Commercial Property Owner Application

Commercial Property Owner Insurance Application

IMPORTANT: Please answer ALL questions fully. If there is insufficient space please provide details on your letterhead. Where provided, select ( ) appropriate box to indicate answer. The Applicant will be referred to in this Proposal as "You" or "Your".

THE APPLICANT/S
Name(s) in full
Tax Status	Registered Business	Yes No	ABN	Taxable
Postal Address
Contact Numbers	Phone No. (Private)		Phone No. (Business)
	Fax No.		Email:
Other Interested Persons (e.g. Mortgagees or Lessors) - Name & Address
Period of Insurance	From		To	at 4 p.m.

DETAILS OF THE BUSINESS/PREMISES
Location(s)	Same as postal address
Activities or Processes Involved By Occupiers/Tenants	</td></tr><tr><td>Construction of Premise(s)</td><td colspan="2"><table cellspacing="0" cellpadding="4" width="100%" border="1"><tbody><tr><td> </td><td>Walls</td><td>Floors</td><td>Roof</td><td>No. of Storeys</td><td>Age of Building</td></tr><tr><td>Location 1</td><td><select name="Walls1"> <option /><option value="Brick">Brick</option><option value="Timber">Timber</option><option value="Fibro">Fibro</option><option value="Iron">Iron</option><option value="Brick Timber">Brick Timber</option><option value="Other">Other</option></select></td><td><select name="Floors1"> <option /><option value="Concrete">Concrete</option><option value="Timber">Timber</option><option value="Concrete Timber">Concrete Timber</option><option value="Other">Other</option></select></td><td><select name="Roof1"> <option /><option value="Iron">Iron</option><option value="Tiles">Tiles</option><option value="Slate">Slate</option><option value="Fibro Cement">Fibro Cement</option><option value="Concrete">Concrete</option><option value="Other">Other</option></select></td><td><input size="10" name="Storeys1" type="text" /></td><td><input size="10" name="Age1" type="text" /></td></tr><tr><td>Location 2</td><td><select name="Walls2"> <option /><option value="Brick">Brick</option><option value="Timber">Timber</option><option value="Fibro">Fibro</option><option value="Iron">Iron</option><option value="Brick Timber">Brick Timber</option><option value="Other">Other</option></select></td><td><select name="Floors2"> <option /><option value="Concrete">Concrete</option><option value="Timber">Timber</option><option value="Concrete Timber">Concrete Timber</option><option value="Other">Other</option></select></td><td><select name="Roof2"> <option /><option value="Iron">Iron</option><option value="Tiles">Tiles</option><option value="Slate">Slate</option><option value="Fibro Cement">Fibro Cement</option><option value="Concrete">Concrete</option><option value="Other">Other</option></select></td><td><input size="10" name="Storeys2" type="text" /></td><td><input size="10" name="Age2" type="text" /></td></tr></tbody></table></td></tr><tr><td valign="top" rowspan="2">Survey Details</td><td><input type="radio" name="Survey" value="Yes" />Yes <input type="radio" name="Survey" value="No" />No Date <input name="Survey_Date" type="text" /></td></tr><tr><td colspan="2">A survey/inspection of your premises may be required. Please supply the name and contact telephone number of the appropriate contact person, with whom an appointment can be made. <br /><input size="100" name="Survey_Details" type="text" /> <input name="Survey_Details_Ph" type="text" value="PH:" /></td></tr><tr><td colspan="2">Number of years you have owned this property</td><td><input name="Yr_owned" type="text" /></td></tr><tr><td valign="top">Occupancy <br /><br /></td><td colspan="2"><p>Where you are the Owner of a multi-tenanted property, please show:</p><table cellspacing="0" cellpadding="4" width="100%" border="1"><tbody><tr><td align="center" colspan="2">Location 1</td><td align="center" colspan="2">Location 2</td></tr><tr><td align="center">Name</td><td align="center">Occupation</td><td align="center">Name</td><td align="center">Occupation</td></tr><tr><td><input size="25" name="Location1_Name1" type="text" value="1" /></td><td><input size="25" name="Location1_Occupation1" type="text" /></td><td><input size="25" name="Location2_Name1" type="text" value="1" /></td><td><input size="25" name="Location2_Occupation1" type="text" /></td></tr><tr><td><input size="25" name="Location1_Name2" type="text" value="2" /></td><td><input size="25" name="Location1_Occupation2" type="text" /></td><td><input size="25" name="Location2_Name2" type="text" value="2" /></td><td><input size="25" name="Location2_Occupation2" type="text" /></td></tr><tr><td><input size="25" name="Location1_Name3" type="text" value="3" /></td><td><input size="25" name="Location1_Occupation3" type="text" /></td><td><input size="25" name="Location2_Name3" type="text" value="3" /></td><td><input size="25" name="Location2_Occupation3" type="text" /></td></tr><tr><td><input size="25" name="Location1_Name4" type="text" value="4" /></td><td><input size="25" name="Location1_Occupation4" type="text" /></td><td><input size="25" name="Location2_Name4" type="text" value="4" /></td><td><input size="25" name="Location2_Occupation4" type="text" /></td></tr><tr><td><input size="25" name="Location1_Name5" type="text" value="5" /></td><td><input size="25" name="Location1_Occupation5" type="text" /></td><td><input size="25" name="Location2_Name5" type="text" value="5" /></td><td><input size="25" name="Location2_Occupation5" type="text" /></td></tr><tr><td><input size="25" name="Location1_Name6" type="text" value="6" /></td><td><input size="25" name="Location1_Occupation6" type="text" /></td><td><input size="25" name="Location2_Name6" type="text" value="6" /></td><td><input size="25" name="Location2_Occupation6" type="text" /></td></tr><tr><td><input size="25" name="Location1_Name7" type="text" value="7" /></td><td><input size="25" name="Location1_Occupation7" type="text" /></td><td><input size="25" name="Location2_Name7" type="text" value="7" /></td><td><input size="25" name="Location2_Occupation7" type="text" /></td></tr><tr><td><input size="25" name="Location1_Name8" type="text" value="8" /></td><td><input size="25" name="Location1_Occupation8" type="text" /></td><td><input size="25" name="Location2_Name8" type="text" value="8" /></td><td><input size="25" name="Location2_Occupation8" type="text" /></td></tr><tr><td><input size="25" name="Location1_Name9" type="text" value="9" /></td><td><input size="25" name="Location1_Occupation9" type="text" /></td><td><input size="25" name="Location2_Name9" type="text" value="9" /></td><td><input size="25" name="Location2_Occupation9" type="text" /></td></tr></tbody></table>If more please attach a list. <br /><input type="file" size="50" name="Locations" /> <br />Changes in tenancies and the types of business conducted must be notified to us in writing as they occur. Failure to do so may affect your entitlement to claim benefits in the event of loss or damage. <br /><strong>N.B.</strong> You must advise us if any unit is unoccupied in excess of 60 days. </td></tr><tr><td valign="top">Fire and Theft Protection <br /><br />Installed and Maintained at the Premises</td><td colspan="2"><table cellspacing="0" cellpadding="4" width="100%" border="1"><tbody><tr><td>Is the section of premises occupied solely by you protected by:</td><td>Location 1</td><td>Location 2</td></tr><tr><td>1.Connection to Mains Water Supply?</td><td><input type="radio" name="Protection_L1_Q1" value="Yes" />Yes <input type="radio" name="Protection_L1_Q1" value="No" />No </td><td><input type="radio" name="Protection_L2_Q1" value="Yes" />Yes <input type="radio" name="Protection_L2_Q1" value="No" />No </td></tr><tr><td>2.Fire Sprinkler System?</td><td><input type="radio" name="Protection_L1_Q2" value="Yes" />Yes <input type="radio" name="Protection_L1_Q2" value="No" />No </td><td><input type="radio" name="Protection_L2_Q2" value="Yes" />Yes <input type="radio" name="Protection_L2_Q2" value="No" />No </td></tr><tr><td>3.Fire Extinguishers?</td><td><input type="radio" name="Protection_L1_Q3" value="Yes" />Yes <input type="radio" name="Protection_L1_Q3" value="No" />No </td><td><input type="radio" name="Protection_L2_Q3" value="Yes" />Yes <input type="radio" name="Protection_L2_Q3" value="No" />No </td></tr><tr><td>4.Fire Hoses?</td><td><input type="radio" name="Protection_L1_Q4" value="Yes" />Yes <input type="radio" name="Protection_L1_Q4" value="No" />No </td><td><input type="radio" name="Protection_L2_Q4" value="Yes" />Yes <input type="radio" name="Protection_L2_Q4" value="No" />No </td></tr><tr><td>5.Deadlocks on all External Doors?</td><td><input type="radio" name="Protection_L1_Q5" value="Yes" />Yes <input type="radio" name="Protection_L1_Q5" value="No" />No </td><td><input type="radio" name="Protection_L2_Q5" value="Yes" />Yes <input type="radio" name="Protection_L2_Q5" value="No" />No </td></tr><tr><td>6.Bars/Grills on all External Windows?</td><td><input type="radio" name="Protection_L1_Q6" value="Yes" />Yes <input type="radio" name="Protection_L1_Q6" value="No" />No </td><td><input type="radio" name="Protection_L2_Q6" value="Yes" />Yes <input type="radio" name="Protection_L2_Q6" value="No" />No </td></tr><tr><td>7.Burglar Alarm System?</td><td><input type="radio" name="Protection_L1_Q7" value="Yes" />Yes <input type="radio" name="Protection_L1_Q7" value="No" />No </td><td><input type="radio" name="Protection_L2_Q7" value="Yes" />Yes <input type="radio" name="Protection_L2_Q7" value="No" />No </td></tr><tr><td align="right">Type: Local Siren only</td><td><input type="radio" name="Protection_L1_Q7_Local" value="Yes" />Yes <input type="radio" name="Protection_L1_Q7_Local" value="No" />No </td><td><input type="radio" name="Protection_L2_Q7_Local" value="Yes" />Yes <input type="radio" name="Protection_L2_Q7_Local" value="No" />No </td></tr><tr><td align="right">: 24 hr Monitored</td><td><input type="radio" name="Protection_L1_Q7_Monitored" value="Yes" />Yes <input type="radio" name="Protection_L1_Q7_Monitored" value="No" />No </td><td><input type="radio" name="Protection_L2_Q7_Monitored" value="Yes" />Yes <input type="radio" name="Protection_L2_Q7_Monitored" value="No" />No </td></tr></tbody></table></td></tr></tbody></table><br /><table cellspacing="0" cellpadding="4" width="100%" border="0"><tbody><tr><td colspan="2"><h3>PROPERTY SECTION</h3></td></tr><tr><td>INTEREST INSURED <br /><table cellspacing="0" cellpadding="4" width="100%" border="1"><tbody><tr><td> </td><td colspan="2">SUM INSURED</td></tr><tr><td> </td><td>Location 1</td><td>Location 2</td></tr><tr><td>Building</td><td><input name="L1_Building" type="text" /></td><td><input name="L2_Building" type="text" /></td></tr><tr><td>Contents</td><td><input name="L1_Cts" type="text" /></td><td><input name="L2_Cts" type="text" /></td></tr><tr><td>Removal of Debris</td><td><input name="L1_Debris" type="text" /></td><td><input name="L2_Debris" type="text" /></td></tr><tr><td>Your Cover under this section includes Accidental Damage for 10% of the Sum Insured to a Maximum of $50,000. If increase of cover required please show amount</td><td><input name="L1_AD" type="text" /></td><td><input name="L2_AD" type="text" /></td></tr></tbody></table></td></tr></tbody></table><br /><table cellspacing="0" cellpadding="4" width="100%" border="0"><tbody><tr><td colspan="2"><h3>BUSINESS INTERRUPTION/LOSS OF RENT SECTION</h3></td></tr><tr><td>INTEREST INSURED <br /><table cellspacing="0" cellpadding="4" width="100%" border="1"><tbody><tr><td> </td><td colspan="2">SUM INSURED</td></tr><tr><td> </td><td>Location 1</td><td>Location 2</td></tr><tr><td>Gross Rentals, Indemnity Period <input size="5" name="Gross_Income_Period" type="text" /> months</td><td><input name="L1_G_Income" type="text" /></td><td><input name="L2_G_Income" type="text" /></td></tr><tr><td align="center" colspan="3"><strong>OR</strong></td></tr><tr><td>Claims Preparation Costs</td><td><input name="L1_Cl_Preparation" type="text" /></td><td><input name="L2_Cl_Preparation" type="text" /></td></tr><tr><td><strong>TOTAL SUM INSURED</strong></td><td><input name="L1_Total" type="text" /></td><td><input name="L2_Total" type="text" /></td></tr></tbody></table></td></tr></tbody></table><br /><table cellspacing="0" cellpadding="4" width="100%" border="0"><tbody><tr><td colspan="2"><h3>THEFT SECTION</h3></td></tr><tr><td>INTEREST INSURED <br /><table cellspacing="0" cellpadding="4" width="100%" border="1"><tbody><tr><td> </td><td colspan="2">SUM INSURED</td></tr><tr><td> </td><td>Location 1</td><td>Location 2</td></tr><tr><td>Contents (replacement value)</td><td><input name="L1_Contents" type="text" /></td><td><input name="L2_Contents" type="text" /></td></tr></tbody></table></td></tr></tbody></table><br /><table cellspacing="0" cellpadding="4" width="100%" border="0"><tbody><tr><td><h3>MACHINERY BREAKDOWN SECTION</h3></td></tr><tr><td>Note:Fire and Perils risks are to be insured under the Property Section. Theft risks are to be insured under the Theft section. <br /><table cellspacing="0" cellpadding="4" width="100%" border="1"><tbody><tr><td colspan="2">Do you require cover for</td><td>LIMIT OF INDEMNITY</td></tr><tr><td>1. Breakdown of Machinery, Plant, Boilers and Pressure Vessels?</td><td><input type="radio" name="Machinery_BDown_Q1" value="Yes" />Yes <input type="radio" name="Machinery_BDown_Q1" value="No" />No</td><td>$5,000</td></tr></tbody></table></td></tr><tr><td><strong>Note:</strong> <br /><ol><li>If your Machinery answer is Yes please complete the following list by showing the number of each type of equipment at all locations shown on the schedule </li><li>No plant must exceed 4Kw/5hp. </li></ol></td></tr><tr><td><table cellspacing="0" cellpadding="4" width="100%" border="1"><tbody><tr><td>Plant List</td><td>No.</td><td>Plant List</td><td>No.</td></tr><tr><td><strong>Air Conditioning Equipment</strong></td><td><input size="5" name="AirCon_No" type="text" /></td><td><strong>Laundry Equipment</strong></td><td><input size="5" name="Laundry_No" type="text" /></td></tr><tr><td>Split System</td><td><input size="5" name="Split_System_No" type="text" /></td><td>Washers, Extractors, Dryers</td><td><input size="5" name="Washer_No" type="text" /></td></tr><tr><td>Window/Wall Type</td><td><input size="5" name="Wall_Type_No" type="text" /></td><td><strong>Misc. Equipment</strong></td><td><input size="5" name="Misc_No" type="text" /></td></tr><tr><td><strong>Commercial Refrigeration Equipment</strong></td><td><input size="5" name="Refrigeration_No" type="text" /></td><td>Air Compressor</td><td><input size="5" name="Air_Compressor_No" type="text" /></td></tr><tr><td>Freezers/Soft Serve Machine</td><td><input size="5" name="Freezer_No" type="text" /></td><td>Auto Car Wash</td><td><input size="5" name="Car_Wash_No" type="text" /></td></tr><tr><td>Temprites</td><td><input size="5" name="Temprites_No" type="text" /></td><td>Car Hoist</td><td><input size="5" name="Car_Hoist_No" type="text" /></td></tr><tr><td>Other Units</td><td><input size="5" name="Other_Units_No" type="text" /></td><td>Cash Register/Scanning Equip.</td><td><input size="5" name="Cash_Reg_No" type="text" /></td></tr><tr><td><strong>Kitchen Equipment</strong></td><td><input size="5" name="Kitchen_Equip_No" type="text" /></td><td>Coffee Machine</td><td><input size="5" name="Coffee_Machine_No" type="text" /></td></tr><tr><td>Dish or Glass Washers</td><td><input size="5" name="Dish_Washer_No" type="text" /></td><td>Electronic Scales</td><td><input size="5" name="Elec_Scales_No" type="text" /></td></tr><tr><td>Exhaust Fans (incl. Canopy)</td><td><input size="5" name="Exhaust_Fans_No" type="text" /></td><td>Engine Diagnostic Unit</td><td><input size="5" name="Engine_Diagnostic_No" type="text" /></td></tr><tr><td>Microwave Ovens</td><td><input size="5" name="Microwave_No" type="text" /></td><td>Pump (noc)</td><td><input size="5" name="Pump_No" type="text" /></td></tr><tr><td>Slicing, Mincing & Mixing equipment</td><td><input size="5" name="Slicing_No" type="text" /></td><td>Refrigerant Reclaimer</td><td><input size="5" name="Refrigerant_No" type="text" /></td></tr><tr><td> </td><td> </td><td>Vacuum Cleaners</td><td><input size="5" name="Vacuum_No" type="text" /></td></tr><tr><td> </td><td> </td><td>Wheel Aligner/Balancer</td><td><input size="5" name="Wheel_Aligner_No" type="text" /></td></tr><tr><td> </td><td> </td><td>Work Shop Plant (noc)</td><td><input size="5" name="Work_Shop_Plant_No" type="text" /></td></tr></tbody></table></td></tr></tbody></table><br /><table cellspacing="0" cellpadding="4" width="100%" border="0"><tbody><tr><td><h3>PROPERTY OWNERS LIABILITY SECTION</h3></td></tr><tr><td>LIMIT OF INDEMNITY</td><td colspan="2"><input name="PL_Limit" type="text" value="$" /></td></tr><tr><td> </td><td>Location 1</td><td>Location 2</td></tr><tr><td>Annual Turnover</td><td><input name="L1_Turnover" type="text" value="$" /></td><td><input name="L2_Turnover" type="text" value="$" /></td></tr><tr><td><p>Total Area of Premises in square metres </p></td><td><input name="L1_Total_Area" type="text" />m<sup>2</sup></td><td><input name="L2_Total_Area" type="text" />m<sup>2</sup></td></tr><tr><td>Replacement Value of Building</td><td><input name="L1_Replacement_Building" type="text" value="$" /></td><td><input name="L2_Replacement_Building" type="text" value="$" /></td></tr><tr><td>General Description of Occupancy i.e. Retail, offices, Industrial, Residential etc.</td><td><input name="L1_Occupancy" type="text" /></td><td><input name="L2_Occupancy" type="text" /></td></tr></tbody></table><br /><table cellspacing="0" cellpadding="4" width="100%" border="0"><tbody><tr><td><h3>GLASS SECTION</h3></td></tr><tr><td>INTEREST INSURED <br /><table cellspacing="0" cellpadding="4" width="100%" border="1"><tbody><tr><td> </td><td colspan="2">SUM INSURED</td></tr><tr><td> </td><td>Location 1</td><td>Location 2</td></tr><tr><td>Internal Glass</td><td align="center"><input type="radio" name="L1_Int_Glass" value="Yes" />Yes <input type="radio" name="L1_Int_Glass" value="No" />No</td><td align="center"><input type="radio" name="L2_Int_Glass" value="Yes" />Yes <input type="radio" name="L2_Int_Glass" value="No" />No</td></tr><tr><td>External Glass</td><td align="center"><input type="radio" name="L1_Ext_Glass" value="Yes" />Yes <input type="radio" name="L1_Ext_Glass" value="No" />No</td><td align="center"><input type="radio" name="L2_Ext_Glass" value="Yes" />Yes <input type="radio" name="L2_Ext_Glass" value="No" />No</td></tr><tr><td>General Description of Occupancy, Factory, Warehouse, Retail, Office</td><td><input name="Glass_L1_Occupancy" type="text" /></td><td><input name="Glass_L2_Occupancy" type="text" /></td></tr><tr><td>Size of Largest Pane of Glass</td><td><input name="L1_Largest_Glass" type="text" />m<sup>2</sup></td><td><input name="L2_Largest_Glass" type="text" />m<sup>2</sup></td></tr><tr><td>Additional Cover in excess of $3,000 for Temporary Protection and Shattering, Signwriting, Shopfronts, Damage to Property and Damage to Electric Signs</td><td><input name="L1_Glass_AD" type="text" value="$" /></td><td><input name="L2_Glass_AD" type="text" value="$" /></td></tr></tbody></table></td></tr></tbody></table><br /><table cellspacing="0" cellpadding="4" width="100%" border="0"><tbody><tr><td colspan="2"><h3>GENERAL INFORMATION</h3></td></tr><tr><td colspan="2"><strong>(If "Yes", to any questions below, please provide full details including name of insurer, dates, amount in $'s, reason for cancellation)</strong></td></tr><tr><td style="width: 80%"><strong>a) Have you (in the past 5 years)</strong> <br />1. made any claim(s) on an insurer for loss or damage? <br /><input size="100" name="Qa1_Details" type="text" /></td><td style="width: 20%" align="center"><input type="radio" name="Qa1" value="Yes" />Yes <input type="radio" name="Qa1" value="No" />No</td></tr><tr><td>2. had any insurance declined or cancelled, proposal/application rejected, renewal refused, claim rejected, special conditions or excess imposed by an insurer? <br /><input size="100" name="Qa2_Details" type="text" /></td><td align="center"><input type="radio" name="Qa2" value="Yes" />Yes <input type="radio" name="Qa2" value="No" />No</td></tr><tr><td>3. suffered any loss or damage which would have been covered by the proposed insurance policy? <br /><input size="100" name="Qa3_Details" type="text" /></td><td align="center"><input type="radio" name="Qa3" value="Yes" />Yes <input type="radio" name="Qa3" value="No" />No</td></tr><tr><td><strong>b) Have you or any partner(s) or director(s) of the business</strong> <br />1. ever been declared bankrupt? <br /><input size="100" name="Qb1_Details" type="text" /></td><td align="center"><input type="radio" name="Qb1" value="Yes" />Yes <input type="radio" name="Qb1" value="No" />No</td></tr><tr><td>2. ever been involved in a company or business which became insolvent or subject to any form of insolvency administration (e.g. liquidation or receivership)? <br /><input size="100" name="Qb2_Details" type="text" /></td><td align="center"><input type="radio" name="Qb2" value="Yes" />Yes <input type="radio" name="Qb2" value="No" />No</td></tr><tr><td>3. been convicted of any criminal offence within the past 5 years (other than minor traffic convictions)? <br /><input size="100" name="Qb3_Details" type="text" /></td><td align="center"><input type="radio" name="Qb3" value="Yes" />Yes <input type="radio" name="Qb3" value="No" />No</td></tr><tr><td>4. been liable for any civil offence or pecuniary penalty (exceeding $5,000)? <br /><input size="100" name="Qb4_Details" type="text" /></td><td align="center"><input type="radio" name="Qb4" value="Yes" />Yes <input type="radio" name="Qb4" value="No" />No</td></tr></tbody></table><br /><table cellspacing="0" cellpadding="4" width="100%" border="0"><tbody><tr><td><h3>EXCESS OPTION</h3></td></tr><tr><td>A reduction in premium can be obtained should you choose to bear one of the following excess choices.</td></tr><tr><td align="center"><input type="radio" name="Excess" value="Excess $500" />Excess $500 <input type="radio" name="Excess" value="Excess $1000" />Excess $1000</td></tr><tr><td><strong>N.B. These excess amounts when selected apply to all sections of the policy that are operative (except Broadform Liability for bodily injury claims).</strong></td></tr></tbody></table><br /><table cellspacing="0" cellpadding="4" width="100%" border="0"><tbody><tr><td><h3>DECLARATION</h3></td></tr><tr><td><ol><li>All answers and statements made in this application are true and accurate in every respect and no information has been withheld which is likely to affect your decision about accepting this insurance. </li><li>I acknowledge you reserve the right to decline any application. </li></ol></td></tr><tr><td><div align="center"><input onclick="agreesubmit(this)" type="checkbox" name="agreecheck" value="on" /> <strong>I have read the Declaration, Terms & Conditions, Acknowledgement & Financial Services Guide:</strong> </div></td></tr></tbody></table><br /><br /><div align="center"><input disabled="true" type="submit" name="Submit" value="Send Information" /> <input type="reset" value="Reset" /> </div></form> </div> <br class="clear" /> </div> </div> <div id="footerWrap"> <div id="footer"> <div id="footerlhs"><a class="footerlink" href="/page/privacy_statement.html" target="_self">Privacy Statement</a></div> <div id="footerrhs">© Rose Stanton Insurance \| powered by <a class="footerlink" href="http://www.sitesuite.com.au" target="_blank">SiteSuite</a></div> <br class="clear" /> </div> </div> <!-- Overall Wrapper ends below--> </div> <!-- stats --> <div class="stats"><SCRIPT LANGUAGE="javascript" SRC="http://stats.sitesuite.org/ss_statsjs?client=rosestanton"></SCRIPT> <NOSCRIPT><IMG align="right" SRC="http://stats.sitesuite.org/ss_stats?client=rosestanton" /></NOSCRIPT></div> </body> </html>

Commercial Property Owner Application

Commercial Property Owner Insurance Application

THE APPLICANT/S

DETAILS OF THE BUSINESS/PREMISES