Business insurance quotation form

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Personal Info

Title

Name *

First

Last

Date of Birth//

Employment Status

What is your occupation?

What type of business?

Contact Details

Mobile / Telephone Number

Email *

Business / Trade Address

House Number

House 1st line of Address:

Postcode

Year established at this address since//

Correspondence Address (If Different)

House Number

House 1st line of Address

Postcode

Company Details

Current/Previous Insurer

Company status

Business, Company or Partnership Name

Business Description?

Please specify the business type

What date was your business established?//

Total number of employees including partners, principals and directors

What is your Estimated Annual Turnover?

What is your Estimated Annual Wages?

If your business is a restaurant or takeaway, what is your food hygiene rating?

Premises

Where is your premises located?

What are the opening hours for your business?

Any CCTV camera inside this premises

Is this premises entitled as a listed building?

The roof of this premises, is it flat or slope?

The floor, is it made of concrete or wood?

The walls, are they made of bricks or wood?

Does anyone live upstairs and if yes who are they?

The back door, is it secured enough, any shutters or grilled

When is the premises occupied?

Does the property have a roller shutter which covers all ground floor exposed glazing?

Does the property have grilles fitted which cover all ground floor exposed glazing?

Do you have any sort of alarm in the premises?

If yes, Type or name/brand of the alarm?(Please specify in the box)

Does the alarm notify you along with police or only you?

Is the alarm being checked regularly by any organization?

Do you have use of kitchen in the premises for commercial use?

If you are running a: Café, Take Away and Restaurant:

Yes
No

Your Details

Percentage of collection: (Please specify in the box)

How many persons could be dined at a time?

Is your fryer a standing fryer or just a small basket fryer?

How often the kitchen extractor fan is cleaned?

Maximum how many liters of oil the fryer can occupy?

Cover Details

Is the Premises’ Owned / Leased / Rented by you?

What’s the maximum cash amount to be covered during the business hours?

Do you require buildings cover?

Yes
No

Do you want any cash sum to be covered outside the premises?

Yes
No

Stocks to be insured

Wines, Fortified Wines and Spirits sum insured amount

Cigarettes, Cigars and tabacco sum insured amount

Other Stock (other than target stock shown above) to be insured

Frozen items to be insured

Contents (If any Till, Computers & other electrical Equipment’s) sum insured amount

Contents (Fixtures & Furniture’s) sum insured amount

Claim Summary

Have you had any losses or incidents that have or could have given rise to claims (whether insured or not) in the past 5 years in connection with your current, or previous, business?

Yes
No

Employer Reference Number Details

Are you exempt from paying PAYE?

Yes
No

Please provide your Employer Reference Number

Policy Start Date

When would you like your policy to start//

Name of your last insurer

Renewal quote from your insurer

Additional comments:

Agreement *

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