Client Details
Name of Policyholder
Inception date:
Building No.:
Risk postcode:
Trade*:
Trading experience:
years
* Cooking - Is there a frying range?
Yes
No
% Turnover from Hot Food Takeaway:
* Hairdressing - Are all Dyes, Bleaches and tints used of Propriety Brands?
Yes
No
Claims
Has the risk been subject to any claims or incidents in the last 3 years?
Yes
No
If Yes please list information below
Year
:
Details of loss:
Amount paid:
Amount Outstanding:
Risk Location
Building Type:
Year Built:
Construction
Walls:
Brick
Stone
Concrete
Other
(If other please list)
Roof:
Tile
Slate
Metal
Other
(If other please list with % flat if applicable)
Floors:
Concrete
Timber
No. of Storeys
Within Shopping Mall with 24hr Security?
Yes
No
Premises Occupied Overnight by Insured or Staff?
Yes
No
Core Covers All Risk
Tobacco, Cigarettes & Cigars:
Wines & Spirits:
Stock & Goods Held in Trust:
Contents including Fixtures & Fittings:
Money in Safe During Buiness Hours/Transit:
Deterioration of Stock:
In Safe Outside Business Hours:
Public Liability LOI:
Employers Liability LOI:
Goods in Transit:
Optional Cover
Buildings:
Is Subsistance Cover Required?
Yes
No
Loss of Licence:
Is there any work undertaken away from the premises?
Yes
No
If Yes provide number of people:
Business Interuption
Loss of Gross Profit:
24 Month Indemnity Period
Target Premium:
£