General Information Please state the number of years
0
1
2
3
4
5
6
7
8
9
10
11+
If a new venture, please state the number(if applicable) :
0
1
2
3
4
5
6
7
8
9
10
11+
Construction of Walls (e.g. brick, stone, etc.) : Construction of Roof (e.g. tile, slate, felt, etc.) : Percentage Flat Roofing (if applicable) : If any flat roofing, please state the type(e.g. 'felt/bitumen on wood' or 'concrete flat roof') : Construction of Floors (e.g. concrete, wood, etc.) : Approximately, what year was the property built? Is the property a listed building (i.e. grade I, II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II* Please state the distance to the nearest water(e.g. river, canal, lake, coast, etc.) : Has the property ever suffered
Please Select
No
Yes If yes, please provide details:(i.e. date of damage, amount of Entertainment Do you have a late licence/extended opening hours?
Please Select
No
Yes If yes, please provide details: Do you employ doormen?
Please Select
No
Yes Is there any live entertainment at the premises?
Please Select
No
Yes If yes, state the type of entertainment (e.g. disco, bands, etc.) , how many times Is there a dance floor?
Please Select
No
Yes
If yes, please state the maximum Are there any childrens play area's?
Please Select
No
Yes If yes, please state the type of play(e.g. bark chippings, cork, grass, etc.) : Security Is the pub occupied by the landlord/manager overnight?
Please Select
No
Yes Are all your external doors fitted with a minimum(look for the British Standard Kitemark) ?
Please Select
No
Yes Are all opening windows fitted
Please Select
No
Yes Is the pub protected by an intruder alarm?
Please Select
No
Yes If yes, is the alarm N.A.C.O.S.S. approved?
Please Select
No
Yes
Not Sure Type of intruder alarm fitted:
- - - - - - Please Select - - - - - -
Audible - Bells or Siren
Monitored - Central Station
Dialler - To Principals House
REDCARE - To Police
Are your premises situated within a street
Please Select
No
Yes Please provide details of(e.g. shutters, window grilles, etc.) Claims History/Experience Have you or any other director or partner (in this
Please Select
No
Yes If yes, please provide details:(i.e. date of claim, description Cooking/Accomodation Is any cooking carried out at the premises?
Please Select
No
Yes If yes, please confirm whether or not you provide
- - - - - - Please Select - - - - - -
Bar Meals Only
Restaurant Area Only
Bar Meals + Restaurant Area
Not Applicable Do you carry out Deep Fat Frying?
Please Select
No
Yes If yes, please state type of frying equipment:
- - Please Select - -
Full Frying Range
Freestanding Fryer
Table Top Fryer Do you provide accomodation?
Please Select
No
Yes If yes, please indicate the total number of guest rooms: Please state the maximum number of guests(if applicable) : Type of guests staying (if applicable)
- - Please Select - -
Overnight Only
D.S.S.
Bed and Breakfast
Other Total guests effects sum insured (if required)
Contents / Cover Level of Cover Required?
- - - - Please Choose - - - -
Fire & Theft Cover
Fire, Theft & Accidental Fixed External Glass Sum Insured: Money Sum Insured (£2,000 std. cover) : Goods In Transit Sum Insured (if required) : Electronic Equipment Sum Insured (e.g. tills, etc.) : All Other Pub Fixtures & Fittings/Contents Sum Insured: Personal/Houseshold Contents Sum Insured(if required and you live at the property) : Stock Wines and Spirits (excluding beer) : Tobacco, Cigarettes & Cigars: Frozen Food Sum Insured (if required) : Age of Refrigeration Units (if applicable) : All Other Stock Sum Insured: Buildings (if applicable) Buildings Sum Insured including outbuildings, Do you require subsidence cover for your buildings? Business Interruption Do you require business interruption cover?(i.e. loss of revenue following an insured event)
Please Select
No
Yes If yes, please state the Gross Profit of your business (£'s): Please state the period of(allow sufficient time for rebuilding/refurbishing Do you require cover for loss of liquor licence(i.e. depreciation of the value of the premises) ?
Please Select
No
Yes If yes, please state the sum insured required (£'s): If loss of licence cover is required, Do you require cover for loss of Book Debts?
Please Select
No
Yes If yes, please indicate the maximum amount Public/Employers Liability Cover Public / Product Liability limit of indemnity:
£1,000,000
£2,000,000
£5,000,000 Please state the Turnover of your business (£'s): Do you require Employers Liability cover?(£10 Million limit of indemnity)
Please Select
No
Yes
If yes, please state the total number of employee's: If yes, please state the total wages of the employee's (£'s): Per Annum
