Proposers Details Proposers Name Trading Name: Trading Status:
- Please Select -
Sole Proprietor
Partnership
Ltd. Company
Pub Address: Pub Postcode: Postal Address: Daytime Telephone No. E-Mail Address: General Information Please state the number of years
0
1
2
3
4
5
6
7
8
9
10
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12
13
14
15
16
17
18
19
20
20+
yearsIf a new venture, please state the number(if applicable) :
0
1
2
3
4
5
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20+
yearsConstruction Details 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*
Grade A
Grade B
Grade C
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 extended opening hours?
Please Select
No
Yes If yes, please provide details:(e.g. days and times you stay open until) 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 NACOSS / NSI approved?
Please Select
No
Yes
Not Sure Type of intruder alarm fitted:
- - - - - - Please Select - - - - - -
Audible - Bells or Siren
Monitored - Central Station
Dialler - To Proprietors 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 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 Cover Level of Cover Required?
- - - - Please Choose - - - -
Fire & Theft Cover
Fire, Theft & Accidental Contents/Fixtures & Fittings 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: All Other Stock Sum Insured: Deterioration of Frozen Food Frozen Food Sum Insured (if required) : Age of Refrigeration Units (if applicable) : Glass Fixed External Glass Sum Insured: Money Money Sum Insured (during business hours) :
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
£8,000
£9,000
£10,000
Good In Transit Goods In Transit Sum Insured (if required) : Buildings Cover / Tenants Improvements Buildings Sum Insured including outbuildings, Do you require subsidence cover for your buildings? If you are a tenant, do you require cover for If yes, please state the sum insured: 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): 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 Additional Information / Covers If there is any additional information or cover Details Of Current / Previous Policies Current annual premium: This may help us to get you a better quote Current/Previous insurer: Renewal date/date cover required: (dd/mm/yyyy)
