BUSINESS INSURANCE QUOTATION
PROPOSER
Name
T/as
Trade
Sole Trader
Partnership
Limited
Trading Since
Territory
UK Only
UK & ROI
ROI Only
YOUR ADDRESS
Address :
Postcode
CONTACT DETAILS
Tel
Fax
Mob
Email
Web
THE PROPERTY TO INSURE
Address :
Postcode
Property Age (Years)
<1
2
3
4
5
6
7
8
9
10>
Property Type
Select Type
Retail Unit
Office Unit
Commercial Unit
Industrial Unit
Heating Type
Select Type
Oil
Gas
Electric
Solar
Confirm By Ticking Each Box That The Property...
Is owner occupied? :
Is Not sub-letting? :
Is free of asbestos products? :
Is Not flat roofed? :
Is Not A listed building? :
Is in a good state of repair? :
Is Not subject to flooding? :
Is Not under renovation? :
Is built of brick, stone or concrete? :
Is roofed with slate, tile, or concrete? :
If NOT Ticked Give Details In "OTHER INFORMATION"
SUM INSURED
BUILDINGS
(Reinstatement)
CONTENTS
(Reinstatement)
Buildings
Contents
Accidential Damage?:
Accidential Damage?:
Include Business Interruption Cover:
OTHER CONTENTS
(Reinstatement)
Fixtures/Fittings
TV's:
Office Machinery
Film/DVD
Plant/Machinery
Alcohol
Money (In A Safe)
Tobacco
Money (Not In a Safe)
Perishables
Desktop Computers:
Frozen Food:
Laptops
Fireworks
Photo/Audio
Goods Held in Trust
Phones
Goods In Transit
LIABILITY LIMITS
Employers Liability
10 Million Indemnity
Public/Products Liability
1 Million Indemnity
2 Million Indemnity
5 Million Indemnity
10 Million Indemnity
WORKFORCE
Provide projections for the next 12 months
Number
Wages
Clerical/Office Staff
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
>20
Principals
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
>20
Employees (Premises Based)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
>20
Employees (Work Away)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
>20
Workshop Machinists
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
>20
Turnover
INSURANCE HISTORY
Required Date
Current Insurer
Policy Number
Premium
Current Broker
CLAIMS RECORD
Tick if any claim in last 5 years
Give claim details, types, dates :
PROTECTIONS
Intruder Alarm Type :
Select Type
Bell Only
Central Station
Minimum 5 Lever Mortice Locks On All Doors :
Windows Locks Installed :
Shutters Installed :
Smoke/CO2 Alarms Installed :
CCTV (Recordable) Installed :
Security Safe Installed :
Sprinklers Installed :
Maintained Fire Protection Installed :
OTHER INFORMATION
Telephone 02870325999 for assistance