Client Details
Insured Name:  
Broker Name:
Date quote required by:
Risk Address:  
Risk Postcode:
Telephone:  
Business description:
Including activities
Date business established:
Date cover required from:
Holding insurer:
Target premium:
Renewal date:
Do you want to pay your premium by instalments?
*Instalments allow you to pay your premium by a deposit followed by 10 monthly instalments.
Policy Level Risk Profile
1. has the business been established more than 2 years?
2. Do you export to North America?
3. What is the claims experience in the last 5 years?
No claims in last 5 years*
Up to 4 claims in the last 5 years*
More than 4 claims in the last 5 years*
4. Have you carried out a Health and Safety Risk assessment and are they recorded?
5. Do you have a written employee induction training programme and maintain training records?
6. Is the business ISO 0 IIP accredited?
Location Level Risk Profile
1. What is the construction of the Premises?
Tradition walls to be brick, stone, concrete and external roof covering to be non combustible
Fire Resisting e.g. entirely built with non combustible materials
Non-standard buildings within traditional or fire resisting category but with up to 35% non standard construction e.g. flat roof
Other than the above including all buildings where any composite panels are present

2. Are the buildings less than 5 years old?

3. Is the risk address to be insured Occupied solely by you, or occupied by you with remaining parts occupied by others solely as offices or private dwellings?
4. Is the risk address to be insured heated by any form of portable heating?
5. Is the risk address to be insured adjacent to or in close proximity to a river or watercourse?
6. Does the risk address to be insured have a current IEE certificate?
7. Does the risk address to be insured:
Meet minimum standards of security protection (as detailed in the prospectus)?
Have a NACOSS or SSAIB alarm with remote signalling and police response?
Have 24-hour security or 24 hour occupancy by the Insured?
8. Are all buildings and machinery in a good state of repair and subject to a planned and recorded maintenance programme?
9. Do you remove all waste from the premises at least weekly, and keep your premises clean and tidy?
10. What smoking policy is in force at the risk address?
Smoking is banned
Smoking is controlled and restricted to rest room and canteen areas only
No policy is in force
5 Years Claims Experience
Date: Details: Paid: Outstanding:
£ £
£ £
£ £
Risk Details and Cover
Section 1. Property
1. Buildings including tenants improvements £
2. Contents £
3. Stock £
4. Stock in the open £
5. Computers and Electrical office equipment £

6. Hazardous Stock*

£
7. 12 / 24 / 36 Months Rent £
8. All other property (please specify) £
9. Portable hand tools £
Is Subsidence cover required?
*Hazardous stock = Cigarettes, tobacco, wines, spirits, precious metals and stones, non-ferrous metals and portable hand tools.
Section 2. Business Interruption
Gross Profit Revenue £
Sum Insured
Indemnity period 12 / 24 / 36 months months months

Section 3. Book Debts
Outstanding debit balances £
Sum Insured

Section 4. Money
Limit on premises at the risk address during business hours/bank night safe/in transit (maximum £10,000)
Safe details: Premises: Limit:
Section 5: Goods in Transit
No of vehicles operated by you
Sum insured per vehicle £
Section 6: Specified All Risks
Description of item(s): Sum Insured: Location:
£
£
£
£
Section 7: Employers

Wageroll and salaries for:
1 Clerical staff, commercial travellers and managerial employees
who do not engage in manual labour
£
2 Employees engaged in manual work away £
3 All other manual emplyees £
Section 8: Public and Products Liability
1 Select your limit of Indemnity (£2,000,000 is policy minimum) £
2 Turnover (maximum £2,000,000) £
3 No. of premises for clubs onlu, No. of members
Work away - is cover required?
Does work away include use of heat? (note: £2,000,000 Limit of Indemnity applies)
Wages for work away excluding the use of heat £
Wages for work away including the use of heat £
Section 9: Commercial Legal Expenses
Basic cover - Prosecution defence £50,000 only
Full cover - all items