General Information
Do you sell or supply goods?
Please Select
No
Yes
If yes, please describe the goods sold / supplied:
Please state the number of years trading under current management:
0
1
2
3
4
5
6
7
8
9
10
11+
If a new venture, please state the number of years previous experience (if applicable) :
0
1
2
3
4
5
6
7
8
9
10
11+
Which floor level does your business occupy?(i.e. ground, first floor, second floor, etc.)
Are you the sole occupant(s) of the building in which your premises are situated?
Please Select
No
Yes
If No, please provide details of the other types of businesses that operate from the building:
Is your office entirely self-contained with its own seperate lockable entrance?
Please Select
No
Yes
If No, please provide details:
Is the building of standard construction?(i.e. brick/stone/concrete walls & tile/slate roof)
Please Select
No
Yes
If No, please provide details:
Approximately, what year was the property built?
Has the property ever suffered from subsidence or flood damage?
Please Select
No
Yes
If yes, please provide details:(e.g. date of damage, amount of damage, etc.)
Are any parts of the building at present unoccupied?
Please Select
No
Yes
If yes, please provide details:
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?
Please Select
No
Yes
If yes, please provide claim details:(i.e. date of claim, circumstances of claim, amount claimed, etc.)
Security
Are all your external doors fitted with a minimum of 5 lever mortise deadlocks which comply with BS3621(look for the British Standard Kitemark) ? No   Yes
Are all opening windows, fanlights and skylights fitted with key operated window locks? No Yes
Are all accessible windows protected by either solid steel bars or grilles? No Yes
Are your premises protected by an annually maintained intruder alarm?
Please Select
No
Yes
If yes, is the alarm N.A.C.O.S.S. approved?
Please Select
No
Yes
Type of intruder alarm fitted:
- - - - - - Please Select - - - - - -
Audible - Bells or Siren
Dialler - To Principals House
Monitored - To Central Station
Redcare - Linked to Police
Are your premises situated within a street level CCTV area? No Yes
Please provide details of any other security arrangements (if applicable):
Cover
Standard cover is for Fire, Theft And Special Perils.
Do you wish to extend your cover to include accidental damage for an additional premium?
Please Select
No
Yes
Buildings/Tenants Improvements (if required)
Buildings Sum Insured including outbuildings, rebuilding architects' fees, removal of debris, etc.: £
Tenants Improvements Sum Insured: £
Contents
Computers Sum Insured: £
Other Electronic Equipment Sum Insured:(i.e. fax, photocopiers, telephone equipment, etc.) £
All Other Contents Sum Insured:(i.e. office furniture, filing cabinets, etc.) £
Stock Sum Insured (if applicable) : £
Property Away From The Office
All Risks Sum Insured (i.e. property away from the office) : £
Type of property to be covered away from the office:(e.g. laptops, digital camera's, etc.)
Money
Money during business hours (£2,000 std. cover) : £
Business Interruption
Is Business Interruption cover required?
Please Select
No
Yes
If yes, state the sum insured required for the increased cost of working at an alternative office: £
Do you require cover for loss of Book Debts?
Please Select
No
Yes
If yes, please indicate the maximum amount of Gross Fees and Debit Balances outstanding at any one time: £
Public/Employers Liability Cover
Public / Product Liability Limit Of Indemnity:(£1 Million automatically included)
£1,000,000
£2,000,000
£5,000,000
Employers Liability Limit of Indemnity:(£10 Million automatically included) £10,000,000
Please state the total number of office employee's:
Please state the total annual wages of the employee's: £