Name of Proposer:  
Trading Name:  
Company reg no (if applicable):
Risk Address:  
Postcode:
Renewal date & Current Insurer:
Renewal Premium :
Building Sum Insured inc tenants improvements :
Or Tenants' Improvements Sum Insured :
Trade Fixtures and Fittings and all other contents sum insured :
Stock in Trade sum insured :
Property in Transit Sum Insured if greater than 2,500 :
Business Interruption Sum Insured if greater than 600,000 :
Personal Accident/Assault (sum insured per employee) :
Money in safe sum insured if greater than 1500 :
Money in transit sum insured if greater than 2500 :
Loss of Licence sum insured :
Location of Restaurant e.g. High Street:
Construction of property e.g. brick and tile:
Type of door locks e.g. five lever mortice deadlock:
Type of window locks:
Details of alarm, installers, signaling and level of police response:
Details of any other security e.g. CCTV, Security guard etc.:
Details of claims in the last five years:
Are the Premises in a good state of repair?
Is the property occupied over night?
Is the Restaurant:

 

Does the Restaurant serve Hot or Cold Food?
Is the Restaurant Licensed or Unlicensed?
Are the premises located near a seafront, promenade, cliff or other exposed area, near a lake, reservoir, dam, watercourse, or canal?
(if yes please detail in the additional information box)
Is the premises more than 10 miles by road, from a full time fire brigade?
Additional Information:
Do you provide letting rooms?
If yes how many?
Are any cellars or floors below street level used?
Is deep frying equipment used at the premises?
Optional Cover - Employee Dishonesty?
How is the building heated?
Are the Canopies, Ducting and cooking ranges protected by a fixed fire detection and extinguishing system?
Do you hold a Rentokil annual cleaning contract?
Contact name:
Telephone Number:
Fax Number:
Email Address:
STATEMENT OF FACT QUESTIONNAIRE Please answer yes or no to each question
Is the restaurant self contained with all exit/entry doors to the restaurant under control of the proposer?
Have the insured, directors, partners or family members involved with the business or any other business?
Ever had an insurance proposal declined, renewal refused, insurance cancelled or special terms applied?
Ever been convicted of or charged (but not yet tried) or been given an official policy caution in respect of any criminal offence other than a motoring offence?
Ever been declared bankrupt or insolvent or been disqualified from being a company director?
Has the building ever suffered from or shown signs of damage by subsidence, ground heave or landslip and not situated over made up ground or underground workings of any sort, or sited near a cliff?
Does the insured have no reason to doubt the honesty of any employee?
Does the insured have the accounts balanced and checked by a professional auditor At least annually?
Are all cheques issued with two signatures for values over 5,000 unless the sole Signatory controls more than a 5% interest or share in the company?