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Business Information

Please make sure to answer honestly, with accurate and up-to-date information. If you don’t, your policy may be cancelled, and your insurer could reject your claim or declare not to pay it in full.

Company Name

Company Address

Postal Code

Company Annual Revenue

Number of Employees

Industry

Do you have other types of business insurance currently?

Please state the types of business insurance you currently have

Please describe here

Do you wish to include another entity/company to this policy?

JOINT INSURED

Do you wish to include another entity/company as a joint-insured?

Enter the company name you need to jointly insure:

CROSS LIABILITY

Do you wish to include another entity/company under a cross-liability clause?

Enter the company name you need to have cross-liability with:

WAIVER OF SUBROGATION

Do you wish to include another entity/company for a waiver of subrogation?

Enter the company name you need to have waiver of subrogation with:

(Selected Cleaners as industry) Industry risk declaration

Activity Declaration

1. Do you perform disinfection work with Hazmat suits, or work related to Covid-19 disinfections?
2. Do you perform work at dormitories?
3. Do you perform work at heights > 5m from ground level, or on the exteriors of buildings?

Will your employees perform disinfection work with Hazmat suits, or work related to Covid-19 disinfections?

Will your employees perform work at dormitories?

Will your employees perform work at heights > 5m from ground level, or on the exteriors of buildings?

(Selected Engineering Services) Industry risk declaration

Activity Declaration

1. Do you perform hot works/welding?
2. Do you perform work at heights >5m from ground level, or on the exteriors of buildings?

Will your employees perform hot works/welding?

Will your employees perform work at heights >5m from ground level, or on the exteriors of buildings?

(Selected Inspection and Testing Services (Engineering Related)

Activity Declaration

1. Do you perform hot works/welding?
2. Do you perform work at heights > 5m from ground level, or on the exteriors of buildings?

Will your employees perform hot works/welding?

Will your employees perform work at heights >5m from ground level, or on the exteriors of buildings?

(Selected Electrician) Industry risk declaration

Activity Declaration

1. Do you perform hot works/welding?
2. Do you perform work at heights >5m from ground level, or on the exteriors of buildings?

Will your employees perform hot works/welding?

Will your employees perform work at heights >5m from ground level, or on the exteriors of buildings?

(Selected Domestic/Commercial Appliance Installation) Industry risk declaration

Activity Declaration

1. Do you perform hot works/welding?
2. Do you perform work at heights >5m from ground level, or on the exteriors of buildings?

Will your employees perform hot works/welding?

Will your employees perform work at heights >5m from ground level, or on the exteriors of buildings?

(Selected Air Conditioning Servicing/Installation

(Selected General Handyman) Industry risk declaration

Activity Declaration

1. Do you perform hot works/welding?
2. Do you perform work at heights >5m from ground level, or on the exteriors of buildings?

Will your employees perform hot works/welding?

Will your employees perform work at heights >5m from ground level, or on the exteriors of buildings?

(Selected Wholesalers) Industry risk declaration

Activity Declaration

1. Do you wholesale flammable or explosive goods?
2. Do you wholesale chemicals, or Oil & Gas products?
3. Do you wholesale livestock?

Do you wholesale flammable or explosive goods?

Do you wholesale chemicals, or Oil & Gas products?

Do you wholesale livestock?

(Selected Consumer Goods Repair

Activity Declaration

1. Do you repair art, jewellery, precious stones/metals, or other precious goods?
2. Do you perform hot works/welding?

Will your employees repair art, jewellery, precious stones/metals, or other precious goods?

Will your employees perform hot works/welding?

(Selected Sports Coach) Industry risk declaration

Activity Declaration

1. Do you coach water sports (e.g. swimming, sailing)?

(Selected Private Investigator (PI)) Industry risk declaration

Activity Declaration

1. Do you employees carry any kind of arms/weapons?

(Selected Security Guard Service (Unarmed)) Industry risk declaration

Activity Declaration

1. Do you employees carry any kind of arms/weapons?

(Selected Interior Renovation Contractor) Industry risk declaration

Activity Declaration

1. Do you perform hot works/welding?
2. Do you perform work at heights >5m from ground level, or on the exteriors of buildings?

Will your employees perform hot works/welding?

Will your employees perform work at heights >5m from ground level, or on the exteriors of buildings?

(Selected Photographer/Videographer) Industry risk declaration

Activity Declaration

1. Do you perform adventure shoots?
2. Do you perform work at heights > 5m from ground level, or on the exteriors of buildings?
3. Do you perform overseas shoots?

Will your employees perform adventure shoots?

Will your employees perform work at heights >5m from ground level, or on the exteriors of buildings?

Will your employees perform overseas shoots?

(Selected Warehouse) Industry risk declaration

Activity Declaration

1. Do you store flammable or explosive goods?
2. Do you store chemicals, or Oil & Gas products?
3. Do you store livestock?

Do you store flammable or explosive goods?

Do you store chemicals, or Oil & Gas products?

Do you store livetock

Couriers

What type of goods do you transport?

Are you a member of the Singapore Logistics Association (SLA)?

Do you transport temperature-sensitive goods? e.g Wine, frozen goods, etc.

Please describe what temperature-sensitive items you transport

What is the total value of temperature-sensitive items you transport?

Do you transport high-value goods such as art works, jewellery, cash, etc?

Please describe what high-value goods you transport

What is the total value of such goods you transport?

Do you transport oil, varnish, paint, chemicals, or other flammable/hazardous materials?

CPR Training/First Aid Training Services

Please describe your CPR Training/First-Aid Training services

Are any of your employees involved in the following work?

Work onboard ships or offshore rigs

Will your employees sail with the ships for work?

Work on docked ships only
Sail with ships for work

Work on docked ships only

Number of employees

Frequency of work onboard vessels

Frequency of work per

Duration of work onboard vessels

Sail with ships for work

Number of employees

Maximum duration of each offshore trip

Frequency of work per

Duration of work onboard vessels

Work at Oil & Gas/Petrochemical sites

Frequency of Oil & Gas/Petrochemical work Data

Number of employees

Frequency of Oil & Gas/Petrochemical work

Frequency of work per

Duration of work onboard vessels

Will your employees travel overseas for work?

What’s the average duration of each overseas trip?

What’s the maximum number of employees who will travel overseas?

Which countries will your employees travel to?

Dialysis Service

How many estimated patients will you serve each year?

Do you hold a valid dialysis centre license?

Do you provide services other than dialysis?

Please describe what other services you provide

Dog Walking Service

Will you walk any of the following breeds?

Will you muzzle these breeds of dogs while walking them?

Have any dogs attacked other dogs or people before, while you were walking them?

Church/Hindu Temple/Sikh Temple/Buddhist/Taoist Temple/Mosque

What is your maximum guest capacity?

How many events do you organise per year, on average?

What is the maximum attendance for any event?

What is the average attendance for an event?

Please provide examples of the largest events you’ve organised in the last 12 months

1	Event Name Event Description Maximum Number of Attendees
1	Event Name Event Description Maximum Number of Attendees

Add Row

Do you erect or dismantle scaffolds, e.g. for events?

Do you perform welding to erect or dismantle scaffolds?

Load premium

Do you perform, or organise events, involving any of the following?

Self-flagellation
Exorcism
Any other kind of activity that may result in physical injury

Chauffeur/Limousine Services

Do you transport clients by air or sea?

Please elaborate on how you transport clients by air or sea

Where do you transport clients?

Within Singapore only
Singapore and overseas

Please state the countries that you will transport clients to and from

How many clients do you transport per month, on average?

Under 50
51 to 100
100 to 200
Over 200

Please state the number of clients you’ll transport

Biomedical Engineering

Do you perform work in a laboratory?

Do you own or rent your laboratory?

Own
Rent

Do you perform hot work (e.g. work involving burners, heating elements, etc.)?

Ambulance/Medical Transportation Services

What services do you provide?

Description

Where do you transport patients to and from?

Please state some example countries where you will provide medical transportation services

Number of patients you transport per month, on average

Hotel

What is your maximum guest capacity?

Do you have swimming pools in your hotel?

Are there lifeguards on duty in your swimming pool?

Do you provide valet parking services for your guests?

How many employees do you have?

Shared/Coworking Office Space Operator

What’s the maximum capacity of your coworking space?

Tattoo/Piercing Store

How many clients do you serve per month?

Under 100
101 to 200
201 to 500
Over 500

Do you use autoclaves to sterilise your tattoo equipment?

Please describe what steps you take to maintain hygiene in your tattoo/piercing studio

Tree Pruning Services

Maximum contract value (SGD)

Are any of your employees working at heights of >5 metres above floor/ground level

What is the maximum height your employees work at?

Are any of your employees involved in scaffolding erection or dismantling

Upholstery/Furniture Repair Services

Maximum contract value (SGD)

Do your employees perform carpentry work?

Do your employees use table saws, hand saws, and other power tools?

Watch Store

What’s the highest-valued watch you sell?

Under $500
$500 to $4,999
Over $5,000

Kayak tours

What's the average duration of each kayak tour (in hours)

What's the frequency of kayak tours conducted

What minimum qualifications (if any) do you enforce for kayak tour guides?

Can you confirm that all tour guides and participants must wear life vests while out on the water

Interior Design

Maximum contract value (SGD)

Landscape Architect

Maximum contract value (SGD)

Air Conditioning Servicing/Installation

Maximum contract value (SGD)

Interior Renovation Contractor

Maximum contract value (SGD)

Inspection and Testing Services (Engineering Related)

Maximum contract value (SGD)

Audio and Video (AV) Equipment Technicians

Maximum contract value (SGD)

Building Inspectors

Maximum contract value (SGD)

Carpentry

Maximum contract value (SGD)

Debris Removal Services

Maximum contract value (SGD)

Theatre/Stage Lighting Supply and Installation

Maximum contract value (SGD)

Risk Declaration

1. Do you perform work offshore or onboard vessels?
2. Do you perform work at Oil & Gas, or Petrochemical sites?

Will your employees work onboard ships or offshore rigs?

Will your employees sail with the ships for work?

Work on docked ships only
Sail with ships for work

Please provide more information on the work you perform on docked ships

Max no. of employees

Frequency of work onboard vessels (e.g. 3 x a week)

Duration of work onboard vessels (e.g. 3 hours per job)

Please provide more information on the work you perform if they sail with ships for work

Max no. of employees

Frequency of work onboard vessels (e.g. 3 x a week)

Duration of work onboard vessels (e.g. 3 hours per job)

Will your employees work at Oil & Gas, or Petrochemical sites?

Please provide more information on the work you perform at Oil & Gas, or Petrochemical sites

Max no. of employees

Frequency of work (e.g. 3 x a week)

Duration of work (e.g. 3 hours per job)

Claims Declaration

1. Have you filed insurance claims for the risks proposed in the last 3 years?
2. Have you had any business insurance policy cancelled in the last 12 months due to non-payment of premium?

Have you filed insurance claims for the risks proposed in the last 3 years?

Please provide more information on your prior insurance claims

Claim Year

Claim amount (SGD)

Explanation of claim

Is the claim fully resolved?

Add claim

Have you had any business insurance policy cancelled in the last 12 months due to non-payment of premium?

Please provide more information on why your business insurance policy was cancelled

Policy Year

Policy Name

Name of Insurance Company

Price/premium of cancelled policy

Reasons for cancellation

Add claim

Contact Information

First Name

Last Name

Phone

Employee Information

Please provide details of the workers you want to insure.

Workers

1	Type of Occupation Category of worker No. of Workers Total Annual Wages (Total in this occupation) Total annual est. wages should consist of: basic pay + bonus + overtime pay + annual wage supplements + food and housing allowances. CPF contributions and travel allowances are excluded. Please enter the total wages for all employees in each occupation category.
1	Type of Occupation Category of worker No. of Workers Total Annual Wages (Total in this occupation) Total annual est. wages should consist of: basic pay + bonus + overtime pay + annual wage supplements + food and housing allowances. CPF contributions and travel allowances are excluded. Please enter the total wages for all employees in each occupation category.

Add Occupation