Proposers Details
Proposers Name(s) (include all partners names if partnership ):
Limited Company Name (if applicable ):
Trading Name:
Trading Status:
- - - - - - - Please Select - - - - - - -
Sole Trader
Partnership
Private Limited Company
Public Limited Company (PLC)
Limited Liability Partnership (LLP)
Pub Address:
Pub Postcode:
Correspondence Address: (if different from above)
Daytime Telephone No.
E-Mail Address:
General Information
Have you, or any other partner or director ever been convicted of or charged with any criminal offence? Yes No
If yes, please provide details:(i.e. date of conviction, type of conviction, length of custodial sentence, etc.)
Have you, or any other partner or director ever been declared bankrupt or insolvent? Yes No
If yes, please provide details:(i.e. date of bankruptcy/insolvency, amount of bankruptcy/insolvency, whether discharged, etc.)
Has any insurer ever refused, declined, cancelled or imposed special terms in respect of your pub insurance? Yes No
If yes, please provide details:(i.e. name of insurer, reason for refusal/special terms, etc.)
Please state the number of years trading under current management:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
20+
years
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
12
13
14
15
16
17
18
19
20
20+
years
Construction Details
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, felt, etc.) :
If there any flat roofing? Yes No
Please confirm percentage Flat Roofing: %
Please confirm the type of flat roofing:(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 grade 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 indicate the distance to the nearest water(e.g. river, canal, lake, coast, etc.) :
Has the property ever suffered from subsidence or flood damage? Yes No
If yes, please provide details:(i.e. date of damage, amount of damage, type of damage, etc.)
Entertainment
Do you have extended late opening hours? Yes No
If yes, please provide details:(e.g. days and times you stay open until)
Do you employ doormen? Yes No
Is there any live entertainment at the premises?(e.g. Karaoke, disco's, bands, etc.) Yes No
If yes, state the type of entertainment (e.g. disco, bands, etc.) , how many times per week the entertainment is held and whether an entry fee is charged at the door:
Is there a dance floor? Yes No
If yes, please state the maximum capacity of people on the dance floor area:
Are there any childrens play areas? Yes No
If yes, please state the type of play equipment and the type of floor covering(e.g. bark chippings, cork, grass, etc.) :
Security
Is the pub occupied by the landlord / manager overnight? Yes No
Are all your external doors fitted with a minimum of 5 lever mortise deadlocks (BS3621) or equivalent? Yes No
Are all opening windows fitted with key operated window locks? Yes No
Is the pub protected by an intruder alarm? Yes No
If yes, is the alarm NACOSS / NSI approved?
Please Select
No
Yes
Not Sure
Method of intruder alarm signalling:
- - - - - - Please Select - - - - - -
Audible - Bells or Siren
Monitored - Central Station
Dialler - To Proprietors House
REDCARE - To Police
Are your premises situated within a street level Local Authority Council CCTV area? Yes No
Please provide details of any other security arrangements:(e.g. own CCTV, window grilles, etc.)
Is there an A.T.M. (cash machine) on the premises? 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
If yes, please provide details:(i.e. date of claim, description of claim, amount claimed, etc.)
Cooking/Accomodation
Is any cooking carried out at the premises? Yes No
If yes, please confirm whether or not you provide bar meals only or have a seperate restaurant:
- - - - - - 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 accommodation? Yes No
If yes, please indicate the total number of guest rooms:
Please state the maximum number of guests:
Type of guests staying:
- - Please Select - -
Overnight Only
D.S.S.
Bed and Breakfast
Other
Total guests effects sum insured (if cover is required)
Buildings Cover / Tenants Improvements
Buildings Sum Insured including outbuildings, rebuilding architects' fees, removal of debris, etc:
Do you require subsidence cover for your buildings? Yes No
If you are a tenant, do you require cover for any improvements you have made to the property? Yes No N/A
If yes, please state the sum insured:
Contents / Cover
Cover
Level of Cover Required?
- - - - - - - - - Please Choose - - - - - - - - -
Standard Cover (fire, theft, flood, etc.)
Standard Cover & Accidental Damage
Contents / Fixtures & Fittings
Electronic Equipment Sum Insured (e.g. tills, TV's, 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 (including beer) :
Deterioration of Frozen Food
Deterioration of Frozen Food (if required) :
Glass
Fixed External Glass Sum Insured:
Money
Money Sum Insured (during business hours / in transit) :
£0
£500
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
£8,000
£9,000
£10,000
Money Sum Insured (out of business hours in a locked safe) :
£0
£500
£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) :
Business Interruption
Do you require business interruption cover?(i.e. loss of profit following an insured event) Yes No
Please confirm the Annual Gross Profit of your business (£'s):
Please advise the period of time you wish the cover to extend?(allow sufficient time for rebuilding/refurbishing and further time to resume normal trading) 12 months 24 months 36 months
Do you require cover for loss of liquor licence(i.e. depreciation of the value of the premises) ? Yes No
If yes, please confirm the sum insured required (£'s):
Do you require cover for loss of Book Debts? Yes No
If yes, please indicate the maximum amount of Debit Balances outstanding at any one time (£'s):
Public / Employers Liability Cover
Public / Product Liability limit of indemnity:
£1,000,000
£2,000,000
£5,000,000
Please confirm the annual Turnover of your business (£'s):
Do you require Employers' Liability cover?(£10 Million limit of indemnity) Yes No
If yes, please confirm the total number of employee's:
If yes, please confirm the total wages of the employee's (£'s): Per Annum
Additional Information / Covers
If there is any additional information or cover that you wish to include, please provide details:
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)