Tel: 01623 641 386    
Surgery Insurance
 
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Surgery Insurance Quote Form

For UK Customers Only

Please insert your surgery insurance quote details here and one of our commercial business advisers will contact you shortly.

This form is designed for quotes for surgery insurance. Surgery insurance is a package policy providing cover for contents/fixtures and fittings, buildings (optional), public liability/employers' liability, business interruption, money, etc.

If you have any problems with completing this form, please phone us on 01623 641 386 for assistance.

Proposers/Company Details

Proposers Name
(incl. partners names if partnership):
Trading Name (if applicable):
Trading Status:
Surgery Address:
Surgery Postcode:
Correspondence Address:
(if different from the above)
Description of type of surgery:
(e.g. doctors surgery, dentists surgery, etc.)
Daytime Telephone No.
E-Mail Address:

General Information

Please state the number of
years the surgery has been trading:
If a new venture, please state the number
of years previous experience (if applicable):
Are you the sole occupant(s) of the
building in which your premises are situated?
If No, please provide details of the other
types of businesses that operate from the building:
Is your surgery entirely self-contained
with its own seperate lockable entrance?
If No, please provide details:
Construction Details
Is the building of standard construction?
(i.e. brick/stone/concrete walls & tile/slate roof)
If No, please provide details:
Approximately, what year was the surgery built?
Has the property ever suffered from subsidence or flood damage?
If yes, please provide details:
(e.g. date of damage, amount of damage, etc.)
Are any parts of the building at present unoccupied?
If yes, please provide details:
Claims Experience
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?
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(or equivalent)?		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?
If yes, is the alarm NACOSS/NSI approved?
Type of intruder alarm fitted:
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?
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. surgery furniture, filing cabinets, etc.)		£
Stock Sum Insured (if applicable):£
Property Away From The Surgery
All Risks Sum Insured (i.e. property away from the surgery):£
Type of property to be covered away from the surgery:
(e.g. laptops, digital camera's, etc.)
Money
Money during business hours (£2,000 std. cover):£

Business Interruption

Is Business Interruption cover required?
If yes, state the sum insured required for loss of income:£
Do you require cover for loss of Book Debts?
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)
Employers Liability Limit of Indemnity:
(£10 Million automatically included)		£10,000,000
Please confirm the total number of surgery employee's:
Please confirm the total annual wages of the employee's:£

Additional Information/Covers
  
If there is any more information or type of 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)

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 Surgery Insurance Quote button to send your quotation details to us.