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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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Is the above premises your only trading location?: |
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Are you the sole occupant(s) of the building in which your premises is situated?: |
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Is the above premises your only trading location?: |
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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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Does the premises have a basement?: |
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What percentage of the roof is flat? (if applicable) % : |
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What year were the premises built?: |
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What method of heating is used at the premises?: |
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Do you have an alarm fitted at your premises?: |
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If you have an alarm what type signalling does the system use?: |
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If you have an alarm do you have a maintenance contract in place?: |
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Who are your alarm maintenance company approved by? (if applicable)?: |
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Do you have Metal Grills or Roller Shutters fitted?: |
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Please provide details of any business activities away from your premises other than deliveries or any clerical duties |
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Do you have a deep fat frying range?: |
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Do you offer a delivery service?: |
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If you offer a delivery service please provide details of any deliveries |
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Computers/printers and ancillary equipment £: |
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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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Would you like you quote to include accidental damage?: |
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Is buildings insurance required? If so enter sum Insured £ |
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If Buildings insurance required is subsidence cover required?: |
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Do you require cover for goods in transit? If so enter sum insured £ |
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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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