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Business Insurance Quotation Form

Online

Phone

How did you hear about us?

If by a friend, family or referrer please state their name and number.

Name:

Number:

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“Registered with the ICO, all your personal information is protected under the Data Protection Act 1998”

Personal Info

Title *

First Name *

Middle Name (If any)

Surname *

DOB *

Employment Status *

If Employed/Self Employed, What is your occupation: *

If Employed/Self Employed, What is your business: *

Your Details

Contact Details:

Mobile / Telephone Number: *

Email Address

Business/Trade Address:

House Number: *

House 1st line of Address: *

postcode: *

Company Details

Current/Previous Insurer

Company Status

Business, Company or Partnership Name

Business Description?

If other please specify the business type:

What date was your business established? (DD/MM/YYYY) *

Total number of employees including partners, principals and directors

What is your Estimated Annual Turnover?

What is your Estimated Annual Wages?

Premises

Where is your premises located?

What are the opening hours for your business? (Please specify in the box)

Any CCTV camera inside this premises

Yes

Is this premises entitled as a listed building

Yes

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?

Yes

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

Yes

Do you have any sort of alarm in the premises?

Yes

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? (Please specify in the box)

Is the alarm being checked regularly by any organization?

Yes

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

Yes

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

Yes

Cover Details

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

Do you require buildings cover?

Yes

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

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

Yes

Stocks to be insured:

Cigarettes, Cigars and tabacco sum insured amount

Wines, Fortified Wines and Spirits sum insured amount

Frozen items to be insured

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

Contents (Fixtures & Furniture’s) sum insured amount

Contents (If any Till, Computers & other electrical Equipment’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

Employer Reference Number Details

Are you exempt from paying PAYE?

Yes

Please provide your Employer Reference Number

Policy Start Date

When would you like your policy to start

If other please specify the business type:

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act 1998, this data will be used to provide the cheapest possible quote while being shared with both offline and online markets.