homeworkers - online application form
To apply for HomeOfficesure, simply complete the short application form below; OR use our Postal Application Form and return it FREEPOST to Pavey Group.

If you have any additional queries before returning your completed application form, please telephone Pavey Group on 01803 408241 and we will be pleased to assist you.
 
 
Section 1.
Full Name:
Trading as:
Address:
Postcode:
Telephone:
Email:

Full Business Description and Activities of the Business:

*Date cover to commence: / /
(i.e. 01/01/2004)
Is the home in which your office is situated:
Yes No
a)
Occupied solely by you and your family as an office and private dwelling?
b)
Built of brick, stone or concrete walls with a slate, tile, asbestos, metal or concrete roof, including any outbuildings/garages not attached to the main building if any part of your business is operated from there or any property relating to the Business is stored within?
c) In a good state of repair?
d) Regularly attended by day and night?
e)
If a flat is it self-contained with its own lockable entrance?
Section 2.
a)
Have you ever been refused insurance, or had any special terms or conditions imposed by any insurers?
b)
(i) Is your office on the ground floor or below?
 
(ii) Is it an area which has in the past been flooded?
c)
Have you sustained any loss or had any claim made against you whether insured or otherwise in respect of any of the insurance required at this or any previously occupied home/office during the past 3 years?
d)
Have you ever been convicted or is any prosecution pending for any offence involving dishonesty of any kind (e.g. fire, fraud, theft or the handling of stolen goods)?
e)
Have you or any company in which you have had an interest been declared bankrupt, or subject of bankruptcy proceedings, or made any arrangements with creditors?
f)
Have you any court judgements or arrangements with creditors outstanding?
g)
Are you at present insured, or have you ever proposed for insurance in respect of any of the covers to which this proposal applies?
  Please give details of any questions answered in the shaded boxes below:  
 
 
 
Section 3.
  Please state scale of cover required (1-4):
Section 4

4) Do you require any of the following optional Extra Covers       

Yes No            

Products Liability
Legal Expenses
  
 
 
  Contract Disputes
 
Statutory License Protection
 
Debt Recovery
5) If Products Liability cover is required please answer the following supplementary questions:
   
Yes No 
a) Do you, or to the best of your knowledge, any of your customers, export or sell or supply your products to the USA or Canada?
b) Does your business include distribution or retailing of any goods?
  If yes:
 
(i) Do you repackage or alter the labelling of goods in any way?
(ii) Are any of the goods packaged or labelled with your branding?
 
Important
By clicking the Submit button, you are agreeing to all the details stated in the Declaration below, please ensure that all questions have been answered. You are reminded that you must disclose all material facts likely to influence the acceptance and assessment of the proposal. Failure to do so may render the insurance voidable. If there is any doubt whether facts might be considered material, these should be disclosed. No insurance is in force until the proposal has been accepted by the Company. The Company reserves the right to decline any proposal.

Declaration
I/We declare that:
(i)
the security at my/our home complies with the minimum requirements as stated in the security details laid out here (if applicable) for the Postcode in which it is situated.
(ii)
to the best of my/our knowledge and belief, the answers given are true and that all material facts have been disclosed.
(ii)
this proposal and declaration shall be the basis of the contract between me/us and Fortis Insurance Company Limited and I/we will accept a policy on the standard form issued by the Company and be bound by the terms and conditions thereof.
(iii)
if any answer has been submitted by any other person, such person shall for that purpose be regarded as my/our agent and not the agent of the insurer.

 

We will contact you shortly with further details.



*A confirmed quote is valid for 30 Days. Cover will not commence until Pavey Group have considered the information on the proposal form and confirmed cover in writing.

Please note: Cover will cease from expiry date of the policy but should cancellation be required prior to this date, written instructions must be given to Pavey Group. In the event of a mid-term cancellation, Pavey Group reserve the right to retain a minimum premium of £75 + IPT.

Pavey Group is a trading style of Michael Pavey Ltd which is authorised and regulated by the Financial Services Authority. It's FSA registration no. is 308106. Pavey Group is also a trading style of Michael Pavey Financial Services Limited which is authorised and regulated by the Financial Services Authority. It's FSA registration number is 463257. You can check this on the FSA's Register, by visiting the FSA's website on www.fsa.gov.uk/register or by contacting the FSA on 0845 606 1234.

Michael Pavey Ltd. (Registered in England 3419086) and Michael Pavey Financial Services Ltd (Registered in England No. 3418320) are subsidiary companies of Michael Pavey Holdings Ltd (Registered in England No. 02979493). Our registered Address: 50 The Terrace, Torquay, Devon, TQ1 1DD.

Designed and produced by SpotOn — 01803 407407  

Designed and produced by SpotOn — 01803 407407
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