Insured or Company name:
Company status:
Contact Telephone Number:
Mobile Number:
Fax Number:
Email Address:
House Number / Property Name:
Street:
Town:
County:
Postcode:
Persons Contact Name:
Position / Title:
Nature of Business:
Business Established:
Date of cover
In Order to Calculate the Premium we will require the following Information about your company. If this is a new venture or you have not been trading for a full year, please estimate the figures requested from your company projections or your business plan. If you are unsure please contact one of our specialists today 0800 021 4504:
Buildings Cover Required
Rebuilding Sum insured
Is Subsidence Cover Required
Trade Contents
Stock
Computer / Office Contents
Tenants Inmprovements
Turnover of the Company
In a locked safe when closed for business:
Not in safe when closed for business :
Any Other Loss :
Annual Clerical Wage Roll:
Annual Manual Wages on own premises:
Annual Manual Wages away from own premises:
PUBLIC/PRODUCTS LIABILITY:
Estimate: Annual Turnover For Manual Work -
- away from the Insured Premises:
Limit per own vehicle:
Professional Carriers Limit:
SECURITY: Burglar Alarm:
Is it....:
FIRE: Alarm:
FIRE: Sprinklers:
Method of heating:
Do you have a written Health & Safety Policy in Place:
When was this Last reviewed:
Do You Provide Staff Inductions and Training:
Is this recorded:
Do You carry out Health and Safety Risk Assessments for staff:
Have you made any Claims in the Last 5 Years?