Existing Insurance Details

Care Home & Domiciliary Care Insurance Enquiry Form

Contact Details

Business Trading Name

Group Name:

Address of Home:

(Postcode)

Correspondence Address

(if different):

Contact Name:

Telephone Number(s):

Email Address:

Existing Insurance Details

Renewal Date: Review Date:

Broker / Intermediary: Current Insurer:

Existing Premium: Renewal Premium:

Property Information

Is the property: a) Constructed of brick/stone/concrete: b) Purpose built for current usage: b) Roofed with slate/tiles/concrete:

c) Date of Construction:

d) Is the building Listed: Yes / No Grade:

e) Have any areas flat roof: Yes / No Percentage: f) Do the owners live on the Yes / No property: h) Watercourse within 100 metres Yes / No If yes, please provide further information (we may i) Any history of Subsidence, Landslip require an additional subsidence questionnaire to be Yes / No or Heave. completed)

j) Any history of flooding to the If yes, please provide further information Yes / No property or surrounding areas? k) How long have you operated the home:

Howden is a trading name of Howden UK Group Limited, part of the Hyperion Insurance Group. Howden UK Group Limited is authorised and regulated by the Financial Conduct Authority in respect of general insurance business. Registered in England and Wales under company registration number 725875. Registered Office: 16 Eastcheap, London EC3M 1BD. Calls may be monitored and recorded for quality assurance purposes Page 1 of 3

Intruder &/or Fire detection Information

Do you have an Intruder Alarm? Is the signalling method Audible Only / Central Station / BT Redcare / Other

Do you have a Fire Alarm? Is the signalling method Audible Only / Central Station / BT Redcare How far is the nearest full time fire ______Miles station? Do you have a sprinkler system?

Cover Limits: (Declared Values Only)

Buildings: £ / €

General Contents: £ / €

Residents Effects: £ / € 500 / 1,000 / 2,500 per resident

Business Interruption: Indemnity period 12 18 24 36 Months Approximate Annual Turnover / Fee Income:

Liability information

Regulatory Body & Date of Last Inspection: Outcome of Inspection:

No of nurses & payroll No: £

No of HCA’s (carers) & payroll No: £

All other Staff / Directors No: £

Annual Refresher Training provided? Any specialist training provided ie de-

escalation / Mental Health? No. of Residents? Ages:

Elderly; Dementia; Learning Disability; Mental Disability; Category of Residents Terminally ill; Physical Disability; Child; Other;

Detained under Mental Health Act? Yes / No If so what category;

Any Claims or losses in the Past 5 Years?

Date of claim: Details: Amount Paid:

Risk Management

Do you have a Health & Safety system in place, as well as a written Protection Policy to guard against abuse of your service users?

How is Accident Reporting Undertaken and Controlled?

In respect of all relevant employees are DBS & POVA checks complete:

Registered manager in post & qualifications

Do you operate a system in respect of recording instances or allegations of abuse or assault on employees or service users and the subsequent actions taken:

What training is provided to monitor and deal with the handling of violent and aggressive behaviour?

Are necessary checks carried out regarding employees qualifications, past employment & health:

Do you provide Induction Training incorporating Company Policy & Procedures and provide a system that can evidence Employee Training and Development:

What you need to advise insurers We take this opportunity to remind you that you owe a duty to make a fair presentation of the risk to the insurer. You have a duty to disclose to the insurer every material circumstance which you know or ought to know after a reasonable search or which is sufficient to put the insurer on notice that it needs to make further enquiries for the purpose of revealing those material circumstances. In addition, you have a duty to disclose information in a clear and accessible manner. A circumstance is material if it would influence a prudent insurer’s judgment in determining whether to take the risk and, if so, on what terms. Failure to disclose a material circumstance may entitle an insurer to:

 in some circumstances, avoid the policy from inception meaning any claims under the policy would not be paid  impose different terms on your cover; and/or  reduce the amount of any claim payable. This duty applies before your cover is placed, when it is renewed, and at any time that it is varied.

Enquiry Form Completed by;

Position:

Email Address: