USA Product Liability Proposal Form

Fair Presentation

If you are a business insured (i.e., an insured who has bought insurance wholly or mainly for purposes related to their trade, business, or profession) the business has a duty to make a fair presentation of the risk to the insurer. This entails disclosing to the insurer every material circumstance which you know or ought to know. You should conduct a reasonable search to ascertain all material facts within your organisation, making enquiries of senior management and other relevant individuals where necessary.

You must make accessible to us members of your senior management (or the most appropriate persons) to provide accurate, complete, and timely information to enable us to fulfil our obligations to make a fair presentation of your risk to insurers.

The disclosure should be made in a clear and accessible way.

This duty to make a fair presentation applies before your cover is placed, when it is renewed and any time that it is varied. Your policy wording may also provide that this duty continues for the duration of the policy.

A circumstance is material if it would influence an insurer’s judgment in determining whether to accept the risk, or the terms of the insurance (including premium). If you are in any doubt whether a circumstance is material, we recommend that it should be disclosed.

Failure to disclose a material circumstance may entitle an insurer to impose different terms on your cover or proportionately reduce the amount of any claim payable. In some circumstances an insurer will be entitled to avoid the policy from inception and in this event any claims under the policy would not be paid.

By completion and submission of this form, you confirm that you have read and understood your duty to provide a fair presentation.

CONTACT AND COMPANY INFORMATION

Please complete as much detail as possible. Certain fields are mandatory

Full Name*

Business Name\Trading Name*

Contact Number*

Email Address*

Your Website Address*

Business Address including Postcode*

Business Description*

Is this Business a New Venture*

Yes
No

If this Business is a new Venture, please provide further details here

When was the Business established*

Do you manufacture any safety critical products or components? (Air, Marine or Areospace, Off-shore or Nuclear - Any component parts for Motor Vehicle or Rail)?*

Yes
No

Does the Product you sell require a UK, US or Canadian Quality Standard (EN, CE etc)*

Yes
No

If YES to the above, please advise the current quality standard(s) the product has.

If you use a third party platform such as Amazon, Etsy - please provide details here

Please select the applicable covers you require

Public Liability Insurance
Product Liability Insurance
Employers Liability Insurance
Property Insurance (this might include machinery & plant if you are a manufacturer. Stock whether at your own or other locations)

Is Vendor-Dual Insurance Required?

Yes
No

Vendor Dual Insurance: If you are selling your products to many of the USA’s large chains such as Walmart or other companies you may find there is a requirement to name them as a Dual Insured.

Is "Additional Insured" required on this policy?*

Yes
No

If you are selling on Amazon your statues with them may require that they are named as an additional insured. We recomend you investigate whether this a requirement.

Have you entered into an agreement or contact(s) that include a Hold Harmless Agreement with your supplier*

Yes
No

If YES to the above, please provide details here.

Public and Products Limit of Indeminity Required

£2 Million Pounds (GBP)
£5 Million Pounds (GBP)
£10 Million Pounds (GBP)
Other

PRODUCTS AND SERVICE

Please complete as much detail as possible. Certain fields are mandatory

Does your Business Involve any Manual Work AWAY from Premises? (This could involve installation or Maintenance of a Product or Previous Installation)

Do you use any Woodworking Machinery

Is any Design Work or Advice Provided with regard to your Product or Service

Is any HEAT used in any of your Processes

Full Description of Products Manufacture/Sold

Full Description of your Business Quality Controls

Confirmation of Rights of Recourse from your Supplier

Are you re-branding products as your own? - If so please provide details

Are any instructions for use of your product(s) written by you*

Yes
No

If YES to the above, please provide details

If your product(s) labelling or instructions are written in other languages are they professionally translated*

Yes
No
No Applicable

FINANCIAL DETAILS

Please complete as much detail as possible. Certain fields are mandatory

Turnover Per Annum (£)

UK Sales Per Annum (£)

EU Sales Per Annum (£)

USA and Canada Sales Per Annum (£)

Sales to the Rest of the World (£)

WAGE ROLES

Please complete as much detail as possible. Certain fields are mandatory

Clerical\Sales and NON Manual

Manual Employees based at OWN Premises

Manual Employees AWAY from Premesis

Bona Fide Sub-Contractors

Labour Only (Sub-Contractors)

DIRECTORS, PARTNERS OR SIGNIFICANT PERSONS

Have you or any other Director, Partner or anyone with Significant Control in your business ever been;

Convicted or charged but not yet tried for any crinimal offence (non motor offences)*

Yes
No

Declared Bankrupt or Subject of Bankruptcy Proceedings*

Yes
No

Involved in any Company over the last 12 months before Recivership or Insolvency*

Yes
No

Ever had a Proposal for Insurance Declined, Cancelled or Refused*

Yes
No

Ever had an Insurance Renewal Refused*

Yes
No

Ever been Involved in a Tax Investigation*

Yes
No

Have you ever been Involved in a Health and Safety Investigation by the HSE*

Yes
No

Involved in an Employee Tribunal*

Yes
No

Directors, Partners and Significant Persons Comments

Thank you for Completing the above Details...

A member of our team will be in contact shortly to discuss the above and move your application for cover forward.
In compliance with Data Privacy Legislation, we request that you provide consent for us to contact you by return with regard to this enquiry.

Please provide consent by ticking the enclosed consent option for us to contact you by return in submission of this contact form.*

Please contact me back with regard to my enquiry

USA Protect Enquiry Form

Fair Presentation