Tel: 01623 641 386    
Commercial Combined Insurance
 
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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 that require flexible cover to suit their needs, e.g. factories, manufacturers, wholesalers, warehouses, distributors, etc.

If you require assistance when completing this form, please phone us on 01623 641 386 and we will be happy to help.

Contact/Company Details

Proposers Name(s)
(incl. all 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
Please provide details:
(i.e. type of convictions, date of conviction,
fine/length of sentence, etc,)
Have you or any partner or director ever
been declared bankrupt or insolvent?		Yes     No
Please provide details:
(i.e. date of bankruptcy/insolvency,
amount, whether discharged, etc,)
Has any insurer ever refused, declined,
cancelled or imposed special terms?		Yes     No
Please provide details:
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
Please provide details of the
other businesses that share your space:
Accreditations / Trade Association Links
Does the business hold any industry accreditations?
(e.g. ISO 9000, Investors in People, etc.)		Yes     No
Please provide details of the accreditations:
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
Please provide details:
Subsidence / Flood Details
Has the property ever suffered previous
damage by ground movement or flooding?		No     Yes
Please provide details of the damage:
(i.e. date, cost of damage, type of damage, etc.)
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
Please provide details of unoccupancy:
(i.e. percentage unoccupied,
how long unoccupied, etc.)
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. fixed gas 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 ground floor and accessible
opening windows fitted with key operated window locks? 		No     Yes
Are your premises protected by an intruder alarm? No     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
Please state the specification of the system:
(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
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?		Yes     No
Please provide details of claims 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:
Business All Risks
Do you require 'All Risks' cover
for property/items in and away from the premises?
(e.g. laptops, digital cameras, etc.)		No     Yes
Total 'All Risks' cover sum insured:
Type of property/items to be insured (please specify):
Area of cover:
Stock
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):
Stock kept outside in the open:
Deterioration of Frozen Food
Do you require cover for deterioration of frozen food?No     Yes
Please state the 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?Yes     No     Insured Elsewhere
Please choose limit of indemnity required:
(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:
Do you carry out any
work away from the premises?		No     Yes
Please describe the work
activities away from the premises:
 
Product Liability
Is product liability cover required?Yes     No     Insured Elsewhere
Please choose limit of indemnity required:
(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?Yes     No     Insured Elsewhere
Employers' Liability limit of indemnity:£10,000,000 limit of indemnity

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?Yes     No
Please state the Gross
Profit/Revenue of your business (£'s):
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?Yes     No
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?		Yes     No
Please state the total number
of own vehicles you wish to insure:
Please state the maximum
sum insured required per vehicle:
 
Other Covers
 
If there is any other information or type of cover that
you wish to provide details, please enter here:
(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.