ZURICH BUSINESS INSURANCE FACT FINDER
Business Name
Primary Contact
Position
Phone Number / Work / ( ) / Home / ( )
Mobile / Fax Number
Email Address
Address
City / State / Post Code
Professional Associates Details
Accountant
Name
Company
Phone Number / Work / ( ) / Home / ( )
Mobile / Fax Number
Email Address
Address
City / State / Post Code
Solicitor
Name
Company
Phone Number / Work / ( ) / Home / ( )
Mobile / Fax Number
Email Address
Address
City / State / Post Code
Business Details and Structure
Business Structure / Sole Trader / Private Company / Partnership / Unit Trust
Public Company / Family Trust / Service Trust
Nature of the business
(industry, speciality, franchise or any JV arrangements etc)
What is your business financial year?
Number of employees / Full time / Part time / Casual
Proprietors details
Enter all proprietors details, including name, date of birth, gender and % of ownership in the business / Owner
Partner
Shareholder
Other / Active or silent / Name / Date
of
Birth / M/F / Own’ship
% / Smoker / Date ownership acquired
Insert diagram of the business structure, including roles and names of people performing roles. Show any related companies or businesses
Debts and Personal Guarantees
Current Debt / Interest Rate / Finance Provider / Term / Guarantees
Loans / $ / %
$
$ / %
$ / %
Lines of Credit/ Overdraft Facilities
$ / %
$
$ / %
$ / %
Creditors
$ / %
$
$ / %
$ / %
Shareholder/ Director Loans
$ / %
$ / %
$ / %
Other
$ / %
$
$ / %
$ / %
TOTAL / $
Have any proprietors given guarantees for business loans? / Yes / No
Corporate / Personal / Both
What asset is securing the guarantee? / Business / Personal
For what events do the proprietors wish to protect against the loans being called in?
Death / Disablement / Trauma
Business Valuation
Estimated value of the business / $
How was this amount calculated?
Was the value calculated by the accountant, business value or an estimate of the purchase?
Agreed by
Date business commenced or purchased
Have ownership arrangements changed since this date? / Yes / No
If yes, what were the changes and when did they take place?
Business Continuation
Would you and /or other principals intend to, if something happened to one of the business owners, buy their interest in the business? / Yes / No
Do you have control over who you are in business with, in the event that a co-principal suffered a tragic event? / Yes / No
Would it be intended for the business to continue? / Yes / No
In which situation/s would you like the opportunity to buy out a co-principal? / Yes / No
- If your partner was severely ill or injured / Yes / No
- If your partner became totally and permanently disabled / Yes / No
- If your partner died / Yes / No
- If your partner wanted to leave the business / Yes / No
Do you have written agreement between the Proprietors that gives the right to buy or sell ownership/interest? If yes, complete details below / Yes / No
Date agreement formalised / Last time reviewed
How would you fund such a buy out?
Haven’t considered:
Vendor finance:
Personal Assets/Loan:
Other:
What cost? / $
Would your business continue in the event of the sudden departure of one of the owners or would the spouse/estate sell it as a going concern?
Would the proprietors wish to fund for their possible CGT liability as well as their equity payout obligations? / Yes / No
What are the likely CGT implications?
Proprietor / CGT Liability
1. / $
2. / $
3. / $
4. / $
5. / $
Do you wish to take account of funding for the retirement of any proprietors? / Yes / No
Retirement age details
Proprietor / Current Age / Retirement Age / Retirement Funded
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
How will the remaining proprietors fund the retirement of the departing proprietors
Saving / Borrowing / Combination of both
Key People
Are there any people in your business whose long term absence or departure would result in the business suffering financially? / Yes / No
Who are the key people in your business?
Name / Position / D.O.B / M/F / Smoker? / Why are they key people?
1.
2.
3.
4.
5.
Insurance Currently in Place for the Business
Do any of the proprietors currently have insurance in place? / Yes / No
Specify the details of these policies
Policy Owner / Sum Insured / Type of Cover / Annual Premium / Provider / Purpose
Do you have a personal Will? / Yes / No
Do your co-principals? / Don’t know / Yes / No
Have copies of latest financial statements been provided? / Yes / No
From this information we will analyse your business issues, would you like a similar analysis of your personal situation? / Yes / No
Additional Information
The information contained in this Business Fact Finder is complete and accurate to the best of my knowledge:
Name / Signature
Client / X / Date
Client / X / Date
Client / X / Date
The information in this document provides the necessary framework to analyse your current situation and subsequent recommendations.
The information will be used for that purpose.
Inaccurate or incomplete information will hinder accurate analysis and advice.