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Office Insurance Quotation Form
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Proposer's Details |
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Proposer's full name: |
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Company trading name: |
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How many years have you been in
business
(at this address): |
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How many years have you been in
business
(in this trade): |
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Is the business: |
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What is your occupation/business description:
(please describe all your activities to be insured): |
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What is the legal status of the business: |
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Risk address: |
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Risk address postcode: |
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What is your estimated annual turnover: |
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How many
full-time
employees do you
have?: |
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How many
part-time
employees do you
have?: |
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About The Building |
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What cover do you require?: |
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If Buildings Cover Is Required, What Sum Insured?: |
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Do you require cover for
subsidence, heave & landslip?: |
Yes
No
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Property Information. (Please Complete
This Section, Even If Only Insuring Contents) |
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What is the construction of the property -
Walls?: |
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What is the construction of the property -
Roof?: |
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Is there any flat roof on the property?: |
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Original year property was built?: |
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Is the property a listed building?: |
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Is the property alarmed?: |
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Please select all additional security at the
premises?
(Press and hold 'Ctrl' key whilst making multiple selections): |
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Maintained in a good state of repair?: |
Yes
No
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Occupied by you in connection with your business and as a
private dwelling?: |
Yes
No |
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Heated only by a low pressure hot water apparatus, fixed gas
appliances or fixed electrical appliances?: |
Yes
No |
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If you have answered 'No'
to any of
the above, please give details here |
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About The Contents |
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Please give the sum insured
required for each category: |
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Category |
Sum insured (£)
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Trade fixtures & fittings & all contents:
(but excluding computers and other listed items below): |
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Computers and electrical
equipment: |
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Works of art: |
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Business files and records: |
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Exhibition Equipment: |
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Stock & Trade Samples: |
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Goods In Trust: |
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Office Contents In Transit: |
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Fixed glass & Office Fronts: |
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Business Money |
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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). |
Yes
No
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Is cover required for Theft by Employees?: |
Yes
No
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Business interruption:
(Estimated 'Gross Income' for next 12 months) |
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Is terrorism cover required?: |
Yes
No
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More About The
Insured And Premises |
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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?: |
Yes
No
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Has any previous insurer
declined a proposal, refused to renew a policy or imposed any special
terms or conditions?: |
Yes
No
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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? |
Yes
No
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Does the Insured undertake to work away from
the premises? |
Yes
No |
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Does any other business occupy or operate from
these buildings? |
Yes
No |
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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?: |
Yes
No
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Is there a safe at the
premises?: |
Yes
No |
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If the answer is 'Yes' to any of
the above, please provide full details in the box here:
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