DOMESTIC ELECTRICAL PRODUCTS EXTENDED WARRANTY QUESTIONNAIRE

Please complete all parts of this questionnaire. Where a question is marked with an asterisk * please delete as applicable.

1. / Name and Address of Client:
2. / Is Client *
a. Manufacturer b. Importer/Distributor c. Retailer d. End User e. Administrator
3. / Product Details
a. Manufacturer (Name and Address)
b. Brand Name and Model Details:-
description and model no. / recommended retail price / number sold
1997 / 1998 / 1999 / 2000 / 2001
total
c. Number of Authorised Dealers.
d. When was product first introduced?
e. Has product ever been subject to a recall for modification?YES / NO
If so, please give details on separate sheet. (NB: Insurance excludes such recall)
f. Are spare parts readily available in all countries where product is sold?YES / NO
g. Please attach copies of current sales brochure and retail prices.
h. Are Products manufactured to British Standard or any other criteria?YES / NO
If yes, please provide details.
4. / Please specify countries where Products are sold.
5. / Is Product for use in:
a. Industrial environment / YES / NO
b. Commercial environment / YES / NO
c. Domestic environment / YES / NO
6. / Does Product require regular maintenance?YES / NO
If so, at what levels? (Please attach copy of maintenance agreement if applicable)
7. / a. Who maintains/repairs Product?
b. What are current rates for:
i.Call out charge? / …………..incl. VAT
iiHourly/part hour rate on site? …………incl. VAT
iiiRepairers % mark-up on spare parts? ………%
Are these a) specially negotiated rates or b) normal retail charges?
If a) how much are they below retail? / special/retail *
c. By what % have repair rates increased in the last two years?
d. What % increase will be charged in the next two years?
e. Will Insurers receive a discount on parts?
If yes, what will be the discount? / YES / NO
f. What guarantee is given on repairs?
g. Is there a charge for repeat calls? / YES / NO
h. Average time to complete repairs
i. Average cost of repairs (parts and labour) / £
8. / a. What is manufacturer’s warranty period?
Please attach specimen wording.
b. Please provide details of warranty claims on sales over the last 3 years.
9. / What extension is required to manufacturer’s warranty period?
Tick appropriate box: / 1 Year / 2 Years / 3 Years / 4 Years
10. / What will be maximum payment on any item
a. Any one claim? / £
b. In the aggregate during the period of insurance? / £
11. / Will insurance be / compulsory / optional*
If optional, what % take-up is expected? / %
12. / Will products be subject to rental, leasing or hire purchase?
If yes, please provide copies of agreements. / YES / NO
13. / If Warranty is to be sold by a retailer, what is number of retail outlets?
14. / For non-UK clients. please advise
A.Whether front required and if so, will there be
i) any retention
ii) fronting fee
iii) premium or claims reserve / YES / NO
A i)
A ii)
A iii)
14,
Contd. / B.What is the level of:-
i) VAT (or equivalent)
ii) Insurance Premium Tax
iii) Reinsurance Premium Tax.
CInflation levels i) last 3 years
ii) current
iii) projected for next 3 years / B i)
B ii)
B iii)
C i)
C ii)
C ii)
15. / In the event the client shown in No. 2 is not the Administrator, who will undertake administration for the day to day handling? This would normally be an independent Third Party Administrator.
16. / What will be the mark ups for
a.Broker’s commission
b.Administrator
c.Sales Commission
d.Client Commission etc / a.
b.
c.
d.
17. / Has there previously been an insurance programme in place for this type of insurance?
If so, please provide full details. / YES / NO *
18. / Has any Insurer declined to insure or renew the insurance or imposed terms at renewal. If so, please give details. / YES / NO
19. / If risk has not previously been insured, what statistics can you provide in respect of the loss or damage for which insurance is sought?

DECLARATION:

I/we wish to insure through the Insurer provided by Mocden Insurance Services for this class of business and I/we warrant that the foregoing statements and particulars are correct and complete.

Signature of proposer(Director)

Date:

IMPORTANT NOTICE

a.Answer questions to the best of your knowledge and belief.

b.All material facts must be disclosed as failure to do so may nullify any insurance issued. (N.B. A material fact is one likely to influence acceptance or assessment of this proposal by Insurers. If you are in any doubt as to what constitutes a material fact, you should consult your Broker.)

c.If you consider that any question requires expert knowledge which you are unable to provide, indicate this in your answer.

d.A full copy of the insurance wording is available on request.

e.The completion of this form does not bind you to any contract with the Insurers and no insurance will be in force until the proposal has been accepted by the Insurers.

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