property Questions
Are your business premises constructed Yes No
with walls of brick, stone or concrete
and roofed with slates, tiles or profile metal?
Are the buildings free from cracks or other Yes No
signs of damage that may be due to
subsidence, landslip or heave and
have not previously suffered damage
by any of these and are not in a known subsidence area?
Are your business premises occupied Yes No
solely for the purposes of the business or
with an element of residential accommodation
or are self-contained within a studio or media complex?
Are the premises left unoccupied for more Yes No
than 30 consecutive days?
Is the electrical installation at the premises Yes No
inspected at least every five years by a
qualified electrician and all defects
are remedied accordingly?
Has your business premises been affected Yes No
by flooding or is it within 500 meters
of any water source?
Please provide additional information if any of the above answers are no
Do you require Professional Indemnity Cover? £100,000 £250,000
0 £500,000 £1,000,000
0 No
If prior to inception please enter any [ / / ]
earlier Retroactive Date required?
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Professional Indemnity Questions
Do you or have you ever worked under Yes No
any contract with a total value to you
greater than £250,000 in any twelve month period?
Do you or have you ever worked under any Yes No
contract with applicable law outside the
European Union?
Do you take all reasonable steps to ensure Yes No
that any photograph, film clip, music or other
content used or licensed by you does not
breach any third party rights?
Are you aware after reasonable enquiry of any matter which may lead to a claim against you,
including but not limited to;
� A shortcoming or problem in your work which cannot reasonably be put right
� A complaint about your work or anything you have supplied which cannot immediately be resolved
� An escalating level of complaint on a particular project
� Any of your customers withholding payment to you after a complaint
Yes No
Please provide additional information if any of the above answers are no
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
End of Freelancers Policy section, please fill out the following sections as they apply to both
policies
Previous Insurance Details
Previous Insurer and/or Broker Yes No
Are you the holding broker Yes ☐ No ☐
Do you wish to pay by installments? Yes No
Are you a Member of BECTU? Yes No
Members of the Broadcasting, Entertainment, Cinematograph and Theatre Union (BECTU) receive a
20% discount.
Client Activities
The following client’s activity section and claims sections apply to both the Bespoke Policy and the
Freelancers package
You are domiciled in the United Kingdom True False
and all premises are based in
the United Kingdom
You do not work outside of the UK for True False
more than 90 consecutive days
You do not undertake any work in a territory True False
where the Foreign Office advise against
all non-essential travel?
You do not undertake any work in or on True False
blast furnaces, chimney or well shafts,
viaducts, bridges, mines, refineries,
off-shore installations, power stations,
dams, tunnels, airports or aerodromes,
docks, wharves, piers, harbors, railways,
motorways, aircraft towers, steeples or
ships unless docked
You do not undertake any work involving True False
the use or application of heat away from
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
their own premises other than the use
of soldering irons
You do not undertake any work in or on True False
water or underground
You do not undertake any work with animals True False
You do not undertake any work more than 10 True False
meters above ground or floor level
You do not undertake any activities involving True False
speeds of over 20 mph
Your activities do not involve participating True False
in Horse riding or other equine activities
You do not participate in winter sports True False
You do not participate in climbing, caving, True False
potholing or any underground activity or any
activity that requires the use of cables, ropes,
wires or guides
.
General Questions
If you have answered False to any of the below questions, please provide full details in the below
declarations detail box. :
You have not been declared bankrupt or become insolvent or made any voluntary arrangement with
creditors or been subject to enforcement of a judgement debit either in a personal capacity or as a
business
True ☐ False ☐
You are not aware of any potential claim or loss from the dishonesty or malice of any employee or
self -employed freelancer
True ☐ False ☐
You have not had an insurance or proposal cancelled, withdrawn, declined or made subject to
special terms
True ☐ False ☐
You have not been convicted of or charged with any offence, other than a motoring offence or
conviction spent under the Rehabilitation of Offenders Act 1974
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
True ☐ False ☐
You are not aware after enquiry of any potential injury or disease to an employee, which may give
rise to a claim
True ☐ False ☐
Declaration Details if any answered as False:
Claims
Have you had any claims, whether successful or not relating to property damage to be covered under
this policy in the last 5 years?
Yes ☐ No ☐
Has any claim or loss, whether successful or not, ever occurred or been made against you or your
predecessors in business or any past or present partner, principal or director?
Yes ☐ No ☐
Please detail below if answered Yes
Date of Loss:
Loss code : (Select from drop down list)
Loss description:
Outstanding Amount: £
Claim Amount Paid: £
Email: enquiries@bhibaffinities.co.uk Telephone: 0330 013 0036
Brokerbility Limited is registered in England and Wales number: 05074716
Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ
Authorised and regulated by the Financial Conduct Authority
Total Amount £
+ add another claim
End of quotation document
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