PoundGates Insurance¸ Claims & Risk Management Solutions

MoversPlus Enquiry Form

Click below to download: -
FSA Authorised Removal & Storage companies - PDF <63kb>
Removal & Storage companies operating under ‘Standard Liability’ conditions - PDF <62kb>
Removal & Storage companies operating under ‘Insured Remover’ conditions - PDF <65kb>

Please enter your details below:
NOTE: All fields marked with a * must be filled in for a successful form submission.

Broker Contact Details

*Company Name:
*Contact Name:
*Phone Number:
*FSA Membership Number:
Email:
Fax Number:
UA Number if known:

General Information

*Where did you here about our MoversPlus scheme?

*Full trading title of company (indicate if Ltd):
*Full Address:
*Postcode:
*Full Description of business:
*Domestic Transit/Storage:	% of turnover
*Vehicle Transit /Storage:	% of turnover
*Archive Transit/Storage:	% of turnover
*Commercial Transit/Storage: (used goods eg surplus office furniture)	% of turnover
*Commercial Transit/Storage: (new goods intended for sale)	% of turnover
*Telephone Number:
*Fax Number:
Email Address:
*Renewal Date:
*Are you in a new venture?	Yes No
If Yes, what experience do you have in the removals industry?
If No, how long have you been trading?
*Current Insurers:
*Current Premium:

*What territories do you operate in?
UK	%	Europe	%
USA	%	Australia	%
Other	%
If Other, please give details

Section 1: Contractual and Legal Liabilities

*What conditions do you trade under?	FSA Authorised Insured Remover/Contractor Extended/Standard Liability Other
*Do you belong to any Trade Associations (i.e. BAR, National Guild) If so, which?
*What is you estimated turnover for the next 12 months?	£
*Any claims occurring or pending in the last 3 years?	Yes No N/A (New Venture )
If Yes, please give details:

Year

No. of claims

Paid

Outstanding

Totals

Current Year	£	£	£
Minus 1	£	£	£
Minus 2	£	£	£
Minus 3	£	£	£
Totals	£	£	£

Section 2: All Risks

Goods in Transit
*Goods in transit sum insured. Any one vehicle:	£
*How many vehicles are used for removals?
*Approximate number of removals carried out in the last 12 months:
Goods in Storage
*Goods in store sum insured required. (If more than one location is used please give sum insured details for each below)	£
*Current all risks excess:	£
*Number of storage locations:
*Are all customers goods containerised?:	Yes No
*Do any of the storage premises have composite Polystyrene or Polyurethane paneling within the wall?:	Yes No

Storage Location Details

Location 1
*Address of premises:
*Postcode:
*Method of Construction:
*Year premises built:
*How long have you operated from these premises?:
*Method of heating the premises:
*What security measures are in place? (i.e. RedCare Alarm, CCTV etc.):
*What Fire Protections are in place? (i.e. Fire Alarm, Smoke Detectors, Fire Extinguishers etc.)
*Is there any storage in the open?	Yes No
If Yes, please give details regarding type of storage and security measures in place:
*Are you the sole occupant of the premises?	Yes No
If No, please give details of other occupants
*Has the premises ever suffered from a claim or incident involving flood or subsidence?	Yes No
If Yes, please give details:
*Customer Goods Sum insured:	£

Location 2
Address of premises:
Postcode:
Method of Construction:
Year premises built:
How long have you operated from these premises?:
Method of heating the premises:
What security measures are in place? (i.e. RedCare Alarm, CCTV etc.):
What Fire Protections are in place? (i.e. Fire Alarm, Smoke Detectors, Fire Extinguishers etc.)
Is there any storage in the open?	Yes No
If Yes, please give details regarding type of storage and security measures in place:
Are you the sole occupant of the premises?	Yes No
If No, please give details of other occupants
Has the premises ever suffered from a claim or incident involving flood or subsidence?	Yes No
If Yes, please give details:
Customer Goods Sum insured:	£

Location 3
Address of premises:
Postcode:
Method of Construction:
Year premises built:
How long have you operated from these premises?:
Method of heating the premises:
What security measures are in place? (i.e. RedCare Alarm, CCTV etc.):
What Fire Protections are in place? (i.e. Fire Alarm, Smoke Detectors, Fire Extinguishers etc.)
Is there any storage in the open?	Yes No
If Yes, please give details regarding type of storage and security measures in place:
Are you the sole occupant of the premises?	Yes No
If No, please give details of other occupants:
Has the premises ever suffered from a claim or incident involving flood or subsidence?	Yes No
If Yes, please give details:
Customer Goods Sum insured:	£

*Do you require cover (non-motor) on trailers, containers etc?	Yes No
If Yes, Sum insured:	£
*Any claims occurring or pending in the last 3 years?	Yes No N/A (New Venture)
If Yes, please give details:

Year

No. of claims

Paid

Outstanding

Total

Current Year	£	£	£
Minus 1	£	£	£
Minus 2	£	£	£
Minus 3	£	£	£
Totals	£	£	£

Section 3: Employers, Public and Products Liability

Details of wage roll	No. of Full-time Staff	No. of Part-time Staff	Wage roll Estimate for next 12 months
Clerical Employees			£
Warehousemen/Porters			£
Drivers			£
Directors (if a Ltd company)			£
Own drawings of Proposer (if not a Ltd company)			£

*Turnover estimate for the forthcoming year:	UK	£
	Europe	£
	USA/Canada	£
	Rest of World	£

*Any claims occurring or pending in the last 3 years?	Yes No
If Yes, please give details:

Year

No. of claims

Paid

Outstanding

Total

Current Year	£	£	£
Minus 1	£	£	£
Minus 2	£	£	£
Minus 3	£	£	£
Totals	£	£	£

Section 4: Engineering Inspection

It is a legal requirement that lifting equipment is thoroughly examined by a competent person to ensure it is suitable and safe.

If you would like a quotation for this inspection service, please indicate below the make, model and number of items you have within the specified categories:

*Fork Lift Trucks:
*Pallet Trucks:
*Passenger Lifers:
*Vehicle Tailboard Lifts:
*Fixed Crane Lift in Storage Premises:
*Other:
*Would you like to receive a qoutation for insurance cover on these items?	Yes No

Section 5:Commercial Combined

*including machinery, plant and tenants improvements
** packing materials

*Has the premises ever been the subject of an incident or claim involving flood or subsidence?	Yes No
If Yes, please give details:

*Any claims occurring or pending in the last 3 years?	Yes No
If Yes, please give details:

Year

No. of claims

Paid

Outstanding

Total

Current Year	£	£	£
Minus 1	£	£	£
Minus 2	£	£	£
Minus 3	£	£	£
Totals	£	£	£

Please note that this form is for enquiry purposes only. Further information may be required prior to a quotation being provided. A full PoundGates Cargo policy wording is available on request.