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Personal Information

First Name *

Last Name *

Email Address *

Contact Number *

Fax Number

Date of Birth *

Postal Address *

Postcode *

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.

Cover Type *Business ProtectBusiness Protect Plus

Values to be Insured

Section 1 - Contents

Furniture, Fixtures, & Fittings

EUR

Machinery and Equipment

EUR

Description of Stocks

Value of Stocks

EUR

Section 2 - Buildings

Value of Buildings

EUR

12 Months Rent

EUR

Section 3 - Equipment

Items of Equipment

Description

Serial Number

Model Number

Sum to be insured

EUR

Section 4 - Glass

Internal Glass

EUR

External Glass

EUR

Signs

EUR

Section 5 - Goods in Transit

Vehicles

Vehicle

Registration Number

Limit of Liability

EUR

Section 6 - Deterioration of Stock

Plants

Type of Plant

Sum to be insured

EUR

Section 7 - Money & Assault Cover

Limit of Liability

In the business premises

EUR

In transit

EUR

In bank night safes until removed by a bank official

EUR

In your private residence or that of authorised employee

EUR

Replacement of safe or strong room

EUR

Section 8 - Machinery Breakdown

Machinery

Type of Machinery

Sum to be insured

EUR

Section 9 - Personal Accident

People

Full Name

ID Number

Occupation

Date of Birth

Sum to be insured

EUR

Section 10 - Loss of Income

Loss of revenue and additional expenses

EUR

Section 11 - Public Liability

The premises to which the cover under this section will apply

Premises

Property Details

Section 12 - Employer's Liability

Employees

Occupation of employees

Estimated number of employees

Estimated total salaries

EUR

Section 13 - Cyber

Cover is in respect of data restoration expenses and/or loss of business income and/or incident response expenses as a result of the unauthorised access to and/or use of your Computer System or Data Assets by a Third Party or an Employee, including where access has been gained by using stolen authorised user credentials.

Cover OptionsRestoration OnlyRestoration & Business InterruptionRestoration, Business Interruption & Incident Response

Limit of Indemnity€25,000€50,000€75,000

Do you maintain anti-virus software on any device that is part of your Computer System and routinely update the protection as reasonably necessary? *YesNo

Do you maintain firewalls on any device that is part of your Computer System and connected to the internet? *YesNo

Do you subject your Data Assets to monthly back up procedures, and store these back-ups in a cloud environment or at an offsite location disconnected from your Computer System? *YesNo

*Cover under this section can be granted only if the above are marked as ‘Yes’.

Employee count(last full 12 months)

Business turnover/revenue

EUR

Glossary of terms

Computer System

any computer, hardware, software, communications system, electronic device (including but not limited to, smart phone, laptop, tablet, wearable device), server, cloud infrastructure or microcontroller including any similar system or any configuration of the aforementioned and including any associated input, output, data storage device, networking equipment or back up facility.

Data Asset

any nonphysical, machine-readable information in digital form, including programs.

General Questions

Are the premises protected by an intruder alarm? *YesNo

Is the intruder alarm equipped with an auto-dialler facility? *YesNo

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 *YesNo

Concertina type shutter *YesNo

Solid wooden shutter or door *YesNo

Steel panelled door or window *YesNo

Metal grille door or window *YesNo

Fixed metal grille or bar *YesNo

Do you have any fire extinguishing appliances installed at the premises? *YesNo

Are you currently insured? *YesNo

Have you had any claims or losses in the past 5 years? *YesNo

Quotation

How would you like to receive your quotation? *PostFaxEmail

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

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