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Risk Questionnaire for Motor Trade Business
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Name of the person providing information within this form
Position held within the business
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Email
Phone
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PROPOSERS DETAILS:
How many Directors and/or Partners the Proposer have in total?
1
2
3
4
1) Full name / Date of Birth / Position within the company
2) Full name / Date of Birth / Position within the company
3) Full name / Date of Birth / Position within the company
4) Full name / Date of Birth / Position within the company
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Select if any of the following that apply to any Proposer, Director or Partner:
been declared bankrupt or insolvent or been the subject of bankruptcy proceeding or insolvency proceeding
had a proposal refused or declined
had an insurance cancelled
had a renewal refused
had special terms imposed
Not applicable
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Select if any of the following that apply to any Proposer, Director or Partner:
been the owner or director of, or partner in, any business, company or partnership had a CCJ awarded against them
been disqualified from holding company directorship
been served with prohibition or improvement order under health and safety regulation
been the subject of a recovery action by Customs and Excise or the Inland Revenue
Have CCJ and Sheriff Court Decrees
Not applicable
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Business Name:
Trading name
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Status of entity :
Please select from the list
Limited
Partnership
Private
Public Limited
Sole Proprietor
Religious Organisation
Charity
Association
Club
Community Group
Community Interest Company
Voluntary Organisation
Incorporated
Limited Liability Partnership
Local Authority
Public sector
Self Employed
Society
Trade Union
Trust
Business description:
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Date established:
Years of experience:
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Business address:
Would you like to add a correspondence address?
Yes
No
Please provide your correspondence address:
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What is the Business Total Annual Turnover?
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Percentage split of the business turnover
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Turnover made on Sales:
Turnover made on MOT:
Turnover made on Service:
Second Hand Parts:
Turnover made on Repairs:
Part Worn Tyres:
Turnover made on New Tyres:
Turnover made on ECU Map:
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Do you specialise in customising, modification or other major alteration works to vehicles?
Yes
No
If yes, provide details, please
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State percentage of the work split between:
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Agricultural Vehicles & Mobile plant
Heavy Goods Vehicles
Motor Cars
Light Goods Vehicles
Veteran / Vintage or Classic Cars
Motorcycles
Sports or High Performance Cars
Buses, Coaches & over 8 seats
Others (Please specify)
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Are you a sub dealer for any Motor Manufacturer?
Yes
No
If yes, provide details
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BUSINESS RISK INFORMATION
Are you the member of Trade Association?
Yes
No
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Is there a Health & Safety policy in force and up to date?
Yes
No
Health And Safety - Risk Assessments Undertaken?
Yes
No
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Health And Safety Inspections Undertaken?
Yes
No
Health And Safety - Training Officer Appointed?
Yes
No
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Are the premises solely occupied by the Proposer?
Yes
No
Is there full separation between the different business activities at the premises?
Yes
No
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Are the premises occupied 24 hours a day?
Yes
No
Has the Electrical system been inspected in the last 6 years and been certified IEE (or equivalent) compliant?
Yes
No
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Do you have a test certificate?
Yes
No
Have the premises been surveyed in the past five years?
Yes
No
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Any Risk Improvements / Requirement?
Yes
No
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Have they been completed?
Yes
No
Have you got any evidence?
Yes
No
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Do you have any employees?
Yes
No
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Employer PAYE No
Total number of employees?
Are all employees (inc. LOSC, trainees, apprentices) paid below PAYE threshold?
Yes
No
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What is the estimated Annual Wageroll for Principals and Partners?
What is the estimated Annual Wageroll for Clerical and Sales Employees?
What is the estimated Annual Wageroll for Mechanics/ Fitters/ Technicians?
What is the estimated Annual Wageroll for Pump attendants and cashiers?
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ROAD RISK
Does your company own any vehicles?
Yes
No
How many own vehicles the company have?
1
2
3
4
5
6 or more
1st Vehicle Make / Model / Engine size / Registration number / Value?
2nd Vehicle Make / Model / Engine size / Registration number / Value?
3rd Vehicle Make / Model / Engine size / Registration number / Value?
4th Vehicle Make / Model / Engine size / Registration number / Value?
5th Vehicles Make / Model / Engine size / Registration number / Value?
6th and Other Vehicles Makes / Models / Engine sizes / Registration numbers / Values?
If there is more than 6 vehicles, please list each vehicle in number order.
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Number of Drivers?
1
2
3
4
5
6
1st Driver Full Name/ DOB / Home address / Occupation / Years of driving experience / Years of NCD?
1st Driver Driving Licence number / Licence Type / Licence Expiry Date
2nd Driver Full Name/ DOB / Home address / Occupation / Years of driving experience / Years of NCD?
2nd Driver Driving Licence number / Licence Type / Licence Expiry Date
3rd Driver Full Name/ DOB / Home address / Occupation / Years of driving experience / Years of NCD?
3rd Driver Driving Licence number / Licence Type / Licence Expiry Date
4th Driver Full Name/ DOB / Home address / Occupation / Years of driving experience / Years of NCD?
4th Driver Driving Licence number / Licence Type / Licence Expiry Date
5th Driver Full Name/ DOB / Home address / Occupation / Years of driving experience / Years of NCD?
5th Driver Driving Licence number / Licence Type / Licence Expiry Date
6th Driver Full Name/ DOB / Home address / Occupation / Years of driving experience / Years of NCD?
If there is more than 6 drivers, please list each driver in number order in the last field.
6th Driver Driving Licence number / Licence Type / Licence Expiry Date
If there is more than 6 drivers, please list each driver in number order in the last field.
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Please select if any of the following options apply to any of the company driver?
Does not have a licence issued by DVLA
Has any notifiable medical conditions of which the DVLA should be aware
Had any convictions or pending prosecution in past 5 years
Had any driving accidents, claims or losses in the last 3 years
Had car insurance withdrawn or subjected to an increased rate or special conditions
If any of the options above have been ticked, please state the name of the relevant driver
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BUILDING AND CONTENTS
Description of the premises type:
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Year the property was built?
Number of years at this address?
Number of years trading elsewhere?
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Please select if any following options are applicable to the premises:
The premises is not self contained with its own means of access
The proposer is not the sole occupant of the property
The property is unoccupied, or has not been used in the last 30 days
The premises is closed for more than 3 consecutive months
The premises is in area with history of flooding
The property is erected on made up ground or has been underpinned
The property has visible signs of cracks
Not appplicable
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Please select if any following options are applicable to the premises:
There are trees or shrubs, which are more than 5 meters in height and within 10 meters of the property
The property or adjacent property has suffered from, or shows any visible signs of damage from subsidence, landslip or ground heave
The property is unduly exposed to storms or high winds
The property is close to mines/underground workings
The property is close to cliffs, embankments, railway cuttings, tunnels, quarries or other excavations
The property is close to vibrations from major roads/ railways
Not applicable
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Total number of stories
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Are the walls of the building constructed from:
Standard, one type of material
More than one type of materials
Please select the walls material of the building from the options provided below:
Click here
Brick
Concrete
Stone
Asbestos
Brick/Timber Frame
Cob
Slate
Corrugated iron
Fibreglass
Flint
Metal
Plastic
Prefabricated building - Combustible Materials
Prefabricated building - Non-combustible Materials
Tile
Timber
Please specify what materials and describe percentage of each material used:
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Does the building have a roof constructed from:
Standard, one type of material
More than one type of materials
Please select the roofing material of the building from the options provided below:
Click here
Asbestos
Asphalt
Concrete
Corrugated iron
Felt on timber
Fiberglass
Glass
Metal
Plastic
Shingle
Slate
Thatch - Fibre
Thatch - Reed
Tile
Timber
Woodwork
Please specify what materials and describe percentage of each material used:
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Is the premises in a good state of repair and free from damage?
Yes
No
Please describe the materials used for floors, staircases and internal partitions. Also, detail the type and extent of any composite (sandwich) panels used; their location in the building and the type of core material (PIR, PUR, etc.) including age and condition.
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Is there an area of flat roofing?
Yes
No
If yes, please state the approximate percentage of the roof being flat?
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Please select relevant option to describe area of your location:
Predominately residential
Commercial
Industrial
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Please select the type of the property heating?
Hot Air
Portable Heaters
Radiators - Hot water filled
Radiators - Oil filled
Night Storage Heater
Gas Central Heating
Electric Central heating
Fire - open
Oil Heater
Pressure Jet Heater
Radiant Panel Heater
Stove
Underfloor heating
Other
No heating
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FIRE PROTECTION AND SECURITY
Do you use Welding Plant or equipment?
Yes
No
If yes, please state percentage of turnover
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Do you use Angle Grinders?
Yes
No
Do you use Hot Air Guns?
Yes
No
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Do you use Blow Torches?
Yes
No
Do you use Flame Cutting Equipment?
Yes
No
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Do you use Soldering Equipment?
Yes
No
Do you use Blow Lamps?
Yes
No
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Are FEA’s installed and regularly maintained?
Yes
No
Is there any spraying?
Yes
No
If so, is there a proprietary built spray booth with extraction?
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Are PHT boxes secured to fabric of the building or vehicle lifting platforms?
Yes
No
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Please indicate which Risk Management Features are currently active for this property:
Intruder Alarm
Fire Alarm
Fire blankets
Fire extinguishers
Smoke detectors
Sprinklers
Electrical Installation Inspected Regularly
Trade waste stored in metal containers / removed weekly
Vehicle keys are kept in a proprietary key cabinet in a secure area
Vehicles regularly checked, findings recorded, any faults remedied and documented
All Machines Properly Guarded
Employee driving incentives in place
Computer record back-up & off-site storage
Maintenance Prog In Force For Building/Plant/Fire Extinguishing Apps
Employee induction programme
Driving licences checked before permitting new driver to drive & at least annually thereafter
Business Continuity Plan
Not applicable
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Please continue to indicate which Risk Management Features are currently active for this property:
CCTV
Access Control
Shutters
Window bars
Dwarf walls
Security Guards
Wheel clamps
Palisade fencing
Security Post / Hoops
Not applicable
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What's the name of the intruder alarm?
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What type of signalling your alarm has?
Redcare
Digicom
Bells only
Other
Is the alarm connected to the Police response?
Yes
No
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What type of vehicle key security do you practice overnight?
What type of vehicle access to the site including gates / barriers the premises have?
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What is your method of locking you exit door?
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Please specify type of door locks
Please specify type of window locks
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SUMS INSURED AND FINANCIAL DETAILS:
Does the business own the building?
Yes
No
What is the estimated total value of the building? (Including fixed glass, landlords fixtures/fitting)
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SUM REQUIRED TO BE INSURED:
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Value of the Machinery, Plant and other business equipment:
Value of Stock:
Value of the Electrical Equipment:
Value of Portable Hand Tools:
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Value of (own) Motor Vehicles in Compound:
Cover required for Customer Vehicles:
Cover required for Motor Vehicle (Stock) in Open:
Cover required for Contents of Customer Vehicles:
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Would you like to insure your business Profit e in case of unexpected interruption to the business?
Yes
No
What is your Gross Profit you would like to cover? (£)
Preferred Indemnity Period:
6 months
12 months
24 months
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MONEY COVER
Do you require to cover Money in Safe or Strongroom in the Premises?
Yes
No
What is the Safe Make? / Model ?/ Description /? How is it secured?
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SUM REQUIRED TO BE INSURED:
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Sum contained in a locked safe:
Sum not in a locked safe:
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Sum on premises during business hours:
Sum on premises outside business hours:
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What's the amount of annual cash carrying by you?
What's the amount of annual cash carrying by security company?
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Have you made any insurance claims within the last 5 years?
Yes
No
Claim history within the last 5 years:
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Insurance renewal date:
Current or previous insurer:
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Is there any other information you would like to tell us about? Please let us know below:
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