*What is Your Business Name?
*Select Business Category —Please choose an option—Home Business InsuranceSalon & Barbers’ InsuranceHotel, B&B & Guest House InsuranceMarine Trade InsuranceRestaurant & Takeaway InsuranceOffice & Surgery InsuranceCafé InsurancePub InsuranceShop & Retail InsuranceNursing Home InsuranceNursery InsuranceManufacturers & Wholesalers’ InsuranceSports, Leisure & Entertainment InsuranceContractors Combined InsuranceOther
If other please explain
*Title —Please choose an option—MrMrsMissMSProfessorDrSir
*First Name
*Last Name
*Main Contact Number
*Business Email Address
*Insurance Cover Start Date
*Select any of the following that apply to any proposer, director or partner of the Trade or Business or its Subsidiary Companies if they have ever, either personally or in any business capacity:
NoneHad any convictions or criminal offences which are not spent under the Rehabilitation of Offenders Act or has any prosecutions pending.Been declared bankrupt or insolvent or been the subject of bankruptcy proceedings or insolvency proceedings.Had a proposal refused or declined.
Had an insurance cancelled.Had a renewal refused.Had special terms imposed.Been the owner or director of, or partner in, any business, company or partnership had a county court judgement awarded against them.Been disqualified from holding company directorship.
Been served with a prohibition or improvement order under health and safety legislation.Been convicted of, charged (but not yet tried) with or officially cautioned for a breach of any Health and Safety or Welfare or Environmental Protection legislation.Been the subject of a recovery action by Customs and Excise or the Inland Revenue the Inland Revenue.
If yes any of above then could you please give more detail
Building YesNo
Do you own this Property: YesNo
Year Built:
Year established at this address:
Address:
Building Declared value
Sum Insured
Location: AirsideArcadeBusiness ParkCanal SideCliffCovered Shopping CentreDomestic PremisesEmbankmentHigh StreetIndustrial EstateIndustrial UnitLakesideMarketMarket HallNuclear InstallationParadePrecinctQuarryRiversideSeafrontWarehouse
Listed building:—Please choose an option—YesNo
Resident type: NoneCommercial/Business TravellersGovernment/Local Authority Financially AssistedResidentialStudentsTourist
Material facts: None of themBuilding roof is flat or partially flatThe business is not self contained with its own means of accessThe premises is closed for more than 3 consecutive monthsThe premises is in an area with a history of floodingThe property has walls or roofs constructed of composite panels
The property has walls or roofs containing combustible liningsThe property is erected on made up ground or has been underpinnedThe property is of non-standard construction (walls not built only of brick, stone, metal or concrete or roofed only with slates, tiles, metal or concrete)The property is unoccupied, or has not been used in the last 30 days
The property or adjacent property has suffered from, or shows any visible signs of damage from subsidence, landslip or ground heaveThe proposer is not the sole occupant (if other than offices or private dwellings)There are trees or shrubs which are more than 5 metres in height and within 10 metres of the propertyThere is an ATM on the premises
Total number of storeys:
Number of storeys where floor is of wooden construction:
Additional comments i.e If any floor empty or unoccupied.
Risk Management: Intruder Alarm—Please choose an option—YesNo
Accreditation of intruder alarm: NSI NACOSS Installed
Maintenance contract accreditation —Please choose an option—Not MaintainedYes Maintained
Police Response: YesNo Does the alarm incorporate confirmable technology: YesNo Does the alarm is Under the sole control of proposer: YesNo Fire Extinguisher: YesNo Is there Deep Fat frying range: YesNo If yes : Please confirm the capacity of Oil
Additional security details: None3 Bolt Multipoint Locking SystemAnti Ram Raid BollardsBarsClose Shackle Padlock - 5 Or More LeversEncasement and entrapment devices on all computer equipmentExternal GrillsHinge BoltsInternal GrillsKey Operated Window LocksLock Down DevicesMortise Deadlock - 5 Or More LeversMortise Deadlock - 5 Or More Levers BS3621Open Shackle Padlock - 5 Or More LeversPrivate CCTVRim DeadlockRim LockRim Lock Automatic DeadlockRim Lock Automatic Deadlock BS3621Security FenceShutters - MetalShutters - WoodenStandard Iron GrillsSteel Lined DoorsTown Centre/Local Authority CCTV
Risk management features: Current IEE electrical certificateSprinklers
Covers Requested: Contingencies: Accidental DamageAll RisksStandard Fire & Specified PerilsSubsidence Ground Heave LandslipTheft
Content Insurance: YesNo
Electronic equipment and office content
Machinery, Plant, Fixture and Fitting Sums
Stock sums
Loss of Profit
Employees Details YesNo
Employee type (Full time/Part Type/Care Taker etc.)
Number of Employees (Example: 2-Full Time, 3-Part Time)
PAYE No
Is any work away carried out other than collection and delivery
Does any employee work with heat—Please choose an option—YesNo
Wageroll
Public Liability YesNo
Limit of Indemnity —Please choose an option—£1000000£2000000£5000000£5000000+
Additional Information
Products Liability YesNo
Turnover
Wholesalers Finished Goods imported from: NoneAsiaAustralia, NZ, USA and CanadaEU (exc UK)Rest of world (exc UK)
Employees Liability YesNo
Legal Expenses YesNo
Limit of Indemnity —Please choose an option—£50000£100000£250000
Claims History Any Claim in last 5 years YesNo
Please send us any documents that may help to get a quote (You can send us any insurance schedules or business documents)
Please provide any information you would like for your business/trade or profession.
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