Personal Information
Risk Details
Business Description *
Address to be Insured *
Type of Cover
'Business Protect' offers standard perils cover, while 'Business Protect Plus' offers additional accidental damage cover.
Please select: * Business Protect Business Protect Plus
Kindly complete the following details of values to be insured
Section 1 - Contents
Section 2 - Buildings
Section 3 - Equipment
Descriptions
Serial Numbers
Model Numbers
Sums to be insured €
Section 4 - Glass
Section 5 - Goods in Transit
Section 6 - Deterioration of Stock
Section 7 - Money & Assault Cover
Limit of Liability €
Section 8 - Machinery Breakdown
Section 9 - Personal Accident
Section 10 - Loss of Income
Loss of revenue and additional expenses €
Section 11 - Public Liability
The premises to which the cover under this section will apply
Premises 1
Premises 2
Section 12 - Employer's Liability
General Questions
Are the premises protected by an intruder alarm? * Yes No
Is the intruder alarm equipped with an auto-dialler facility? * Yes No
Are any of the openings, including each external door, window and glass shop front protected and locked by means of any one or all of the following security devices?
Roller Shutter * Yes No
Concertina type shutter * Yes No
Solid wooden shutter or door * Yes No
Steel panelled door or window * Yes No
Metal grille door or window * Yes No
Fixed metal grille or bar * Yes No
Do you have any fire extinguishing appliances installed at the premises? * Yes No
Details of fire extinguishing appliances
Are you currently insured? * Yes No
Have you had any claims or losses in the past 5 years? * Yes No
If yes, please provide details
Quotation
How would you like to receive your quotation? Post Fax Email
Data Protection Notice
To the extent that the information supplied by you, whether orally or in writing, constitutes personal data, including sensitive data within the provisions of the Data Protection Act, you consent to the processing of such data for purposes of administering your proposal for insurance, your Policy, underwriting, handling of claims and also for the purposes of detecting, preventing and suppressing fraud and of keeping statistics. We maybe required to collect further information from our sub-agents, other insurance companies, insurance intermediaries or insurance associations.
In addition, we may pass some or all of the information to other insurance companies, or insurance associations for underwriting and claims handling purposes and also for the purposes of detecting, preventing and suppressing fraud and of keeping statistics. This also helps us to check the information provided. When we deal with your request for insurance, we may search this information. When you tell us about an incident which may or may not give rise to a claim, we will pass information relating to it to the Malta Insurance Association.
We and other companies within our group would like, on occasion, to keep you informed of our products and services, by mail, fax, e-mail or other electronic means. Please inform us in writing if you do not wish to receive this information or if you wish to receive such information solely from GasanMamo Insurance Ltd. Moreover, were hereby ask you whether you wish to receive direct marketing information from us by e-mail to your e-mail address provided below.
You have the right to request access to, and rectification of, your personal data held by us by directing your request in writing signed by yourself to the Data Protection Officer, GasanMamo Insurance Ltd, Msida Road, Gzira GZR 1405
