Titan Insurance Advisors | Insurance Solutions in the Bahamas

Proposer Details

Name of Proposer *

Address

Telephone

Email *

Occupation

Business Name

Years in Business

Type of Business

Premises & Business Details

Business Premises Address

Are the premises owned or rented?

Full Description of Business Activities *

Number of Employees

Annual Turnover

List all business activities carried on at the premises

Access & Facilities

Premises Condition & Safety

Condition of premises

How often is maintenance performed?

Are regular safety inspections conducted?

YesNo

Are fire extinguishers present and serviced?

YesNo

Is a first aid kit available?

YesNo

Are emergency exits clearly marked?

YesNo

Away From Premises Activities

Do you perform work away from your premises?

YesNo

Employees & Sub-contractors

Total Employees

Full-Time

Part-Time

Annual Payroll

Do you use sub-contractors?

YesNo

Hazardous Materials & Waste

Products & Services Liability

Current Insurance

Current Insurer

Policy Number

Expiry Date

Current Limit of Indemnity

Claims History

Have you had any liability claims in the past 5 years?

YesNo

Ever been declined liability insurance?

YesNo

Indemnity Required

Limit of Indemnity Per Occurrence *

Aggregate Limit (Optional)

Products Liability Limit (if applicable)

Required Documents

Business Documents (Optional)

Business license, registration, certificates

Upload files

Safety Certificates (Optional)

Fire inspection, safety audit, equipment certifications

Upload files

Additional Documents (Optional)

Upload files

Declaration & Signature

I/WE declare that the above statements are true and complete and that no material facts have been withheld. I/WE agree that this proposal shall form the basis of the contract with NAGICO Insurance (Bahamas) Limited.

Signature *

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Public Liability Insurance Application

Proposer Details

Premises & Business Details

Access & Facilities

Premises Condition & Safety

Away From Premises Activities

Employees & Sub-contractors

Hazardous Materials & Waste

Products & Services Liability

Current Insurance

Claims History

Indemnity Required

Required Documents

Declaration & Signature