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Date cover required from
Current insurance held with
Current insurance premium
How did you hear about us?
—Please choose an option—AI OverviewChatGPTClaudeGeminiCoPilotMetaGoogle Web SearchGoogle Sponsored ResultGoogle AdYahoo Web SearchBing Web SearchOther Web SearchFacebookTwitterLinked InRecommendationExisting clientWord of mouthAdvertisementOther
Contact name*
Company name
Telephone number*
Email address*
Business address
Town
Postcode*
Location of premises*
—Please choose an option—Business park unitIndustrial unitUnit within indoor shopping centreSelf contained premises within multi tenure millResidential streetsideHigh streetIndoor leisure complex
Business description
Trading status*
—Please choose an option—Limited CompanyPartnershipSole Trader trading asOther
If 'Other', please detail
Website
Number of years trading in total
Have you had any claims in the last 5 years?*
—Please choose an option—YesNo
If 'Yes', please detail dates, incidents & amounts
Please provide a detailed list of all the facilities and activities provided
Is frying equipment used?*
SUMS INSURED – IF A NEW VENTURE, PLEASE PROVIDE YOUR BEST ESTIMATES
Buildings
Do you require subsidence cover?*
Tenants improvements
Computers, cash registers & other electronic business equipment
All activity and play equipment
All other contents, fixtures & fittings
All other stock
Wines & spirits
Beers
Frozen or refrigerated stock
Glass
Signs & canopies
Money (during business hours)
Money (after business hours in a locked safe)
Type of safe on the premises*
—Please choose an option—No safe on premisesSafe installed and operated correctly
Goods in transit
Maximum business interruption cover required
Maximum business interruption indemnity period required*
—Please choose an option—12 months18 months24 months36 months
Loss of rental income
Outstanding debit balances (book debts)
Loss of licence
Public liability indemnity limit*
—Please choose an option—£1,000,000£2,000,000£5,000,000£10,000,000
Your annual turnover
Number of employees
Your annual staff wageroll
Your Employers Reference Number (ERN)
Do the premises have an intruder alarm?
—Please choose an option—NoYes - bells/audible onlyYes - digital communicatorYes - central station
Does your alarm have police response?
—Please choose an option—NoYes - Level 1Yes - Level 2Yes - Level 3
Do the premises have CCTV?
Do the premises have a fire alarm?
What year were the premises built?
—Please choose an option—Pre 18511851 - 19201921 - 19391940 - 19791980 - 19891990 - 19992000 & later
Notes, if any
DECLARATION
You or any director or partner in any business, any partner in any partnership, any director of any company, or the company; either in any personal capacity, in the name of the business proposed or in respect of any other business in which any of you have ever had an interest have:
- Never had a proposal for insurance declined, cancelled or refused? - Never had insurance cancelled mid-term, a renewal refused, increased or special terms or conditions imposed by an insurer? - Never been given an official police caution, convicted of, charged (but not yet tried) or have any prosecution pending for any offence (excluding any motoring convictions and any offences which are spent under the Rehabilitation of Offenders Act 1974)? - Never been the subject of or issued with a County Court Judgement (CCJ), money judgement or court decree and/or ever been cited in any unsatisfied court judgements (or the Scottish equivalent) or any other judgements or decrees in relation to debt? - Never been declared bankrupt or insolvent, the subject of an individual voluntary arrangement (IVA) or company voluntary arrangement (CVA) with creditors, voluntary liquidation, a winding up or administration order, or administrative receivership proceedings, bankruptcy or insolvency proceedings? - Never been disqualified from being a company director? - Never been censured by any regulatory or trade body or any action been taken against the company by the office of fair trading, consumer groups or the alike? - Never been served under any Health & Safety, Welfare, Environmental, Consumer Protection or Food Safety legislation or any other legislation, with any warnings, enforcement measures, prohibition notice, improvement orders, proceedings or criminal proceedings by any Health and Safety Executive, Environmental Health Office, Environment Agency, local or government authority or any other enforcement agency or authority? - Never been convicted of, charged (but not yet tried) with, officially cautioned or have any prosecution pending for a breach of any Health & Safety, Welfare, Environmental, Consumer Protection, Food Safety legislation or any other legislation? - Never been the subject of a recovery action by Customs and Excise or the Inland Revenue?
Please confirm if you agree with the Declaration*
—Please choose an option—NO - I Do Not AgreeYES - I Agree
If you DO NOT agree, please advise why here
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