Business Insurance Quotation


Personal Information  
*Name:
Address:
Postcode:
*Email Address:
Date of Birth:
*Telephone Number:
Fax Number:
Risk Details
Occupation/Business:
Address of the Premises to be Insured:
Select the type of Cover required:
Business Protect - Standard perils cover Business Protect Plus - Accidental damage cover
Values to be Insured
Kindly Complete the following details:
Section 1 - Contents
Furniture, Fixtures & Fittings: €
Machinery and ancillary equipment: €
Description of stocks: (Includes a description of stock below)
€
Section 2 - Buildings
Buildings: €
12 Months Rent: €
Section 3 - Business Equipment
Description Serial No. Model No. Sum to be Insured
€
€
€
Section 4 - Glass
Internal Glass:   €
  External Glass:  €
  Signs:                   €
Section 5 - Goods in Transit
Vehicle Registration No. Limit of Liability
€
€
Section 6 - Deterioration of Stock
Type of Plant Sum to be Insured
€
€
Section 7 - Money & Assault
Cover Limit of Liability
1. In the Business Premises €
2. In transit €
3. In bank night safes until removed by a bank official €
4. In your private residence or that of any authorised employee €
5. Replacement of safe or strong room €
Section 8 - Machinery Breakdown
Type of Plant Sum to be Insured
€
€
Section 9 - Personal Accident
Name Occupation ID Card No. Date of Birth Benefit*

* the benefits that you select should represent the declared annual salary with respect to the Death/Disability Benefit, while any amount for the Weekly Benefit should not exceed 75% of the gross weekly pay.
Section 10 - Loss of Income
Limits/Sum Insured
   
Loss of Revenue and Additional Expenses €
Section 11 - Public Liability
The Premises to which the cover under this Section will apply;-
A.
B.
Section 12 - Employer's Liability
Occupation of Employees Estimated number of Employees Estimated total salaries, wages and other earning on which premium under this Section is based
General Questions
Are the Premises protect by an intruder alarm Yes No
 
Is the intruder alarm equipped with an auto-dialer facility Yes No
 
Are any of the openings including each external door, window and glass shop front protected and locked by means of any one or all of the following security devices;-
 
Roller shutter Yes No
Concertina type shutter Yes No
Solid wooden shutter or door Yes No
Steel panelled door or window Yes No
Metal grille door or window Yes No
Fixed metal grille or bar Yes No
 
Do you have any fire extinguishing appliances installed at the Premises? If yes, please give details. Yes No
 
Details of Fire Extinguishing Appliances:
 
Are you currently insured? Yes No
 
Have you had any claims or losses in the past 5 years? Yes No
 
If yes please give us some details  
How would you like to receive your quotation?

 

Post
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Data Protection Notice

To the extent that the information supplied by you, whether orally or in writing, constitutes personal data, including sensitive data within the provisions of the Data Protection Act, you consent to the processing of such data for purposes of administering your proposal for insurance, your Policy, underwriting, handling of claims and also for the purposes of detecting, preventing and suppressing fraud and of keeping statistics. We maybe required to collect further information from our sub-agents, other insurance companies, insurance intermediaries or insurance associations.

In addition, we may pass some or all of the information to other insurance companies, or insurance associations for underwriting and claims handling purposes and also for the purposes of detecting, preventing and suppressing fraud and of keeping statistics. This also helps us to check the information provided. When we deal with your request for insurance, we may search this information. When you tell us about an incident which may or may not give rise to a claim, we will pass information relating to it to the Malta Insurance Association.

We and other companies within our group would like, on occasion, to keep you informed of our products and services, by mail, fax, e-mail or other electronic means. Please inform us in writing if you do not wish to receive this information or if you wish to receive such information solely from GasanMamo Insurance Ltd. Moreover, were hereby ask you whether you wish to receive direct marketing information from us by e-mail to your e-mail address provided below.

You have the right to request access to, and rectification of, your personal data held by us by directing your request in writing signed by yourself to the Data Protection Officer, GasanMamo Insurance Ltd, Msida Road, Gzira GZR 1405