Application form for Business Insurance

All cover is arranged through leading insurance companies and at Lloyd's of London

The next step:

Brochure Request Clubs Farms Factories Garden Centres Group Life Hotels Inns Motels Nursing Homes Nurseries Offices Pensions Pubs Retailers Restaurants Shops Surgeries Takeaways Business Name

email: Fax/Tel:

Address

Post Code Do you live on Premises Yes No

Number of years trading:

Cover from: Business Description

Buildings Sum Insured:  £ Contents:  £

 Stock: £ Plant & Machinery  £

Electronic Business Equipment: £  Fixture & Fittings £

Frozen Foods £ Personal Contents £

Computers: £ Other property: £

Goods in Transit Cover £ All Risks Cover Specified Items £

Special Glass or Sign Writing £ Business Interuption Cover  £

Number of staff: Wage Roll: £ Turnover £

Any Work away from premises

Include Public, Employers & Products Liability if applicable Yes No

Alarm System Yes No Nacoss Approved Yes No

All external entry/exit doors must be fitted with at least one 5 lever mortice deadlocks & all accessible windows must be fitted with key operated window locks.

Claims during last five years:

Have your ever had insurance cancelled or refused Yes No

Please supply any other information that may be helpful in providing a quick and competitive quotation

Thank You