fields marked with * are required
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Proposer Details |
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Company / Business Name:* |
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Mobile |
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Fax * |
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| Email * |
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Contact Address & Post Code * |
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Type of Business |
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Date of Cover required |
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Current Insurer |
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Nos Years Trading |
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Nos Years Experience in type of business |
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Premises |
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Building Sum Insured £ |
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Rent Cover Required
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Property Age |
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Construction Type
(Brick, Wood, Stone, Etc) |
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Grade if Listed |
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Any Flat Roof Area |
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Yes
No
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Security |
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Specify Lock Types |
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Alarm Type
( Bell, Central Station, Redcare, CCTV) |
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Approved by NACOSS or SSAIB |
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Yes
No
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Yearly Maintenance |
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Yes
No
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Shutters, Grilles, Bars Other |
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Yes
No
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Is the Premises Occupied Overnight |
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Yes
No
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The Business |
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Gross Profit £ |
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No of Employees |
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Landlords – Fixtures & Fittings £ |
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Tenant Improvements £ |
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General Stock/ Contents £
(excl items below) |
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Electronic Business Equipment £ |
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Plant & Machinery £ |
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Goods in Transit £ |
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Frozen Foods £ |
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Wines & Spirits £ |
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Tobacco £ |
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Any Other High Risk Items £
(Videos. CDs, Mobile Phones etc) |
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Money Cover – On Premises £
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Loss of Licence £ |
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Additional Covers |
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Terrorism |
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Yes
No
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Legal Expenses |
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Yes
No
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Please provide details of any claims and convictions |
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