Commercial Contents Application

Is the Policyholder a Company?*

Yes No

Legal Business Name

Contact Name:*

First Name

Last Name

Phone*

Email*

Mailing Address:*

What is the nature of your business?*

Has the building been properly and regularly maintained?*

Yes No

Is the building in need of repairs?*

Yes No

Please provide details:*

What is the longest continuous number of days that the building will be left unoccupied?*

Less than 45 Consecutive Days More than 45 Consecutive Days

State the approximate distance of your building from the nearest body of water:*

Have you in the last 5 years had a loss from any of the perils to be insured?*

Yes No

Please Provide Details:

Have you ever had an application for contents insurance declined?*

Yes No

Please provide details:*

Are you now insured in respect of this property for which you are proposing insurance?*

Yes No

Details of Contents

Please state your Contents Sum Insured

KYD

Please state the value of improvements

KYD

Please state the total of your valuables

KYD

Total Sum Insured

KYD

Is there any single item which exceed 5% of the total value OR $2,500 in value?*

Yes No

Is there a mortgage interest on your Contents?*

Yes No

Name of Institution:*

Current Insurance Details:

Insurer

Renewal Date

Annual Premium

Excess structure

CI$ amount for each and every claim, and for which claims that the excess varies (with amounts)

Where did you hear about us?

Declaration

This information has been collected to determine a quotation. The collection of a quotation by Saxon Motor & General Insurance Company Ltd. does not constitute acceptance of insurance. Insurance will not commence until we have a completed proposal form, and Saxon Motor & General Insurance Company has indicated acceptance of this application.

Signature*

[clear]

Use your mouse or finger to draw your signature above

Property Information

What are your normal opening hours?

Details of Contents

Current Insurance Details:

Where did you hear about us?

Declaration