Title

Proposer (put 'business' in not an individual)

Contact Name

Date Of Birth (dd/mm/yyyy)

Business Name

Email

Contact Phone Number

Other Phone Number

Business Address

Number or Name

Street

Town or City

County

Postcode

Years trading at business address

Please provide the following information, If the particular question doesn't apply to you and your business; simply leave it blank.

Renewal / Start Date Required (dd/mm/yyyy)

Is the company LTD Select Yes No

Company Trade

Your Occupation

Estimated annual turnover (£)

How many business staff

Is there a cash machine on the premises Select Yes No

Business Security*

*Minimum Security: 5 Lever mortice locks and lockable (or non opening) windows

Does the property meet minimum standards Select Yes No

Does the property have an alarm Select No Bells Only Remotely Monitored REDCARE

If there is an alarm, is a maintenance contract in place Select Yes No

Is there any CCTV Select Yes - Proposer CCTV Yes - Local Authority CCTV Yes - Both No

Are there any shutters or grilles Select Yes - Grilles Yes - Bars Yes - Roller Shutters No

Any other security

Property Details

Is the business property brick or stone with a slate or tile roof Select Yes No

Does the property have any flat roof area Select No Up to 10% 10 - 25% 25 - 40% 40 - 50% More than 50%

Any previous claims or uninsured losses Select Yes No

Is the property within 200m of any water or in a flooding area Select Yes No

Is the property listed Select No Grade 1 Grade 2 Grade 3

Is there any residential accommodation Select No Yes - occupied by proposer/staff Yes - occupied by employed tenant Yes - occupied by unemployed tenant

Buildings sum insured (£)

If you need Buildings Cover, Please answer the following three questions:

Any subsidence, heave or landslip history Select Yes No

Is the property near cliffs, quarries, mines or anything of that nature Select Yes No

Are there any trees or large shrubs within 7m of the property Select Yes No

Other Business Details

Fixtures and fittings insured (£)

Electronic Equipment (computers/tills etc) (£)

Business equipment insured (£)

General stock insured (£)

Cigarette and tobacco stock (£)

Alcohol stock (£)

Deterioration of stock (£)

Other contents sum insured (£)

Goods in transit (£)

Glass Cover (£)

Please inform us of anything else we should know.

Please tell us the best quote you have received so far and we will try and beat it

Policy Quote Amount (£)

We will be in contact regarding your insurance quote within 24 hours to confirm details and progress the policy.