Affinity Insurance - Motor Dealers

• Site conducted

  Select

• Client Name

• Conducted on

  Date

• Prepared by

• Location
  Address

About the Insured

• Insured Name(s) and respective ABN

• Select the type of trading structure

  Select Sole Trader Partnership Pty Ltd company Trust as trading entity with person as trustee Trust as trading entity with corporate trustee Other

  • Sole Trader
  • Partnership
  • Pty Ltd company
  • Trust as trading entity with person as trustee
  • Trust as trading entity with corporate trustee
  • Other

• Motor Dealers License Number(s)

• Interested Parties

Interested Party

• Name of Interested Party

• What is the interest

• On what item(s) is there an interest?

Insurance History

• Who is the current insurer

• Who is the current broker

• Are you unhappy with any particular aspect of the current insurance that is in place for you, either the policy, the insurer, or the broker?

• What is the due date of the policy?

  Date

• Claims History Last 5 Years

Claim

• Year and Month of the Claim

• What happened?

• Who was the insurer at the time?

• How much did it cost?

• Have you or any person applying for this insurance, including directors, ever been bankrupt or a director of a company which went into liquidation?

  Yes

  No

  N/A

• Have you ever had insurance for this business or a similar business declined, refused, or cancelled?

  Yes

  No

  N/A

• Have you or any director in the past ten years had any criminal conviction or had fines or penalties for any crime involving drugs, dishonesty, arson, fraud, or, violence?

  Yes

  No

  N/A

About the business

• Business Description

• Select the Brands you are a Licensed Dealer to represent

  Select Alfa Romeo Aston Martin Audi BMW Bentley Chery Chevrolet Chrysler Citroen Daewoo Dodge Fiat Great Wall HINO Hummer Infiniti Motors Isuzu Jaguar Jeep Land Rover Lexus Lotus Mini Mitsubishi Opel Porsche Proton Range Rover Renault Saab Skoda Ssangyong Subaru Suzuki Tata Volvo

  • Alfa Romeo
  • Aston Martin
  • Audi
  • BMW
  • Bentley
  • Chery
  • Chevrolet
  • Chrysler
  • Citroen
  • Daewoo
  • Dodge
  • Fiat
  • Great Wall
  • HINO
  • Hummer
  • Infiniti Motors
  • Isuzu
  • Jaguar
  • Jeep
  • Land Rover
  • Lexus
  • Lotus
  • Mini
  • Mitsubishi
  • Opel
  • Porsche
  • Proton
  • Range Rover
  • Renault
  • Saab
  • Skoda
  • Ssangyong
  • Subaru
  • Suzuki
  • Tata
  • Volvo

• What services do you provide

  Select New Vehicle Sales Used Vehicle Sales Parts and Accessories Sales Restricted Warranty only servicing of Vehicles Sold General Motor Mechanical or Electrical Motor Vehicle Repairs (panel beating or spraying) Finance Insurance Agency Insurance Broking Insurance - CTP Importing (overseas buyers agent)

  • New Vehicle Sales
  • Used Vehicle Sales
  • Parts and Accessories Sales
  • Restricted Warranty only servicing of Vehicles Sold
  • General Motor Mechanical or Electrical
  • Motor Vehicle Repairs (panel beating or spraying)
  • Finance
  • Insurance Agency
  • Insurance Broking
  • Insurance - CTP
  • Importing (overseas buyers agent)

• What type of Vehicles do you sell or service?

  Select Sedans, Utes and Wagons Light Commercial (Trucks < 5t GVM) Heavy Vehicles and Buses Motor Cycles Caravans Tractors and Agricultural Equipment Watercraft Aircraft

  • Sedans, Utes and Wagons
  • Light Commercial (Trucks < 5t GVM)
  • Heavy Vehicles and Buses
  • Motor Cycles
  • Caravans
  • Tractors and Agricultural Equipment
  • Watercraft
  • Aircraft

• How long has the business been established?

• Number of Employees

• Retail sales per month

• Wholesale sales per month

• Do you import Vehicles or Accessories

  Yes

  No

  N/A

• Estimated Turnover by Source
  

• Retailing Vehicles

• Wholesaling Vehicles

• Retailing Spare Parts

• Vehicle Servicing

• Commissions from finance and insurance

• Other Income

• This section is a risk survey for each location. The factfinders for sums insured is in the next section.

Locations

• Click here to add a new location

Location
• Add location
  Address

Construction

• What are the walls made of

  Select Brick concrete tilt slab metal weatherboard sandwhich panels timber

  • Brick
  • concrete
  • tilt slab
  • metal
  • weatherboard
  • sandwhich panels
  • timber

• What is the ground floor made of?

  Select Concrete floating timber on concrete slab timber on foundations timber on raised piers dirt

  • Concrete
  • floating timber on concrete slab
  • timber on foundations
  • timber on raised piers
  • dirt

• What is the upper floor made of

  Select Concrete floating timber on concrete slab timber on foundations timber on raised piers n/a

  • Concrete
  • floating timber on concrete slab
  • timber on foundations
  • timber on raised piers
  • n/a

• What are the stairs made of?

  Select Timber steel concrete n/a

  • Timber
  • steel
  • concrete
  • n/a

• What is the age of the building

• Is there any internal or external use of sandwhich panels?

  Yes

  No

  N/A

• Does the client know what type of materials are inside the sandwhich panels as the insulator? (EPS, XPS, MWRF, PIR, LPBC) some are fire resistant, is there a fire authority certificate to prove the materials?

• Is any part of the Core Exposed?

  Yes

  No

  N/A

• As a percentage of the total wall space, what percentage is constructed from sandwhich panels?

  Select None present 0 - 10% 10 - 20% 20 - 30% 30 - 40% 40 - 50% 50% or greater

  • None present
  • 0 - 10%
  • 10 - 20%
  • 20 - 30%
  • 30 - 40%
  • 40 - 50%
  • 50% or greater

• Photo of Sandwich Panel

  Media

• Is there any potential asbestos at this site?

  Yes

  No

  N/A

• Is there an asbestos report available for there site?

  Yes

  No

  N/A

• Where is the asbestos or suspected asbestos? (Walls, Roof, Awning, Powerboards, Fire Doors etc)

• Photo of the front of the building

  Media

• Photo of the left of the building (standing from the front of the building looking toward the rear of the property)

  Media

• Photo of the right of the building (standing from the front of the building looking toward the rear of the property)

  Media

• Photo of the rear of the building

  Media

• Photo inside offices

  Media

• Photo of Stock Car Parking

  Media

• Photo of Customer Vehicle Parking

  Media

• Photo of Workshops

  Media

Fire safety

• Are there monitored heat or smoke alarms hardwired at the site<br>

  Yes

  No

  N/A

• Did the site have extinguishers

  Yes

  No

  N/A

• What type of extinguisher was present?

  Select Co2 a b powder water foam wet chemical vapourising liquid

  • Co2
  • a b powder
  • water
  • foam
  • wet chemical
  • vapourising liquid

• What was the date of last service?

• Photo of extinguisher or the service tag

  Media

• Does the site have hose reels?

  Yes

  No

  N/A

• Does the site have a hydrant point?

  Yes

  No

  N/A

• What is the distance to the nearest fire station if known

• Does the site have single source sprinklers?

  Yes

  No

  N/A

• Does the site have dual source sprinklers? Mains and a backup supply?

  Yes

  No

  N/A

• Is there a backup power supply for the fire suppression system pumps?

  Yes

  No

  N/A

• Was there an escape plan on the wall?

  Yes

  No

  N/A

• Photo of the fire safety or evacuation plans

  Media

• Has the business conducted a fire drill or emergency evacuation drill in past 12 months

  Yes

  No

  N/A

• Photo of Fire Exits

  Media

• Are emergency exits marked with correct signage?

  Yes

  No

  N/A

• Were there any obstructions blocking free access to equipment or fire exits

  Yes

  No

  N/A

• Other fire safety notes

Security measures

• Describe door security

• Describe window security

• Do all display windows have 11mm plate glass?

  Yes

  No

  N/A

• Type of alarm system

  Select None local back to home back to monitored company (b2b) b2b with gsm phone backup b2b with securitel line

  • None
  • local
  • back to home
  • back to monitored company (b2b)
  • b2b with gsm phone backup
  • b2b with securitel line

• Described security guard useage

• Is there a Vehicle key safe?

  Yes

  No

  N/A

• Does the business utilise CCTV

  Yes

  No

  N/A

• Is there a 2m high full perimiter fence

  Yes

  No

  N/A

• Does the business have bollards or other ram raid prevention measures?

  Yes

  No

  N/A

• Is there after hours security lighting

  Yes

  No

  N/A

• Other security notes

Housekeeping and external risk questions

• Are all roof gutters free from debris and free flowing?

  Yes

  No

  N/A

• Are all roof downpipes connected to a drain system, unblocked and free flowing?

  Yes

  No

  N/A

• Is there any evidence of lime, moss, or calcium buildup on the external walls or ground around the premise which may indicate a long term water flow problem with guttering or drainage?

  Yes

  No

  N/A

• Photo of any potential drainage risks

  Media

• Is there any evidence of smoking adjacent to the building, check gardens and directly outside staff exits?

  Yes

  No

  N/A

• Is there a delivery or pickup dock?

  Yes

  No

  N/A

• Does the building have any sign of impact damage in the delivery dock? (Check around docks and any awnings along drive route)

  Yes

  No

  N/A

• Is there any existing damage to the driveway from oversized vehicles or trucks hitting kerbs?

  Yes

  No

  N/A

• Are bollards installed in delivery areas to mitigate risk of impact damage?

  Yes

  No

  N/A

• How frequently is the waste removed from the location

  Select Daily weekly fortnightly monthly as needed

  • Daily
  • weekly
  • fortnightly
  • monthly
  • as needed

• What is the distance of the waste area to the main building?

• Are any pallets or flammable items stored against or adjacent to the building?

  Yes

  No

  N/A

• A photograph of the waste storage area

  Media

• Is there petrol, diesel, or LPG storage?

  Yes

  No

  N/A

• Distance to buildings?

• Is there an emergency shut off?

  Yes

  No

  N/A

Carparks

• Does the Business have a car park for which they are responsible for?

• How many car park spaces are there?

• Is each car space clearly marked and well defined?

  Yes

  No

  N/A

• Is the surface of the car park ashphalt or concrete ?

  Yes

  No

  N/A

• Is the car park surface in good condition with no pot holes or divets that may cause scratches to cars or trip hazards to pedestrians?

  Yes

  No

  N/A

• Are all handrails or balustrades in good condition solidly fixed into the ground or walls?

  Yes

  No

  N/A

• Does the car park have sufficient drainage?

  Yes

  No

  N/A

• Are the drains of the car park free free flowing and unlikely to be blocked by organic growth such as weeds or dirt buildup?

  Yes

  No

  N/A

• Notes on the carpark

Locale risks

• What is the occupation and distance to the neighbouring building (left)

• What is the occupation and distance to the neighbouring building (right)

• What is the occupation and distance to the neighbouring building (rear)

• Type of location

  Select Industrial unit complex freestanding in industrial or commercial park suburban road main road strip of shops with street frontage multi tenure office block multi tenure shopping mall or arcade secure shopiping centre (westfield etc)

  • Industrial unit complex
  • freestanding in industrial or commercial park
  • suburban road
  • main road
  • strip of shops with street frontage
  • multi tenure office block
  • multi tenure shopping mall or arcade
  • secure shopiping centre (westfield etc)

• Are there any immediate neighbours or businesses in the same complex that have a late friday or saturday trading hours such as dominos, kfc, mcdonalds etc

  Yes

  No

  N/A

• Is there any graffiti or other evidence of a high pass through pedestrian traffic such as general rubbish buildup like drink bottles, snack foods or mcdonalds wrappers?

  Yes

  No

  N/A

• Photo of any graffiti

  Media

• Notes

Office risk questions

• Does the business have an office of more than 3 desks?

• Was there evidence of testing and tagging on electrical appliances such as computers and laptops.

  Yes

  No

  N/A

• Was there any evidence of the use of power leads, double or multi point adapter boards?

  Yes

  No

  N/A

• Do any power leads, extension cables, or powerboards cross over walkways which may present a tripping hazard?

  Yes

  No

  N/A

• Where there is use of multi point adapter boards, are they surge protected and to what voltage or surge level?

• Was there a server for the office?

  Yes

  No

  N/A

• Is the server isolated within a temperature controlled environment?

  Yes

  No

  N/A

• Is it secured by UPS systems that have been tested within the last 3 months?

  Yes

  No

  N/A

• Is there any evidence of water damage to the ceiling nearby to the server?

  Yes

  No

  N/A

• Photo of the server room if applicable

  Media

• Other notes about the office

• General photo of the office or reception

  Media

Electronics and machinery

• Please indicate type of Electrical switchboard or mains system that best describes the system in use at the location

  Select External (enclosed) external (open) Internal (enclosed) Internal (open) analogue or aged system modern or digital system

  • External (enclosed)
  • external (open)
  • Internal (enclosed)
  • Internal (open)
  • analogue or aged system
  • modern or digital system

• Photo of the electrical mains board

  Media

• Is the power mains or switchboard protected by a UPS

  Yes

  No

  N/A

• Does the premise have a backup generator

  Yes

  No

  N/A

• Is the backup generator manually started?

• Does the business or occupier have access and training sufficient enough to turn on the generator if manual?

  Yes

  No

  N/A

• What type of fuel is used in the generator?

  Select Solar backup gas diesel petrol

  • Solar backup
  • gas
  • diesel
  • petrol

• When was the generator system last serviced and tested?

• What is the total number of overhead cranes, elevators, lifts and Vehicle hoists?

• Are all hoists compliant with Australian Standards

  Yes

  No

  N/A

• Describe the Space heating or cooling?

• Notes

Storage / Warehouse

• Check if there is a storage or warehouse on site

• What type of storage is used

  Select Unorganised ground storage (where ever it fits!) unorganised ground storage on pallets or racks marked or defined ground level storage directly onto the ground marked or defined ground level storage on pallets or racks shelving under 6m shelving over 6m

  • Unorganised ground storage (where ever it fits!)
  • unorganised ground storage on pallets or racks
  • marked or defined ground level storage directly onto the ground
  • marked or defined ground level storage on pallets or racks
  • shelving under 6m
  • shelving over 6m

• Are shelves bolted to the floor?

  Yes

  No

  N/A

• What is the distance from the average highest stored item to the internal ceiling

• Is there sufficient clearance from the Fire sprinklers / suppression heads?

  Yes

  No

  N/A

• Storage Media

  Media

Completion

• General notes

• Add any final notes

  Media

• Signature of surveyor

  Sign

• Signature of client

  Sign

• Time completed

  Date

Material Damage

• Is cover required for material damage?

• Click here to add a location

Location
• Location Address
  Address

• Building declared value

• Contents declared value

• Stock of vehicles or watercraft

• Customers vehicles or watercraft

• Other Stock

• Other section 1 declared values

• Total declared value section 1

• Preferred excess

  Select $100 $250 $500 $1,000 $2,500 $5,000 $10,000

  • $100
  • $250
  • $500
  • $1,000
  • $2,500
  • $5,000
  • $10,000

• Is cover required for flood?

Business Interruption

• Is cover for Business Interruption Required

• Gross Profit Declared Value

• Have you included payroll within your Gross Profit Figures

  Yes

  No

  N/A

• Payroll

• Loss of Rent Receivable

• Are there any uninsured working expenses?

Crime and Contingency

• Do you require cover for theft

• Theft of Vehicles - limit per vehicle

• Theft of Vehicles - Maximum per event

• Theft of Stock of Accessories

• Theft of Plant and Equipment (Contents)

• Do you require cover for money / cash?

• Combined Money Limit of Liability

• Do you require cover for Glass?

• External and Plate Glass

• Internal Glass

• Replacement value of Illuminated Signs

Hail

• Is cover required for Hail

• Value of External / Exposed Stock

• Value of Stock Protected by specifically built Hail structures

• Value of Stock within a permanent building structure

Portable Equipment / General Property

• Is cover required for Equipment away from site?

• Unspecified tools in mobile vans

• Spare parts in mobile vans or owned delivery vans

• Unspecified Laptops

Broadform Liability

• Is cover for this section required?

• Turnover

• Number of Staff (including directors)

• Limit of Liability Required

• Does the business knowingly provide products or services to

  Select Mining (underground sites) Mining (Above ground sites) Oil, Energy, Resources, or Gas Sites Dockside at Ports or Terminals Airside at Airports Train stations or railway lines (Trackside) Train Stations or Railway Lines (No Trackside work) Roads, Bridges, or Civil Works Dept of Defence Aircraft Boats that exceed 8m in length

  • Mining (underground sites)
  • Mining (Above ground sites)
  • Oil, Energy, Resources, or Gas Sites
  • Dockside at Ports or Terminals
  • Airside at Airports
  • Train stations or railway lines (Trackside)
  • Train Stations or Railway Lines (No Trackside work)
  • Roads, Bridges, or Civil Works
  • Dept of Defence
  • Aircraft
  • Boats that exceed 8m in length

• undefined

• undefined

• Are any of the following liability risks present

  Select Tenants Liability Property Owners Liability Unregistered Vehicles Liability Inn-Keepers Liability (Accomodation) Importers (Manufacturing) Liability Exporters Liability

  • Tenants Liability
  • Property Owners Liability
  • Unregistered Vehicles Liability
  • Inn-Keepers Liability (Accomodation)
  • Importers (Manufacturing) Liability
  • Exporters Liability

• List all countries you import from or export to including a % of income from that area

• List unregistered vehicles used on site

• Add location
  Address

Professional Indemnity Insurance

• Is cover required for professional indemnity

• Limit of indemnity any one claim

• Limit of Indemnity aggregate limit

• Do you have any operations or perform any work outside of Australia?

  Yes

  No

  N/A

• Do you perform work for clients outside of Australia

  Yes

  No

  N/A

• Other than financing a vehicle as part of a sale, do you offer any other financial services?

  Yes

  No

  N/A

• Have any claims, either successful or otherwise ever been made against you or your subsidiaries or related companies or their predecessors in business or any present or past director or principal.

  Yes

  No

  N/A

• Are you aware of any circumstances which may give rise to a claim at a later date?

  Yes

  No

  N/A

Equipment Breakdown Insurance

• There are two options. The client can insure for motor breakdown or electronic breakdown in a business pack with a maximum limit of $20,000 with no loss of income or payroll covers. Or client can cover both types of breakdown and consequential loss of income cover, the second type is more expensive but offers far greater cover.

• Would the client like simplified business pack cover?

• undefined

• What is the sum insured required?

  $5,000

  $10,000

  $15,000

  $20,000

• Please list the total number of each machine type locatedat the premise that the customer wishes to insure

• Coffee machines or grinders

• Air conditioners - split system (wall mount)

• Air Conditioners - ducted system (number of motors)

• Lifts and Hoists

• Other Machinery

• Would client like a comprehensive breakdown cover combining mechanical breakdown and electrical failures and resulting loss of income or payroll?

• The fire and business interruption figures above will be used for this section if this option is selected unless otherwise specified below.
  

• Breakdown limit of indemnity. List machines if specific machine only coveris preferred

• Breakdown consequential loss. List loss of income limit and increasedcost limits following a breakdown.

• Preferred excess for this section

  Select $100 $250 $500 $1,000 $2,500 $5,000 $10,000

  • $100
  • $250
  • $500
  • $1,000
  • $2,500
  • $5,000
  • $10,000

Marine cargo

• Is cover for importing required?

  Yes

  No

  N/A

• Describe the goods imported

• How are they packed and shipped (air sea road rail etc)

• What are the INCOTERMS of the imports?

• What is the maximum value any one import?

• What is the total Annual Sendings per year

• Is cover for exports required?

  Yes

  No

  N/A

• Describe goods exported

• Describe how goods exported are packed and sent (air sea rail road etc)

• What are the INCOTERMS of the export?

• What is the maximum value of any one export

• What is the total Annual Sendings per year

• Is cover for transits within australia required?

  Yes

  No

  N/A

• Describe goods sent within australia

• Describe the packaging and how the items are sent (road, sea, air, rail etc)

• For what purpose is the deliveries in australia (purchases, sales, stock transfers and or returns)

• What will be the maximum transit value within australia

• What is the total Annual Sendings per year

Motor Vehicles

Trade Plates

• Insured Value

• Plate Number

Customers Vehicles

• Insured Value

• Number of workshop staff

• Number of staff aged 30 or under that may drive customers vehicles

Stock Vehicles

• Limit per Vehicle

• Estimated number of Vehicles

• Do you allow customers who are aged 25 or less to be approved drivers?

Heavy Vehicles

• Heavy Vehicles

HMV

• Year make and model

• Rego

• GMV

• Estimated Value

• Name and age of regular driver

• Suburb where kept overnight

• Radius of operations in km

• Goods carried

Light Vehicles

• Light Vehicles

CMV

• Year make model

• Rego

• Estimated Value

• Insure for

  Select TPPD TPF&T Own Damage Only Comprehensive Agreed Value Comprehensive Market Value

  • TPPD
  • TPF&T
  • Own Damage Only
  • Comprehensive Agreed Value
  • Comprehensive Market Value

• Name and age of regular driver

• Suburb where kept overnight

Loan Vehicles

• Loan Vehicles

Loan Vehicle

• Year make and model

• Rego

• Estimated Value

• Insure for

  Select TPPD TPF&T Own Damage Only Comprehensive Agreed Value Comprehensive Market Value

  • TPPD
  • TPF&T
  • Own Damage Only
  • Comprehensive Agreed Value
  • Comprehensive Market Value

Existing policies

• Take notes below about other insurances required. Where possible take a photo of the existing policies.

• If available add photos of existing policies

  Media

Other risks and insurance options

• Management Liability, statutory liability insurance and Employment Liability cover

  Yes

  No

  N/A

• Cyber Risks<br> - own loss<br>- third party loss<br>- business interruption loss

  Yes

  No

  N/A

• Workers compensation nsw, act, vic, nt, sa or wa?

  Yes

  No

  N/A

• Wages NSW for all employees and directors where wages includes PAYG and super

• Is journey cover or a griup personal accident supplement required to add value to employees?

  Yes

  No

  N/A

• Wages VIC for all employees and directors where wages includes PAYG and super

• Wages QLD for all employees only where wages includes PAYG and super, directors are not covered in QLD

• Would directors like a referral to review their life insurance, keyman, business expenses or income protectin insurance?

  Yes

  No

  N/A

• Wages WA employees where wages includes PAYG and super

• Optional: Are directors to be covered by workers comp? If yes list the wages of directors below incl PAYG and super

  Yes

  No

  N/A

• Wages NT for all employees and directors where wages includes PAYG and super

• Corporate travel insurance and, extra territorial workers comp

  Yes

  No

  N/A

• For the below questions, a trip is defined as one return journey per person. A family of four travelling to china with a stop over at manilla before returning home is one trip.

• Estimated number of trips within australia and australian territories?

• Estimated number of trips within pacific region

• Estimated number of trips within asian region

• Estimated number of trips within european region (includes Russia)

• Estimated trips to Africa

• Estimated trips to South America

• Estimated Trips to USA, Canada, Alaska, united Mexican States, Greenland or elsewhere in North America

• Worldwide Trips

• Estimated number of trips using chartered aircraft

• Estimated number of trips using chartered helicopters

• List specific covers or take a photo in media of the existing schedule(s)

• Product recall

  Yes

  No

  N/A

• Trade Credit Insurance

  Yes

  No

  N/A

• Event management or organisers liability including corporate product or development conventions or seminars

  Yes

  No

  N/A

• Motor fleet

  Yes

  No

  N/A

• Ctp and fleet ctp

  Yes

  No

  N/A

• Aviation risks

  Yes

  No

  N/A

• Keyman, life insurance or income protection - refer to a financial planner

  Yes

  No

  N/A

• Common due date

  Yes

  No

  N/A

• Premium funding required?

  Yes

  No

  N/A

End of section

• This information does not represent the schedule of insurance simply the information collected which may be used to produce a sample schedule of insurance. Contact the writer of this document for a copy of the schedule of insurance.