SPECIALIST UNDERWRITING SERVICES
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S P E C I A L I S T U N D E RW R I T I N G S E RV I C E S
SUS_10/20_PPF2Proposal
Please complete the following questions in block capitals.
Name of Proposer:
Full Trading Title:
VAT number:
Postal address: EIR Code:
Telephone: e-mail/web address:
Situations of property to be insured:
EIR Code:
Full description of your Business/Trade:
How long have you been in this business (a) at these premises
(b) elsewhere:
Do you solely occupy premises for Business Yes No
Are there any other occupants (detail):
Does any financial institution or other interest need to be named on this policy? Yes No
What are your daily business trading hours:
Who were your previous insurers?
State Expiry Date of Current Policy? State Expiring Premium:
1. State construction of;
Walls:
Roof:
Floors:
2. Age of building State number of storeys Basement Yes No
3. What form of heating is used:
Yes No
4. Have you a written Safety Statement as required by the Safety Health
and Welfare at Work Act from 2005?
5. Has the Electrical Installation at the Premises/Building been tested by a certified
Electrical Contractor within the last 5 years and all reported defects remedied
6. Is the building a heritage/listed/protected structure
7. Is any building timber framed
8. Is any part of roof flat
9. If so what % of roof area is flat?
What is the construction of the flat roof
10. Are there any parts of the building constructed with Composite panels
11. Are your premises located in an area liable to Flooding or Subsidence
SUS_10/20_PPF2Yes No
12. re there rivers, streams, tidal waters or watercourses
A
within a 250 metre radius of the premises
13. Is a fully maintained Monitored fire alarm installed and in use
14. a). Are all fire extinguishing appliances (Fire hoses/Fire alarms/Smoke detectors in use)
b). If deep fat frying confirm that a Class F extinguisher, a fire blanket and
an extinguisher suitable for use on electrical fires are fitted
15. State level of security in use;
a). Are five lever mortice deadlocks fitted to all entry/exit doors
b). Are key operated window locks fitted to all accessible windows
c). Give details of all bars, grilles or external metal shutters in use?
d). Is an alarm system fitted to Irish Standard ISEN 50131
e). Is alarm system connected to a monitoring station
Please supply a copy of the alarm specification
16. Is any Glass in the premises lettered, decorated, armoured, bent or cracked
17. a) Do you serve food or drink for consumption on the premises
b) What is the maximum seating capacity
18. a) Do you have cooking facilities at the premises (Details)
b) If a fire suppressant system is fitted please provide (details)
c) Is an extraction system fitted
d) Are filters cleaned weekly
e) Are ducts and flues cleaned monthly
f) re deep fat fryers fitted with a separate high temperature cut off switch
A
should the temperature of fat exceed 230degrees centigrade
g) ave all combustible surfaces within 1 metre of deep fat frying apparatus
H
been covered in metal
SUMS INSURED
Property Yes No
Is Cover Required?
19. Building including all outbuildings (rebuilding costs plus fees & debris removal etc.) €
20. Machinery Plant Fixtures Fittings Trade Equipment and All other Contents €
21. Tenants Improvements and decorations €
22. Computer Equipment €
23. Contents in the Open (Restricted Cover) €
SUS_10/20_PPF224. Stock consisting of;
a) In trade and goods in trust €
b) Wines/ Spirits/Cigarettes/Tobacco €
c) Frozen Foods €
d) Other (Specify) €
25. Miscellaneous (Specify) €
Business Interruption Yes No
Is Cover Required?
26. Gross Profit €
27. Gross revenue €
28. Increase in Cost of working €
29. Additional Increase in Cost of Working €
30. Rent Receivable €
31. Indemnity Period Months
Money Yes No
Is Cover Required?
32. a). In the premises during working hours, in transit or in bank night safe €
b). in premises out of business hours
i) in locked safe or strong room €
ii) not in locked safe or strong room €
c). State annual cash Carrying €
d). In ATM out of business hours (max €5000) €
Liability Yes No
Is Cover Required?
33. State estimated annual wages/salaries and other earnings for
i) Clerical & non manual employees €
ii) Employees engaged in work away from your premises (Detail) €
iii) All others (Describe exactly)
€
€
iii) Working director’s remuneration €
34. State estimated annual turnover (breakdown required for multiple Trades) €
SUS_10/20_PPF235. What is number of: Full time employees / Part time employees: /
36. If you export state Countries concerned
37. If you import, state from what countries
Loss of Licence Yes No
Is Cover Required?
38. In whose name is Licence held
39. Have you ever been refused a Licence?
40. Have you ever had a Licence application refused or a Licence suspended
(Details):
General Questions Yes No
Has the proposer of any partner or director of the proposer ever been convicted of,
or charged but not yet tried, with a criminal offence other than a motoring offence?
Yes No
Has the proposer or any partner or director of the propser suffered any losses
whether insured or not, during the last 5 years? Please give details:
Yes No
Has the insurer in respect of the proposer or any partner or director of the proposer
ever declined a proposal, refused renewal, terminated insurance or imposed special terms.
SUS_10/20_PPF2Important Notice You should also be aware that failure to have property insurance in
You must tell us any other facts which are likely to affect whether we place could lead to a breach of the terms and conditions attaching to
agree to provide cover, or how we assess the risks proposed for insur- any loan secured on that property.
ance, including but not limited to: An individual is not required to disclose a spent conviction when
a) Previous insurance claims supplying information on past convictions. To determine whether
b) Any convictions, offences or prosecutions pending of any nature, or not a conviction is a ‘spent conviction’ under the Criminal Justice
fraud, theft etc. (Spent Convictions and Certain Disclosures) Act 2016 please visit www.
If you are not sure whether you should tell us about something, please irishstatutebook.ie
tell us anyway. This is for your own protection because, if you do not Under the third EU Non-life Directive we must give you the following
give us all the information we need, your policy may not provide you information before you buy your policy. The law that applies to the
with the cover you need, a claim may not be paid, the policy may be contract – Under the relevant European and Irish laws, we Specialist
declared invalid and void or may be cancelled, and you may encounter Underwriting Services Ltd. and you, the proposer, are free to choose
difficulty trying to purchase insurance elsewhere. the law that will apply to the contract. We propose that Irish law will
apply to the contract.
Declaration
I/We the undersigned, declare that-
I/We confirm that, all the details, answers and information given in this proposal are true, accurate and complete. I
acknowledge that this proposal will form the basis of my/our contract. I/We confirm that I/we am/are giving my/our
permission to you to use the information that I/we have given on this form for the purposes set out in the Data Protection
customer summary.
All the material facts relevant to this proposal have been declared and the proposal shall form the basis of the contract
between me/us and the Company. All details and answers provided by me/us in this proposal are to the best of my/our
knowledge and belief true and complete.
The buildings and contents shall be maintained in a good state of repair.
All security devices will be maintained and put in operation at the premises outside of business hours.
The warranties/Conditions applying to this cover will be adhered to.
ONLY SIGN THE FOLLOWING DECLARATION IF YOU FULLY UNDERSTAND, AND AGREE ALL REQUIREMENTS.
_______________________________________ ____________________________________
Proposer’s Signature Date:
N.B. U
nderwriters reserve the right to amend or restrict the cover provided. Please provide certified claims experience. In case of any
doubt your Broker should be consulted
SUS_10/20_PPF2Summary of Cover
General Contents
All General and other Contents of the Premises including stock, tenants fixtures and fittings, decorations, improvements
and alterations, machinery, equipment, utensils, the shop front, including all plate glass, other glass and mirrors, signs and
sanitary fittings, against All Risks of physicals loss or damage which incorporates the following:-
(1) Fire, Lightning, Earthquake, Explosion, Riot, Malicious Damage, Impact, Storm, Flood, Burst Pipes and Theft
(2) Loss or theft of keys necessitating changing locks up to €1,000
(3) Employees Personal effects up to €1,500 any one person
Buildings
All Risks of physical loss or damage including Subsidence, Landslip or Heave for suitable risks
Business Interruption
Loss of Gross Profit you may suffer as a result of loss or damage to General Contents, Stock or Buildings. An automatic sum
insured of €800,000 with an indemnity period of 12 months is provided including loss of income resulting from:
1. Denial of access to the premises
2. Closure of the premises by Public Health Authorities
3. Accidental failure of Public supplies of Gas, Electricity or Water
4. Mechanical breakdown of Extractor fan for a period of up to 72 hours up to a maximum of €6,500
5. Customers & Suppliers – 10% of sum insured to a maximum of €325,000
Money
Loss of money up to the follow limits
1. Crossed cheques and the like €750,000
2. In transit or on premises during business hours €15,000
3. In safe outside business hours €15,000
4. Elsewhere on premises outside business hours €1,500
5. In ATM out of business hours €5,000
6. In private dwelling of insured or authorised employee €1,500
- In locked safe or while an adult is in the residence €1,500
- Otherwise €500
7 ersonal accident/assault benefits payable if death/injury results from actual/attempted hold-up or robbery; Death,
P
loss of limb(s) or eye(s), hearing, speech, permanent total disablement €30,000
Temporary total disablement (maximum 104 weeks) €300 per week
Medical Expenses €500
Liabilities
1 Employers Liability covering legal liability for death of, injury or disease to your employees Indemnity – €13,000,000
2 ublic and Products liability covering legal liability to the public for accidental death, injury or disease or loss of
P
damage to property. This includes liability arising from any food, drink or other products sold or supplied i.e. food
poisoning Indemnity up to €6,500,000
3 Legal Defence costs following prosecution under the Health, Safety and Welfare at Work Act and wrongful arrest etc.
Frozen Food
Deterioration of Frozen Foods following breakdown of any acceptable cold room/freezer/chiller, €15,000 or greater if required.
Value at risk of frozen food to be included in stock sum insured for standard policy cover.
Stock in Transit
Stock in Transit. Stock up to €5,000 whilst in transit.
Computer
Computer breakdown cover up to €20,000
SUS_10/20_PPF2Deductibles
Stock in Transit €130 each and every loss
Deterioration of stock €130 each and every loss
Subsidence landslip, Heave €1,000 each and every loss
All other claims – €350 each and every loss other than Liability.
Liability Claims – €500 each and every loss or as agreed.
Commercial Legal Protection
The policy automatically extends to provide legal protection up to €400,000 underwritten by DAS Legal Expenses Insurance
Company Ltd.
Warranties/Conditions
Some of the Warranties/Conditions Applying to this Cover
The following warranties must be complied with and failure to do so could invalidate the Insurance:-
(a) If burglar alarms or fire alarms are installed they must be maintained and tested regularly and always set if the
premises is left unattended.
(b) Fire extinguishing appliances must be installed.
(c) The cash register must be left open and empty while shop is unoccupied
(d) Flues and Flue Filters must be checked regularly and cleaned weekly/monthly.
(e) F inal exit doors must be fitted with a 5-lever mortice deadlock. Accessible windows must be fitted with key operated
locks.
Note: There are qualifications and restrictions to the covers and a copy of the policy wordings are available on request. A copy of
your completed proposal will be available (on request) provided the insurance is effected. Cover is arranged through Specialist
Underwriting Services Ltd., P.O. Box 4611, Dublin 14.
Specialist Underwriting Services Ltd.
is regulated by the Central Bank of Ireland
Complaints procedure
We aim to give excellent service to all our customers; however, we recognise that things may occasionally go wrong. We
will do our best to deal with your complaint as effectively and quickly as possible. If you arranged your cover through
an intermediary or broker, please send your complaint to them. If your complaint is not sorted out to your satisfaction,
please contact: Specialist Underwriting Services Ltd.at 00353 1 2988899.
Or you can contact the following;
Insurance Ireland, Insurance Centre, 5 Harbourmaster Place, IFSC, Dublin 1, D01 E7E8
Phone: 01 676 1914
Fax: 01 676 1943
E-mail: iis@insuranceireland.eu
Website: www.insuranceireland.eu
The Financial Services and Pensions Ombudsman, 3rd Floor, Lincoln House, Lincoln Place, Dublin 2 D02 VH29
Phone: 01 567 7000
E-mail: info@fspo.ie
Website: www.fspo.ie
Your right to take legal action is not affected if you contact either of the above.
SUS_10/20_PPF2GDPR
Specialist Underwriting Services Ltd. takes your privacy and confidentiality seriously. You provide us with
personal and financial information and we want you to understand why we collect your data, what we do
with it, who we share it with, why we share data, and understand your legal obligations.
This document is being provided to you in line with our obligations under the General Data Protection Regulation
(GDPR), which came into force on 25 May 2018. From that date, the GDPR, together with applicable Irish
requirements, amended existing data protection law and placed enhanced accountability and transparency
obligations on organisations when using your information. The GDPR will also introduce changes which will
give you greater control over your personal information, including a right to object to processing of your
personal information where that processing is carried out for our business purposes.
Please take time to read this notice carefully. If you are under 16 years of age, please read this summary
with a parent or guardian and ensure you understand it. If you have any questions about how we use your
information, please contact us as shown below.
This summary explains the most important aspects of how we use your information and what rights you have
in relation to your personal information.
If you would like clarification on any points in this summary document please contact us.
1. Who we are
Specialist Underwriting Services Ltd. is a firm of financial advisors which provides advice on financial matters
and arranges transactions or products suited to your needs.
2. The information we collect about you
We will hold:
- data to identify you, including your contact information i.e. name, address, telephone number(s), email
address, gender, date of birth, occupation, PPS number, photographic identification, nationality;
- your financial details/financial circumstances as necessary i.e., employment, income, assets, liabilities,
bank account details (where applicable);
- your marital or civil status;
- other sensitive information e.g. medical information which you provide to us, where necessary for the
service to be provided;
- information about you provided by others e.g. your spouse/partner, professional advisors, etc.;
- information which you have consented to us using;
- other personal information, if applicable e.g. criminal conviction data, driving penalty points;
- telephone recordings of conversations; and
- information provided when exercising your rights.
Sometimes we may use your information even though you are not our customer. For example, you may be a
beneficiary under a trust, a director of a client company, an employee of a client, a member of your employer’s
pension scheme, or be a potential customer applying for one of our products or services.
3. When we collect your information
We collate information at the initial point of contact with you and aim to update this whenever you require a
further service or product.
4. How and why we use your information
We collate, use and share information only where there is a legal basis for doing so. This includes where you
have given us information in order to provide you with a service, product, or arrange a transaction for you.
Typically, the legal basis for using your data is to provide a service or arrange a transaction which you have
requested. The legal basis will also include complying with our legal and regulatory obligations, e.g. under
our Central Bank authorisations, interaction with the Data Protection Commission, Financial Services and
Pensions Ombudsman, Revenue, Pensions Authority, when conducting Anti-Money Laundering checks, law
enforcement agencies.
Where you have agreed or explicitly consented to the using of your data in a specific way, you may withdraw
your consent at any time.
We may use your data if necessary to protect your “vital interests” in exceptional circumstances e.g. where
we suspect a fraud may be in the course of perpetration.
Data may also be used for our legitimate interests (which you may object to) such as managing our business,
providing service information, conducting marketing activities, training and quality assurance, and strategic
SUS_10/20_PPF2planning.
5. How we use automated processing or “analytics”
We may analyse your information using automated means:
- to help us understand your needs and develop our relationship with you;
- to help us to offer you products and service information we believe will be of interest to you, providing
that you have given us consent to use your data for this purpose;
- by using product providers IT systems and similar systems where you apply for a financial product e.g.
to obtain underwriting terms from an insurer, analyse your investment risk profile, affordability testing.
The types and sources of the information we process by automated means about you are listed in Section 2
above.
We also use automated processing to assist in compliance with our legal obligations in connection with
prevention of money laundering, fraud and terrorist financing.
6. Who we share your information with
When providing our services to you, we may share your information with:
- your authorised representatives;
- third parties with whom (i) we need to share your information to facilitate transactions or services you
have requested, and (ii) you have agreed that we may share your information;
- product providers with which we propose to arrange business on your behalf;
- service providers who provide us with support services;
- statutory and regulatory bodies where we are legally obliged to do so;
- credit reference/rating agencies;
- pension fund administrators, where applicable;
- pension scheme trustees or your employer in relation to the provision of pension benefits, where
applicable.
7. How long we hold your data
How long we hold your data for is subject to legislation and regulatory rules we must follow, set by authorities
such as the Central Bank of Ireland, Office of the Data Protection Commission, Financial Services and Pensions
Ombudsman. The timescales may also depend on the type of financial or insurance, investment, or pension
product provided to you. Our aim is to hold your data for no longer that is necessary and subject then to the
timescales imposed by our legal obligations.
8. Implications of not providing your data
If you do not provide information we may not be able to:
- provide requested products or services to you;
- continue to provide and/or renew existing products or services;
- assess suitability; and
- where relevant, give you a recommendation for a financial product or service which you require.
9. Transfer of information outside the European Economic Area (EEA)
It is our aim to retain any information which we hold within the EEA. However, given the nature of our
business relationships with certain product providers, such providers may have legitimate business reasons
to transfer information outside the EEA. The product providers with which we arrange business on your behalf
are obliged to comply with the provisions of the GDPR in relation to the transfer of data within or outside the
EEA.
10. Data Subject Rights - How to exercise your rights
Under the GDPR you will have additional rights in relation to how your data is used, including the rights to:
- find out if we use your information, access your information and receive copies of your information;
- have inaccurate or incomplete information corrected and updated;
SUS_10/20_PPF2- object to particular use of your personal data for our legitimate business interests or direct marketing
purposes;
- to have your information deleted or our use of your data restricted, in certain circumstances;
- not to be subject to solely automated decisions in certain circumstances, and where we make such
automated decisions, a right to have a person review the decision;
- exercise the right to data portability i.e. obtain a transferable copy of certain information we hold or to
transfer the data to another provider; and
- withdraw consent at any time for processing of your data, based on content of data.
If you wish to exercise any of your rights you can contact us at the address shown.
If we are unable to deal with your requests for data access fully within a calendar month we may extend this
period by a further two calendar months and explain the reason why. If you make your request electronically,
we will try to provide you with the relevant information electronically.
11. Complaints
If you are dissatisfied with our services or how we use your data, you have the right to complain to the Data
Protection Commission, contact details as follows:
Address: Office of the Data Protection Commission,
Canal House, Station House, Portlaoise, R32, AP23, Co. Laois.
Telephone: 076 1104800 or Lo Call Number 1890 252 231
Email: info@dataprotection.ie
12. Updates
We will update our Data Privacy Notice – Customer Summary and Website Privacy Notice from time to time.
You may request copies of our current Notices at any time or refer to our website www.sus.ie for the latest
versions of these documents.
13. Our Contact Details
Specialist Underwriting Services Ltd
Melrose House
Dundrum Road
Dundrum
Dublin 14
D14 C1H5
Telephone no; 00353 1 2988899
Email address: info@sus.ie
Effective Date: January 2021
SUS_10/20_PPF2S P E C I A L I S T U N D E RW R I T I N G S E RV I C E S
The SafeScheme™ products are exclusively arranged and
owned by:
Specialist Underwriting Services Ltd
Melrose House
Dundrum Road
Dublin 14
D14 C1H5
Tel: 01 298 8899
Fax: 01 298 0361
Email: info@sus.ie
Specialist Underwriting Services Ltd.
is regulated by the Central Bank of Ireland
20 Jan 2021 16:58You can also read
