Office Insurance Quote Form

Proposer's Details

Proposer's full name:

Company trading name:

How many years have you been in business (at this address):

How many years have you been in business (in this trade):

Is the business:

What is your occupation/business description: (please describe all your activities to be insured):

What is the legal status of the business:

Risk address:

Risk address postcode:

What is your estimated annual turnover:

How many full-time employees do you have?:

How many part-time employees do you have?:

About The Building

What cover do you require?:

If Buildings Cover Is Required, What Sum Insured?: £

Do you require cover for subsidence, heave & landslip?:

YesNo

Property Information. (Please Complete This Section, Even If Only Insuring Contents)

What is the construction of the property - Walls?:

What is the construction of the property - Roof?:

What percentage of the total roof is flat?

Original year property was built?:

Is the property a listed building?

Is the property alarmed?:

Please select all additional security at the premises? (Press and hold 'Ctrl' key whilst making multiple selections):

Maintained in a good state of repair?:

YesNo

Occupied by you in connection with your business and as a private dwelling?:

YesNo

Heated only by a low pressure hot water apparatus, fixed gas appliances or fixed electrical appliances?:

YesNo

If you have answered 'No' to any of the above, please give details here

About The Contents

Please give the sum insured you require for each covered category.

Cover Category

Sum insured ( £ )

Trade fixtures & fittings & all contents (but excluding computers and other listed items below): £

Computers and electronic equipment: £

Works of art: £

Business files and records: £

Exhibition Equipment: £

Stock & Trade Samples: £

Goods In Trust: £

Office Contents In Transit: £

Fixed glass & Office Fronts: £

Business Money: £

Optional Covers

Is cover required for business equipment whilst away from the premises? (If Yes, please put full information & costs of items in 'Material Facts' box below):

YesNo

Is cover required for Theft by Employees?:

YesNo

Business interruption: (Estimated 'Gross Income' for next 12 months)£

Is terrorism cover required?:

YesNo

More About The Insured And Premises

Has the Insured or any director or partner been declared bankrupt, insolvent, been convicted of or has any prosecution pending for arson or any offence involving dishonesty of any kind?:

YesNo

Has any previous insurer declined a proposal, refused to renew a policy or imposed any special terms or conditions?:

YesNo

Has the Insured or any director or partner incurred any loss, destruction or damage or had any claim made against them in the last 5 years?

YesNo

Does the Insured undertake to work away from the premises?

YesNo

Does any other business occupy or operate from these buildings?

YesNo

Are the premises in an area which is exposed to damage by storm, flood, subsidence, heave or landslip, or within 400 metres of the nearest river, sea, watercourse, lake, cliff or quarry?:

YesNo

Is there a safe at the premises?:

YesNo

If the answer is 'Yes' to any of the above, please provide full details in the box here:

Any Other Material Facts: (A material fact is any fact which could influence the assessment or acceptance of this quotation):

Current Insurance and Contact Information

Date cover is required from:

Current insurers (If applicable):

Renewal/target premium: £

Email address:

Telephone number:

Contact Name:

Preferred choice of quotation contact:

Preferred payment method:

Office Insurance Quotation Form

Proposer's Details

About The Building

About The Contents

More About The Insured And Premises

Current Insurance and Contact Information

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