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Business Insurance Application Form

Please fill in all the mandatory fields marked with *

Cover Details

Property All Risks

Floor Size (sq. ft.)

Seating Capacity

Contents Sum Insured (HKD)

Stock Sum Insured (HKD)

Public Liability

Third party liability required?*

Third Party Liability Limit (HKD)*

Business Interruption

Do you require cover for loss of profits?

Estimated Gross Profit for First 12 Months (HKD)

Maximum Indemnity Period Required?

Sum Insured Required (HKD)

Do you require cover for Additional Expenditure?

Sum Insured (HKD)

Employees Compensation

No. of Employee - Management/Clerical

Estimated Annual Salary (HKD)

No. of Employee - Kitchen Staff

Estimated Annual Salary (HKD)

No. of Employee - Floor Staff

Estimated Annual Salary (HKD)

No. of Employee - Bar Staff

Estimated Annual Salary (HKD)

No. of Employee - Cleaners/Amahs

Estimated Annual Salary (HKD)

No. of Employee - Entertainers

Estimated Annual Salary (HKD)

No. of Employee - Others

Estimated Annual Salary (HKD)

Glass

Do you require cover against accidental breakage of glass?*

Description of Glass*

Replacement Cost of Glass (HKD)*

Money

Maximum Cash on Premises during business hours (HKD)

Maximum Cash in Transit (HKD)

Maximum Cash in locked safe in premises after business hours (HKD)

Maximum Cash in premises not in safe after business hours (HKD)

Maximum amount for crossed cheques, and other non-negotiable items (HKD)

Fidelity Guarantee

Do you require cover for dishonesty of employees?*

Description of Staff*

Sum Insured per person (HKD)

Any other information?

Cover Details

Name of Company*

Trading Name of Business

Company Address*

Business Nature*

Number of Employees*

Website of Company (if any)

Period of Insurance* (from dd/mm/yyyy to dd/mm/yyyy)

Details of Applicant

Full Name*

Corresponding Address

Phone Number*

Email*

Fax No.

Position Held in the Company

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