|
|
|
Your NAME
and partners name(s), OR the
Limited Company name. |
|
| The TRADING
NAME, if any. |
|
|
The POSTAL address.
|
|
| Telephone
number.
Facsimile number.
Email address. |
|
Your DECLARATION and SIGNATURE hereunder
relate to ALL three pages of this questionnaire and to any future
SUPPLEMENTARY pages |
| The BUSINESS
ACTIVITY. Firework manufacture or assembly is not insured; special cover can be
arranged. BONFIRES also need special consideration, cover is not included unless
specifically agreed. |
|
| How long in BUSINESS
?
How many years EXPERIENCE ? |
|
| Any ACCIDENTS /
INJURIES / LOSSES in last 5 years? If none, write ‘None’. |
|
| By signing this
questionnaire, you declare:-
1) There are no ERRORS or OMISSIONS, even though some answers may have been
entered on your behalf from information you have given. 2) You have not withheld any MATERIAL
FACT. A ‘material fact’ is that which may influence underwriters in the
acceptance, assessment or continuation of the risk. |
SIGNED
NAME
POSITION
DATE |
| NON-DISCLOSURE or MISREPRESENTATION OF A MATERIAL FACT WILL ENTITLE UNDERWRITERS TO LEGALLY DECLARE THE INSURANCE VOID
Continued… |
| |
|
|
PUBLIC, PRODUCTS
and EMPLOYERS LIABILITIES |
|
|
|
Which type of
STORAGE LICENSE
do you hold ?
|
State
division/mode A B C D E, as appropriate.
1) Health & Safety Executive Licence
(substantial bunker storage)
2) Local Authority Divisional Licence
(bunker or road container storage)
3) Registered Premises Certificate
(shop/minor store - Mode A or B)
4) 14 day rule storage only
(minor one-off storage) |
|
Licence(s) / certificate(s) NUMBER(S) |
|
|
Circle Public/Products LIMIT
required |
�2m �5m �10m
(Automatic limit of �10m for Employers Liability, if insured) |
|
COLD fallout fireworks
(indoor type) ? |
|
|
Except Category 4 fireworks,
describe any SPECIAL EFFECTS used. |
|
|
Estimated fireworks TURNOVER (must
be a GENEROUS figure)
Any work or sales OUTSIDE UK? What? Where? Turnover? |
DISPLAYS
SALES
|
|
Estimated TURNOVER
for other
RELATED products.
What are the PRODUCTS ? Example: Sale of fusing, firing boxes, etc – please
state if exported. |
|
|
Estimated WAGES
/ SALARIES Paid to all employees, including you if
a Limited Company director and any
temporary workers / casual help. Please
state if only unpaid helpers. |
Firers, drivers,
(manual)
Shop assistants
Clerical staff |
|
|
|
|
| Do you use a RISK
ASSESSMENT with SKETCH PLAN and CHECKLIST ? You must do so for insurance
purposes, no matter how small the display !! Your risk assessments must be to the
standard of the sample we supplied, or better – you could add a more specific
checklist on notifying local stables, etc. |
KEEP a copy of each assessment, there may
be a claim against you, some years after the
display ! |
| Are you familiar with and
do you always adhere to CURRENT LAW and, as far as reasonably possible, HSE
GUIDELINES regarding use, handling, storage and transportation of fireworks? If not,
how do you propose to comply in future ? |
|
| Please circle the CATEGORIES
of fireworks you Display &/or Sell. |
|
|
Please state ADDRESS / LOCATION
Of each store, workshop and retail shop.
Attach continuation sheet if necessary.
|
|
| Do you need a letter (from
us) confirming cover for customers/suppliers? Will be addressed: To Whom It May Concern
? |
|
End of questionnaire. Please consider other available covers on
our home page......