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Full Name: |
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Company Name: |
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Company Status: |
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House Number/Name (Home): |
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Home Postcode: |
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Email Address: |
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Home Phone: |
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Mobile Phone: |
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Date of Birth : |
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Marital Status?: |
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Occupation/Business: |
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Trading Address: |
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Trading Postcode: |
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Required Start Date Of Cover : |
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How many years has this business been trading?: |
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How many years experience do you have this in trade?: |
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Best quote so far?: |
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Where Is That Quote From?: |
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Have you made any claims or suffered any losses in the past 5 years?: |
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Estimated annual turnover (£): |
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How many premises do you operate from?: |
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Have you or you business partner/company director ever been declared bankrupt?: |
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Been convicted or have any prosecutions pending or been given an official police caution, in respect of any criminal offence other than motoring offence?: |
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Had any insurance proposal declined, renewal refused, had any special or increased terms applied or had insurance cancelled mid-term by underwriters?: |
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How long have you woned the property?: |
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Do you occupy the property as your private residence?: |
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Is your property used as a hostel, home for residents referred by the Department of Social Security (DSS) or other local government authority or Charitable organisations?: |
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How many bedrooms does the property have?: |
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How many bedrooms are used for letting?: |
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Maximum no. of guests at any one time?: |
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Do you provide meals other than breakfast?: |
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Are you the sole occupant(s) of the building in which your premises is located?: |
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What year was the property built?: |
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Construction of the Walls of your premises including outbuildings: |
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Construction of the Roof of your premises including outbuildings: |
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What percentage of the roof is flat? (if applicable) % : |
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Would you like you quote to include accidental damage?: |
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What is the buildings sum insured? £ |
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What is the contents sum insured? £ |
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Is subsidence cover required?: |
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Computers/Printers and ancillary equipment £ (sums insured): |
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All other electronic equipment not detailed above £: |
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Shop Front & Fascia £: |
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Tenants improvements £: |
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Fixtures and fittings £ : |
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Wine & Spirits £: |
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Cigarettes & Tobacco £: |
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Mobile Telephones £: |
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CDs , DVDs and video tapes £: |
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Frozen Food £: |
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Do you require cover for any business equipment away from your business premises i.e. laptop computer? Please enter sum Insured and give description of equipment £ |
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Best Time To Contact You?: |
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