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Commercial Combined Insurance Quotation Form

For UK Customers Only

Please insert your details here and one of our commercial insurance business advisers will contact you shortly.

This form is designed for quotes for businesses whose trade description does not fit the normal shop/office package quotation form, e.g. factories including manufacturing, engineering, wholesalers, warehousing, etc. If you require cover for shop or office insurance, please return to our business insurance page for a link to the shop or office insurance quotation form.

If you have any problems with completing this form, please phone us on 08453 455 855 for assistance.

Contact/Company Details

Proposers Name(s) (incl. partners names if partnership):
Ltd. Company Name (if applicable):
Business Trading Name:
Trading Status:
Business Address:
Business Postcode:
Business Website Address (if available):
Full description of business activities (please describe as fully as possible including details of any processes used):
Daytime Telephone No.
E-Mail Address:

General Information

Have you or any partner or director ever been convicted of or charged with any criminal offence?	Yes No
Have you or any partner or director ever been declared bankrupt or insolvent?	Yes No
Has any insurer ever refused, declined, cancelled or imposed special terms?	Yes No
Trading Experience
How many years has the business been trading?	years
Number of years of experience(if different)	years
Premises Details
Type of premises (e.g. factory, warehouse, etc.):
Type of area that the premises are located: (e.g. commercial, industrial, residential, rural, etc.)
Is your portion of the building(s) self- contained with its own means of access:	Yes No
If No, please provide details:
Do you share your business space with any other businesses?	Yes No
Accreditations / Trade Association Links
Does the business hold any industry accreditations? (e.g. ISO 9000, Investors in People, etc.)	Yes No
If yes, please provide details:
Health & Safety
Is there a written health and safety policy in place?	Yes No
Do you have up-to-date risk assessments at the premises?	Yes No
Have you or any partner or director ever been prosecuted under the Health & Safety Act?	Yes No
If yes, please provide details:
Subsidence / Flood Details
Has the property ever suffered previous damage by ground movement or flooding?	No Yes
Please state the approximate distance to the nearest watercourse, river, sea, canal, lake, stream, etc.:
Construction Details
Type of Property:
Please provide details of the type(s) of business activities carried out by adjoining premises (if applicable):
Construction of Walls (e.g. brick, stone, etc.):
Construction of Roof (e.g. tile, slate, etc.):
Percentage Flat Roofing (if applicable):	%
Type of Flat Roofing (e.g. felt on timber, concrete, etc.):
Construction of Floors (e.g. concrete, wood, etc.):
Please state the number of storeys:
Are there any basement floors or below ground level?	No Yes
What year were the premises built?
Are any parts of the building at present unoccupied?	No Yes
If yes, please provide details:
Electrical Systems
What year were the electrics in the building last inspected by a qualified NICEIC electrician?
Heating Systems
How are the premises heated? (e.g. gas central heating, oil, etc.)
Do you use portable heaters?	No Yes
Security Details
Are all your external doors fitted with a minimum of 5 lever mortise deadlocks that comply with BS3621?	No Yes
Are all opening windows fitted with key operated window locks?	No Yes
Are your premises protected by an intruder alarm?	No Yes
If yes, is the alarm NACOSS/NSI approved?	No Yes Not Sure
Type of alarm signalling:
Please provide details of any other security arrangements: (e.g. roller shutters, window grilles, c.c.t.v., security guarding, premises occupied overnight, etc.)
Fire Safety
Do the premises have fire extinguishers?	No Yes
Do the premises have a fire alarm?	No Yes
If yes, type of fire alarm signalling:
Do the premises have a sprinkler system installed?	No Yes
If yes, please state the specification: (e.g. 28th Edition, 29th Edition, etc.)
Distance to the nearest fire brigade?
Do you have any combustible stock or waste stored in the open?	No Yes
What smoking policy is in force? (select whichever is applicable)	Smoking is banned No policy is in force Smoking is restricted to designated areas
Do you ensure that all waste is swept up and removed from the internal premises daily?	Yes No
Do you run any processes unattended?	Yes No
Do you have any hazardous plant? (e.g. paint spraying facilities, coating machines using flammable liquids, oil quench tanks, carding machines, hydraulic oil cellars, spark erosion machines, stentors, frying lines, etc.)	Yes No
If yes, is the plant protected by a fire extinguishing system?	Yes No
Claims History
Have you or any other director or partner (in this or any other trading name) suffered any loss or had any claims made against you in the last 5 years?
If yes, please provide details i.e. date of claim, description of claim, amount claimed, etc.:

Property Cover

Level of Cover Required?
Do you wish to add cover for Terrorism?	No Yes
Buildings / Tenants Improvements
Buildings Sum Insured including outbuildings, rebuilding architects' fees, removal of debris, etc:
Is subsidence cover required?	No Yes
Tenants Improvements Sum Insured: (i.e. improvements you have made to the property, if you are a tenant)
Contents
Plant/Machinery/Contents Sum Insured: (excluding computers/electronic equipment)
Computers/Electronic Equipment Sum Insured:
All Risks
Property temporarily away from premises: (e.g. laptops, digital cameras, etc.)
Stock
Wines & Spirits Sum Insured:
Cigarettes & Tobacco Sum Insured:
General Stock Sum Insured: (excluding wines, spirits, tobacco, non-ferrous metals, jewellery, watches, furs, precious metals & explosives)
Other/High Risk Stock Sum Insured:
Type of Other/High Risk Stock (if applicable):
Deterioration of Frozen Food
Do you require cover for deterioration of frozen food?	No Yes
If yes, state freezer contents sum insured:
Glass Cover (if required)
External Fixed Glass:
External Signs and Blinds:
Money Cover (if required)
Money cover during business hours/in transit:
Money cover out of business hours in a locked safe:

Liability Cover

Public Liability
Is public liability cover required?
If yes, please choose limit of indemnity: (if greater than �1M limit of indemnity)
Is all machinery properly fenced, guarded, maintained & in good order?	No Yes
Do you handle or use any hazardous substances? (e.g. radioactive/explosive substances, toxic chemicals/acids, asbestos, silica, etc.):	No Yes
Does any of your work produce noise levels over 85dB(A)?	No Yes
Do any of your activities at the premises involve the use of heat?	No Yes
If yes, state the type of heat used (e.g. welding, etc.) and the percentage of time using heat:	Type Used: Percent Use: %
Do you carry out any work away from the premises?	No Yes
If yes, please describe the activities away from the premises:
Product Liability
Is product liability cover required?
If yes, please choose limit of indemnity: (if greater than �1M limit of indemnity)
Please describe the goods being sold/supplied/manufactured:
Do you have offices, assets, representations or agents outside the UK?	No Yes
Will any of your products be supplied directly or indirectly to the USA/Canada?	No Yes
Do you import any products, materials or components?	No Yes
If yes, state percentage of turnover from:	EC Countries:% Elsewhere:%
Turnover
Turnover of your business in the U.K.:
Turnover of your business in Europe:	Only complete if applicable
Turnover of your business in USA/Canada:	Only complete if applicable
Turnover of your business in Rest of the World:	Only complete if applicable

Employers' Liability
Is Employers' Liability cover required?
Employers' Liability limit of indemnity:	�10,000,000

Wages/No. of staff - At the premises
	Manual Workers	Non-Manual/ Clerical Workers
Number of Principals/Company Directors:
Annual Wages of Principals/Co. Directors (£'s):
Number of Employees: (Do not include proprietors, partners and directors)
Annual Wages of Employees (£'s):
Number of fixed woodworking machine operators:
Annual wages for the fixed woodworking machine operators (£'s):

Wages - Away from the premises
Annual Wages of Principals/Co. Directors (£'s):
Annual Wages of Employees (£'s):
Annual wages of commercial travellers/salesmen (£'s):
Annual payments to bona-fide sub-contractors (£'s):
Work away using heat (£'s):

Business Interruption

Do you require Business Interruption Cover?
If yes, please state the Gross Profit/Revenue of your business (�'s):
If yes, please state the period of time you wish the cover to extend?	12 months 18 months 24 months 36 months (allow sufficient time for rebuilding/refurbishing and further time to resume normal trading)
Do you require cover for loss of Book Debts?
If yes, please indicate the maximum amount of Gross Fees and Debit Balances outstanding at any one time (�'s):

Goods In Transit Cover

Do you require goods in transit cover for your own vehicles?
If yes, please state the total number of vehicles you wish to insure:
Please state the maximum sum insured required per vehicle:

Other Covers

If there is any other type of cover that you wish to include, please provide details: (e.g. engineering inspection, commercial legal cover, etc.)

Details of Current/Previous Policies

Renewal date/cover start date:	(dd/mm/yyyy)
Current/previous insurer:
Current renewal premium/best quote (£'s):	per annum This will help us to get you a better quote

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct and that you have answered all the questions accurately then press the Request Insurance Quotation button to send your quotation details to us.