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					Insurance Personal Lines | Insurance Commercial Lines




Caravan and Camping Guard
Proposal Form




  To be completed by the Insurance Agent
  Agent’s name                                                          Agency number
  Address
  Quote reference (if any)                                              Cover to start from                      Time
  Premium quoted inclusive of IPT                                       Agent’s reference (if any)
  Touring Caravan n Static Caravan n Trailor Tent n

To be completed by the Proposer
Please see the Caravan and Camping Policy Summary for information on the standard and optional covers available. If you are in
any doubt about the cover you require or the amount(s) that should be insured contact your insurance adviser for help.

PLEASE USE BLOCK CAPITALS AND ANSWER ALL QUESTIONS IN FULL

Section A. Proposer details
  Proposer Surname                                                                              Title
  First name(s)                                                                                 Marital status
  Postal address
                                                                                                          Post code
  Date of birth
  Main occupation
  Other occupation
  Second Proposer Surname                                                                         Title
  First name(s)
  Date of birth
  Second Proposer’s Main occupation
  Other occupation
  Note: Please give full details of occupations as the use of general terms such as Director, Manager or              Salesman
  are not sufficient.
  Are you a member of:
  a The caravan or Camping and Caravanning Club?                                                                      YES   NO
  b The Caravan Storage Site Owners Association?                                                                      YES   NO
  Have you or any person who lives with you:
  a had any insurance cancelled, refused or had special terms applied by any insurer?                                 YES   NO
  b sustained any losses, damage or liability in the last 5 years, whether insured or not?                            YES   NO
  c ever been served with a county court judgement, declared bankrupt or convicted of or charged with but
      not yet tried for any criminal offence? Driving offences only need to be disclosed where a prison sentence      YES   NO
      has been served.
  d been insured before for any of the risks covered by this proposed insurance?                                      YES   NO
      If ‘Yes’ give name of insurer
  If ‘Yes’ to any of the above give details
2                                                                                           Caravan and Camping Guard Proposal Form




Section B. Give details of your caravan or trailer tent
  SPECIAL NOTE: We do not insure foreign manufactured caravans, mobile homes, folding caravans, pop-ups, specialist built
  caravans, caravans or trailer tents more than 15 years old or caravans used for permanent residential purposes.
  Type of cover required
  Touring Caravan n Static Caravan n Trailer Tent n Touring Caravan on Fixed Site n
  Maximum claim limit
  Caravan or trailer tent                                                                                            £
  Contents                                                                                                           £
  Make and Model
  Serial/Vin No. Cover cannot be given unless completed
  Year of manufacture
  Country of manufacture
  Address of caravan when not kept at postal address
                                                                                                 Post code
  Date of purchase                                                                                                 /     /
  Price paid                                                                                                         £
  Market value                                                                                                       £
  If you are prepared to pay the first £100, £150, £250 or £500 of any claim (in addition to any other excess which may apply) in
  return for a reduction in your premium, please indicate by ticking the appropriate box.
  £100 n £150 n £250 n £500 n
  1 Is the caravan kept permanently on a fixed site?                                                                  YES NO

    2 Is cover required whilst the caravan or trailer tent is being towed other than by you or members of your
                                                                                                                      YES    NO
        family permanently residing with you?
    If ‘Yes’ an increased premium will apply, If ‘Yes’ give details

    3 Is the caravan or trailer tent owned by anyone other than you?                                                  YES    NO
    If ‘Yes’ give details

    4 Is the caravan likely to be used as a residence for more than two consecutive months in any one period
                                                                                                                      YES    NO
        of insurance?
    If ‘Yes’ give details

    5 When not in use, is the caravan ever kept in an area likely to be subject to flooding or where flooding has
                                                                                                                      YES    NO
        occurred?
    If ‘Yes’ give details

    6 Is a heating system installed other than a fixed gas or electrical system?                                      YES    NO
    If ‘Yes’ advise type and whether fixed or portable

    7 Does the contents maximum claim limit include any items valued over £400?                                       YES    NO

    8 Is the caravan ever used for business purposes?                                                                 YES    NO
    If ‘Yes’ give details

    9 If the caravan is a touring caravan, is it a twin axle model?                                                   YES    NO

Touring Caravans
  IMPORTANT NOTE: LOSS OR DAMAGE BY THEFT TO A TOURING CARAVAN IS EXCLUDED UNLESS AT THE TIME OF
  LOSS OR DAMAGE IT WAS SECURED BY MEANS OF A WHEEL CLAMP.
  This exclusion does not apply whilst the caravan is parked on a registered caravan site for a period of less than 15 days or
  whilst attached to a towing vehicle in the course of transit.
  Have all persons who will tow the caravan attended a caravan towing course run by one of the institutions mentioned below
  or passed the
  IAM (Institute of Advanced Motorists) caravan test                                                                  YES NO
  The Camping and Caravanning club                                                                                    YES NO
  The Caravan club                                                                                                    YES NO
  Drivecraft                                                                                                          YES NO
HH90 Jan09                                                                                                                     3




  Do you wish to claim a discount for any of these security devices in addition to the standard wheelclamp requirement:
  a Wheelclamp and Hitchlock                                                                                       YES    NO
  b Supermule?                                                                                                     YES    NO
  c Hitchlock with tamper device?                                                                                  YES    NO
  d Stop theft tagging kit?                                                                                        YES    NO
  e Alarm?                                                                                                         YES    NO
  f Sold Secure approved alarm?                                                                                    YES    NO
  g Electronic Traking Device?                                                                                     YES    NO
  h Phantom target tracker or RAC Trackstar?                                                                       YES    NO
  If the caravan is a touring caravan, where is it normally kept?
  a In the boundaries of your home behind a locked gate or parking post?                                           YES    NO
  b In the boundaries of your home behind a locked gate and has at least one of the additional security measures:
      i kept behind a professionally fitted parking post?                                                          YES    NO
      ii the home has security lighting?                                                                           YES    NO
      iii the lock on the gate is a Sold Secure approved lock?                                                     YES    NO
  c On an unsecured driveway?                                                                                      YES    NO
  d In a CASSOA* Bronze award site or Secured by design site whilst not in use?                                    YES    NO
  e In a CASSOA* Silver award site whilst not in use?                                                              YES    NO
  f In a CASSOA* Gold award site whilst not in use?                                                                YES    NO
  g Permanently on a fixed holiday campsite?                                                                       YES    NO
  h Elsewhere?                                                                                                     YES    NO
      If Yes - Give Details

* Caravan Storage Site Owners Association

Fixed Site Caravans
   Does the caravan have an alarm system?                                                                         YES     NO

  Does the caravan have a Sold Secure alarm system?                                                               YES     NO

  Does the caravan have a smoke alarm?                                                                            YES     NO

  In addition to a fully operational smoke alarm does the caravan also have a fire extinguisher?                  YES     NO
  NOTE: IF THE CARAVAN HAS A SMOKE ALARM FITTED THE BATTERY MUST BE CHARGED ANNUALLY

  If the caravan is kept on a fixed site, is the site:
  a an open field?                                                                                                YES     NO
  b A fully fenced field with an access barrier?                                                                  YES     NO
  c A holiday campsite without manned security?                                                                   YES     NO
  d A holiday campsite with a security person throughout the year?                                                YES     NO
  e A holiday campsite with a security person and covered by a closed circuit tv system (CCTV) throughout
                                                                                                                  YES     NO
      the year?
  f None of the above?                                                                                            YES     NO
      If Yes - Give Details



Section C. No claims discount
  1 Number of full years caravan insurance has been held immediately prior to the inception date of this
                                                                                                                          Years
     policy

  2 Number of full years since any caravan claim which would be covered by this proposed insurance                        Years

Section D. Give details of cover required for your camping equipment
  Maximum claim limit
  Camping Equipment                                                                                               £
  Contents                                                                                                        £
  Does the contents maximum claim limit include any items valued over £100?                                        YES    NO
4                                                                                                 Caravan and Camping Guard Proposal Form




Section E. Check your details are correct
  Important
  Before signing the Declaration below, please ensure that all questions have been answered. You are reminded that you must
  disclose all material facts likely to influence the acceptance and assessment of the Proposal. Failure to do so may render the
  insurance voidable. If there is any doubt whether facts might be considered material these should be disclosed. No insurance
  is in force until the Proposal has been accepted by the Company. The Company reserves the right to decline any Proposal.
  You should keep a record (including copies of letters) of all information supplied to the Company for the purpose of entering
  into the contract. A copy of the completed Proposal Form can be supplied on request.
  Declaration
  I/We DECLARE that to the best of my knowledge and belief the answers given by me are true and complete, all material facts
  have been disclosed, and that the maximum claim limit(s) represent(s) not less than full value of the property to be
  insured. I/We agree to accept a Policy on the standard form issued by the Company and be bound by the terms and
  conditions thereof. I/We furthermore agree that if any answer has been written by any other person, such person shall for that
  purpose be regarded as my agent and not the agent of the Insurer.

    Signature of Proposer(s)                                                               Date




    SPECIAL NOTE: To comply with the Road Traffic Act the persons using the caravan must ensure that the Certificate of
    Insurance in respect of the motor vehicle that will tow the caravan does not prohibit the drawing of a trailer.

What we will insure
Your caravan or trailer tent including awnings, toilet tents             Your contents including clothing, personal effects, luggage
and all installations, fixtures and fittings that form an integral       and – for caravans and trailer tents – utensils and furniture not
part of the caravan or trailer tent. Special towing is available for     forming an integral part of the caravan or trailer tent.
anyone authorised by you.
You can tow for up to 60 days in any one year in Northern                C.R.I.S
Ireland, Eire and the rest of Europe. Insure against loss or             The Caravan Registration & Indentification Scheme
damage if you let your caravan or trailer tent for hire or reward        The above organisation keeps a record of touring caravans and
whilst in Great Britain. Legal liability including costs and             the history of such caravans that have been manufactured from
expenses, of up to £2,000,000, resulting from the use of your            1992 onwards. Before buying a used caravan always check
caravan or trailer tent.                                                 with CRIS that it does not have finance outstanding against it,
                                                                         has not been recorded as stolen or been written off by an
Your camping equipment including tents, luggage trailer and              insurance company. For further information or to register your
all utensils, furniture and furnishings used in connection with          caravan, please contact CRIS, Dolphin House, New Street,
camping.Protect against all kinds of unforeseen loss or                  Salisbury, Wilts SP1 2TB Telephone 01722 411430 Please
damage, including storm damage and loss or theft of contents             note: C.R.I.S is an independant organisation and therefore the
(certain restrictions apply whilst the caravan or trailer tent is left   results of any search cannot be guaranteed by Fortis.
unattended).




                                                                                           Office address
                                                                                           Fortis House, The Square
                                                                                           Gloucester Business Park
                                                                                           Brockworth, Gloucester GL3 4AD

                                                                                           Registered address
                                                                                           Fortis House, Tollgate
                                                                                           Eastleigh, Hampshire SO53 3YA

                                                                                           Email: talkback@fortisinsurance.co.uk
                                                                                           Website: www.fortisinsurance.co.uk

                                                                                           Registered number 354568

                                                                                           Fortis Insurance Limited is authorised and
                                                                                           regulated by the Financial Services Authority

                                                                                           HH90 Jan09

				
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posted:11/10/2011
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