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Shop Insurance Quotation Request Form

Arrange a free insurance quote for your shop. Simply complete the quotation form below, submit the form to us and we’ll come back to you shortly. Alternatively give our office a call and we can collect information over the phone.

Shop Insurance Quote Form

Proposer’s Details

Title:

First name:

Surname:

Correspondence address:

Correspondence Postcode:

Declaration

Has Any Proposer, Director Or Partner Of The Trade Or Business, Or Its Subsidiary Companies Ever, Either Personally Or In Any Business Capacity: -

Had Any Convictions Or Criminal Offences Which Are Not Spent Under The Rehabilitation Of Offenders Act Or Are Any Prosecutions Pending For Arson Or Any Offence Involving Dishonesty Of Any Kind, Or Prosecuted Under The Customers Protection Act, Food Safety Act, Health & Safety Or Similar Legislation:

YesNo

Has A Proposal Refused Or Declined Or Ever Had An Insurance Cancelled, Renewal Refused Or Had Special Terms Imposed:

YesNo

Been Declared Bankrupt Or Insolvent Or Been The Subject Of Bankruptcy Proceedings Or Insolvency Proceedings:

YesNo

If Yes To Above Declaration Please Give Full Details, Circumstances, Costs and Dates Here:

Proposers Legal Status Of Business:

Individual Name, Partnership Names Or Limited Company Name:

Trading Name Of Business (Trading as):

Risk Address Of Shop:

Risk Postcode Of Shop:

How Many Years Have You Been In Business (at this address):

How Many Years Have You Been In Business (at this trade):

Primary Trade (e.g. clothing retailing):

Estimated Annual Turnover For The Next 12 Months: £

Number of Full Time employees:

Number of Part Time employees:

What Is The Estimated Wageroll For The Next 12 Months: £

What Are The Shop Opening/Closing Hours:

Is There Any Residential Living Accommodation Above The Shop:

Does The Business Hold A Licence To Sell Alcohol:

YesNo

Is The Shop Occupied Overnight:

YesNo

Location Of Premises:

Original Year The Building Was Built:

Is the property a listed building?

What Is The Construction Of The Walls:

What Is The Construction Of The Roof:

Is there any flat roof area on the property?:

What Are The Floors Made Of:

Has The Property Or Adjacent Property Suffered From, Or Do They Show Any Visible Signs Of Damage From Subsidence, Landslip Or Ground Heave:

YesNo

Are The Premises In An Area With A History Of Flooding:

YesNo

Is The Proposer The Sole Occupant Other Than Offices Or Private Dwellings:

YesNo

Is The Business Self-Contained With Its Own Means Of Access:

YesNo

When Are The Premises Occupied:

Is An ATM On The Premises:

YesNo

Is There An Intruder Alarm Present:

Any Additional Security:

24 House Site SecurityExternal Bars Over WindowsShutters Over Shop FrontNeighbourhood Watch AreaInternal CCTVExternal CCTVFire AlarmSprinkler SystemSecurity Lighting

Are There Any Interested Parties (i.e. mortgagee)

YesNo

If Yes: Please Supply name of interested party:

Covers

Sum insured ( £ )

Is Buildings Cover Required If Owned Or Tenants Improvements If Not Owned:

YesNo

If Yes: Buildings Or Tenants Improvements: £

Contents:

Fixtures, Fittings & All Other Contents (excluding items listed below): £

Own Electronic & Computer Equipment: £

High Risk Stock:

Refrigerated Stock: £

Tobacco, Cigarettes, Cigars and Lighters: £

Wines and spirits: £

Clothing: £

Jewellery, Watches, Precious Metals & Stones: £

Radio, TV, Audio & Video Equipment: £

Video Tapes, DVDs & CDs: £

Computers, Computer Equipment & Games: £

Cameras, Binoculars, & Photographic Equipment: £

Mobile Phones & Equipment: £

Prescription Drugs: £

Goods In Transit: £

Glass (Shop front, blinds & fittings): £

Business Interruption (i.e. estimated Gross Profit for the next 12 months): £

Business Money: £

Is Cover Required For Theft By Employees:

YesNo

Is Cover For Customers Goods Required:

YesNo

Is Legal Expenses Cover Required:

YesNo

More About Insured and Premises.

Have There Been Any Claims Made In The Last 5 Years For This Business Or Owners/Directors:

YesNo

Does The Insured Undertake To Work Away From The Premises:

YesNo

Are The Premises In An Area Which Is Exposed To Damage By Storm, Flood, Subsidence, Heave or Landslip, Or Within 400 Metres Of Any Watercourse, River, Stream, Sea, Canal, Lake, Cliff or Quarry:

YesNo

Is There A Safe In The Premises:

YesNo

Does Any Other Business Occupy Or Operate From These Premises:

YesNo

If The Answer Is Yes To Any Of The Above, Please Provide Full Details In This Box:

Current Insurers and Contact Information.

Renewal Date or Inception Date Of Policy:

Current insurers (If applicable):

Renewal premium or Current Best Quote: £

Full Contact Name:

Telephone number:

Email address:

How Would You Prefer Us To Contact You About Our Best Quotation:

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Office Address:
Chapter House,
Burn View, Bude,
Cornwall.
EX23 8BZ.

Phone:
01288 353999

Main Email:
[email protected]

Hodgson Insurance Services are authorised and regulated by the Financial Conduct Authority. Our Firm Reference Number (FRN) is 306339. You can check this on the FCA register by visiting www.FCA.org.uk.