Domiciliary Care Insurance Form - Livingstones of London Ltd

Do you require buildings cover? *

Yes No

Building sums insured in £ *

Day one reinstatement value

When was premises built? *

If built pre 1850, please confirm the exact year of build *

Is the building occupied in full throughout the year and does the business trade all year round? *

Yes No

Is the building in a good state of repair, kept in a like manner and free from any visable signs of cracking? *

Yes No

Does the building have walls built of brick, stone or concrete? *

Yes No

If No, what construction box? *

Does the building have a roof of slate, tile, metal or concrete excluding any flat roof area? *

Yes No

Does the building have any area of flat roof? *

Yes No

What percentage of the roof is flat? *

What is the flat roof area made from? *

Is any part of the building listed? *

Yes No

What Grade is it listed? *

Is the buiding free from storm exposure and/or are in an area which is free from flooding and at least 400 metres away from the nearest river, canal, lake or tidal waterway? *

Yes No

Is the building free from, and in an area (within 400m of the premises) which is free from any signs of subsidence, heave and/or landslip? *

Yes No

Is the building solely occupied by the business? *

Yes No

Is the building occupied by the proposer, or their employees, overnight? *

Yes No

have residential accommodation at the premises other than that which acts as the private dwelling of the proposer or their employees? *

Yes No

What type of tenants do you have in the property? *

Is the building entirely self contained with its own lockable entrance and exit doors? *

Yes No

Has all sections of the building had the Electrical Installation tested by a certified NICEIC, ELECSA or ECA Contractor within the last 5 years and all reported defects remedied? *

Yes No

Do any sections of the building have any open fires, woodburning or multifuel stoves? *

Yes No

The the trading premises located in a shopping centre, arcade or mill complex? *

Yes No

Is deep fat frying undertaken at the premises? *

Yes No

Is there a full frying range (fish & chip shop style) located and used at the premises? *

Yes No

How is your premises heated? *

Do you require tenants improvement cover? *

Yes No

Tenants improvements insured in £ *

Including external signs, canopies, awnings, etc. for which the Insured is held legally responsible for

Do you require trade contents cover? *

Yes No

Trade Fixtures & Fittings, Machinery, Plant and all Other Contents (Ex. Stock) Including Property Held in Trust in £ *

Do you require Stock and material in trade cover? *

Yes No

General stock and food sums insured in £ *

Do you require cover for electronic business equipment? *

Yes No

Electronic Equipment & Computers in £ *

Do you require cover for money during business hours and In transit? *

Yes No

Money During Business Hours and In Transit *

Do you require cover for Public Liability? *

Yes No

Public Liability levels of cover *

Do you require cover for Employers Liability? *

Yes No

How many clerical/managerial/administrative staff does the business have? *

What is the business' estimated annual wageroll for clerical/managerial/administrative staff for the next financial year in £ *

How many carer staff does the business have? *

What is the business' estimated annual wageroll for carer staff for the next financial year in £ *

How many professionally qualified persons eg Nurses does the business have? *

What is the business' estimated annual wageroll for professionally qualified staff for the next financial year in £ *

What is the business' estimated annual turnover for the next financial year in £ *

Do you require cover for business interruption? *

Yes No

Do you require cover for professional indemnity? *

Yes No

Professional Indemnity levels of cover *

Do you require cover for loss of registration? *

Yes No

Do you require cover for legal expenses? *

Yes No

Do you require cover for terrorism? *

Yes No

Does the business carry out the administration of any medication? *

Yes No

Does the business prompt service users for any medication? *

Yes No

Does the business have a written policy in dealing with the procedure for the administration of medication *

Yes No

Risk Management

Security