| Title |
Please select an item. |
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Name |
A value is required. |
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Surname |
A value is required. |
| Date of Birth |
A value is required. |
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Email Address |
A value is required.Invalid format. |
| First Line of Address |
A value is required. |
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Postcode |
A value is required. |
| Best Contact Number |
A value is required. |
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Alternative Contact Number |
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| Business Name (if applicable) |
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Is your business Limited? |
Please make a selection. |
| Risk Address |
A value is required. |
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Risk Postcode |
A value is required. |
| Year Built (approx.) |
A value is required. |
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Type of building (e.g. industrial unit) |
A value is required. |
| Is the property standard build? |
Please make a selection. |
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Standard Build: brick/stone/concrete walls, with slate or tile roof |
| Does the property have any flat roof area? |
Please select a valid item. |
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What material is any flat roof made from? (e.g. felt on timber) |
A value is required. |
| Any flooding history? |
Please make a selection. |
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Is the property within 200m (220 ft) of any watercourse? |
Please make a selection. |
| Any portable heating on the premises? |
Please make a selection. |
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Are the premises within a shopping arcade? |
Please make a selection. |
| Does the property meet minimum security standards? |
Please make a selection. |
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Minimum Security: locking/non-opening ground floor/accessible windows & at least 5 lever mortice locks on exit doors |
| Does the premises have a maintained alarm? |
Please select a valid item. |
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Any other security (e.g. CCTV, bars/grilles etc.)? |
A value is required. |
| Does the premises have any fire security? |
Please select a valid item. |
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It is assumed the property has a current electrical safety certificate |
| Is there a cash machine on the premises? |
Please make a selection. |
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| Business Trade |
A value is required. |
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What activities does your business do? |
A value is required. |
| How many years trading at this address? |
A value is required. |
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Estimated Annual Turnover £ |
A value is required. |
| No. of staff doing ANY manual work (inc. directors)? |
A value is required. |
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What is your manual wagebill £ |
A value is required. |
| What percentage of this, is for work away from the premises? |
A value is required. |
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Are any fixed woodworking machines used? |
Please make a selection. |
| What percentage of work is heat work? |
A value is required. |
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Is any work done at heights? |
Please select a valid item. |
| Is there any groundwork? |
Please select a valid item. |
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Are any hazardous substances used? |
Please make a selection. |
| No. of other staff (inc. directors)? |
A value is required. |
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What is your clerical wagebill £ |
A value is required. |
| Buildings £ |
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Electronic Stock £ |
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| Alcoholic Stock £ |
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Frozen Food Stock £ |
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| General Stock £ |
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Fixtures & Fittings £ |
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| Tenants Improvements £ |
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Trade Equipment £ |
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| Electronic Equipment £ |
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Other Contents £ |
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| Loss of Alcoholic Licence Cover |
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Legal Expenses |
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| Goods in Transit (per veh.) £ |
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No. of vehicles |
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| Public Liability |
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Employers' Liability |
- £10m as standard |
| Business Interruption (Amount) £ |
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Business Interruption Basis |
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| What is your best quote so far? £ |
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Start date required? |
A value is required. |
Any previous losses or claims? (please give details) |
A value is required. |
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Any special requirements? |
A value is required. |
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Anti-spam question - What has 4 legs and goes "meow" (3 letters) -
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