|
Proposer's Details and Business
Description |
|
Proposer's full name: |
|
|
Company's trading name: |
|
|
Address of premises to be insured: |
|
|
Risk postcode: |
|
|
Primary trade/occupation: |
|
How many years have you been in
business
(at this address): |
|
How many years have you been in
business
(in this trade): |
|
|
How many full-time employees do you
have?: |
|
|
How many part-time employees do you
have?: |
|
|
What is your estimated annual turnover?: |
|
|
Where are the premises located?: |
|
|
What are the shop opening/closing
hours?: |
|
|
Is there any residential living accommodation
above the property?: |
|
|
Does the business hold a licence to sell
alcoholic drinks?: |
Yes
No
|
|
Are the business premises occupied overnight?: |
Yes
No
|
|
About The
Property |
|
What cover do you require at
the premises: |
|
|
If buildings cover is required, What
sum insured?: |
|
|
Do you require cover for
subsidence, heave & landslip: |
Yes
No
|
|
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?: |
|
|
Is there any flat roof on the property?: |
|
|
Original year property was built?: |
|
|
Is the property a listed building?: |
|
|
Maintained in a good state of
repair?: |
Yes
No |
|
Occupied by you in connection with
your business?: |
Yes
No |
|
Heated by low pressure hot water
apparatus,
fixed gas appliances or fixed electrical appliances?: |
Yes
No |
|
Does the property have an ATM (automated
teller machine)?: |
Yes
No
|
|
Does the premises have a deep fat frying
range?: |
|
|
Is the property alarmed?: |
|
|
Please select all additional security at the
premises? (Press and hold 'Ctrl' key whilst making multiple selections): |
|
|
If the answer is 'No' to any
of
the above, or we require more information, please give details here:
|
|
|
About
The Contents
|
Please Give The Sum Insured
Required For Each Category.
|
|
Category |
Sum insured (£)
|
|
Fixtures, fittings & all
contents excluding items listed below: |
|
|
Own electronic and computer equipment: |
|
|
Stock For Sale (excluding 'High Risk Stock' below): |
|
|
High Risk Stock. |
|
Refrigerated stock: |
|
|
Tobacco, cigarettes, cigars and
lighters: |
|
|
Wines and spirits: |
|
|
Clothing: |
|
|
Jewellery, watches, precious metals and stones: |
|
|
Radio, TV, Audio and video Equipment: |
|
|
Video tapes, DVD's and CD's: |
|
|
Computers, computer equipment and games: |
|
|
Cameras, binoculars and photographic equipment: |
|
|
Mobile phones and equipment: |
|
|
Prescription drugs: |
|
|
Goods in transit: |
|
|
Glass (Shop front, blinds, fittings): |
|
|
Business interruption
(Estimated 'Net Takings' for next 12 months): |
|
|
Business money: |
|
|
Is covered required for theft by employees?: |
Yes
No |
|
Is cover for customers' goods required?: |
Yes
No |
|
Is legal expenses cover
required?: |
Yes
No |
|
More About The Insured And
Premises |
|
Have there been any claims made in the last 5 years for this business or
owners/directors?: |
Yes
No |
|
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, or prosecuted under the Customer Protection Act, Food Safety Act,
Health & Safety or similar legislation?: |
Yes
No |
|
Has any previous insurer
declined a proposal, refused to renew a policy or imposed any special
terms or conditions?: |
Yes
No |
|
Does
the insured undertake to work away from
the premises?: |
Yes
No |
|
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, cliff or quarry?: |
Yes
No |
|
Is there a safe at the
premises?: |
Yes
No |
|
Does
any other business occupy or operate from
these premises?: |
Yes
No |
|
If the answer is 'Yes' to any of
the above, please provide full details in this box: |
|
|
Current Insurers and
Contact Information |
|
Current insurers (If
applicable): |
|
|
Renewal/Start date: |
|
|
Renewal/Target premium: |
|
|
Email address:
|
|
|
Telephone number:
|
|
|
Preferred choice of contact:
|
|
|
Preferred payment method:
|
|