Tel: 01623 641 386     
Surgery Insurance Quotes
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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, stock, business interruption, etc.

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

Proposers/Company Details

Proposer's full name(s):
(enter sole trader's name or all partner's names if a partnership)
Contact name:
(if different to proposer's name)
Limited company name:
(if operating as a limited company)
Surgery trading name:
Trading status:
Surgery address:
Surgery postcode:  Help?
Is there a different correspondence address?Yes     No
Correspondence address:
(if different from the above)
Description of type of surgery:
(i.e. doctors surgery, dentists surgery, etc.)
Daytime telephone number:
*E-mail address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.
Proposers Details

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 had
any county court judgements / sheriff decrees or been
declared bankrupt, or involved in a company which has
become insolvent or which has gone into liquidation, receivership or administration?
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 office insurance?
Yes     No
If yes, please provide details:
(i.e. name of insurer, reason
for refusal/special terms, etc.)
Have you, or any other partner or
director ever been prosecuted or served a
prohibition notice by the Health & Safety Executive?
Yes     No
If yes, please provide details:
(i.e. date and reason for prosecution, etc.)
Can you confirm that you meet all the Statutory obligations; including fire safety, electrical inspections, Health & Safety and COSHH regulations, relating to the operation of your business?Yes     No
General Information
Please state the number of years
trading under current management:
If a new venture, please state the number
of years previous experience (if applicable):
Is the property in a good state of repair and maintained?Yes     No
Will the premises ever been left
unoccupied for more than 30 consecutive days?
Yes     No
If yes, please provide details:
Are you the sole occupant(s) of the
building in which your premises are situated?
Yes     No
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 separate lockable entrance?
Yes     No
If No, please provide details:
Construction Details
Is the building of standard construction?
(i.e. brick/stone/concrete walls & tile/slate roof)
Yes     No
If No, please provide details:
What is the construction of the floor(s)?
Number of storeys in the building?
Approximately, what year was the surgery built? (yyyy)
Are the premises of grade listed construction?
Approximate distance to nearest water, river, sea, etc.:
(e.g. 250 metres, etc.)
Is the property heated only by gas or oil central
heating, electric storage heaters, or fixed gas or
electrical appliances or other forms of fixed heating?
Yes     No
If no, please provide details of other heating:
(e.g. any portable heaters, etc.)
Has there ever been any subsidence
or flood damage at the premises or nearby?
Yes     No
If yes, please provide details:
(e.g. date of damage, amount of damage, etc.)
Are any parts of the building at present unoccupied?Yes     No
If yes, please provide details:
Claims Experience
Have you, or any other partner or director ever
suffered any loss or had any claims made against you
at this property or any other property in the last 5 years?
Yes     No
If yes, please provide claim details:
(i.e. date of claim, circumstances
of claim, amount claimed, etc.)
Are all your external doors fitted with a minimum of
5 lever mortise deadlocks (BS3621) or equivalent?
Yes     No
Are all opening windows, fanlights and
skylights fitted with key operated window locks?
Yes     No
Are all accessible windows
protected by either solid steel bars or grilles?
Yes     No
Is the property protected
by permanently manned 24 hour security?
Yes     No
Are your premises protected by an intruder alarm?Yes     No
Is the alarm under the sole control of the business?Yes     No
Who maintains the alarm system?
Is the intruder alarm maintained annually?Yes     No
Type of intruder alarm fitted:
Does the surgery have any CCTV?Yes     No  Help?
Please confirm the coverage area of the CCTV:
Please provide details of any
other security arrangements (if applicable):
Is visitor access during business hours controlled by
either an access control system or a manned reception?
Yes    No
Fire Protection
Are there fire extinguishers at the surgery?Yes     No
Is there an automatic fire
alarm system installed at the surgery?
Yes     No
If yes, please confirm type of alarm signalling:


Standard cover is for Fire, Theft And Special Perils.
Do you wish to include accidental damage cover?Yes     No
Do you wish to include cover for terrorism?Yes     No
Buildings (if owner occupied and required)
Buildings Sum Insured:
(reinstatement value including outbuildings and an allowance for
demolition costs, removal of debris, rebuilding architects fees, etc.)
Is cover required for subsidence, heave or landslip?Yes     No  Help?
Tenants Improvements (if renting the shop and required)
Do you require tenants improvements cover?
(i.e. to insure improvements you have made as a tenant to
the building's fixtures & fittings such as a new counter,
suspended ceiling, partitions, lighting, decorations, etc.)
Yes     No  Help?
If yes, please state the sum insured: 
Computers Sum Insured: 
Other Electronic Equipment Sum Insured:
(i.e. photocopiers, telephone system, etc.)
Works of Art Sum Insured (if required): 
All Other Contents Sum Insured:
(i.e. surgery furniture, filing cabinets, etc.)
Do you require Computer Breakdown cover?
(provides cover for repair or replacement of computer
equipmentand also reinstatement of data)
Yes     No  Help?
Property Away From The Surgery
Is cover required for business
equipment temporarily taken away from the premises?
(e.g. laptops, tablets, digital camera's, etc.)
Yes     No  Help?
All Risks Sum Insured
(i.e. total value of property away from the premises):
Type of property to be covered away from the premises:
(e.g. laptops, digital camera's, etc. Please specify each item.)
Territorial area:  Help?
Stock / Business Files
Trade Stock and Samples: 
Refrigerated Drugs and Medicines: 
Non-Refrigerated Drugs and Medicines: 
Precious Metals (e.g. gold, etc.): 
Business Files & Documents: 
Is money cover required?Yes     No
Money during surgery hours (£2,000 std. cover): 
Money outside surgery hours (£1,000 std. cover):  (kept in a locked safe)

Business Interruption

Is Business Interruption cover required?Yes     No help
If yes, state the sum insured
required for the annual loss of income:
Please confirm the maximum indemnity period:
Do you require cover for loss of Book Debts?Yes     No
If yes, please indicate the maximum amount of Gross
Fees and Debit Balances outstanding at any one time:
(e.g. £25,000)

Public/Employers Liability Cover

Public / Product Liability Limit Of Indemnity:
(£2 Million automatically included)
Annual turnover: 
Employers Liability Limit of Indemnity:
(£10 Million automatically included)
Please confirm the total number of surgery employees:
Please confirm the total annual wages of the employees: 
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available):  help
(e.g. 123/AB12345)
Fidelity Cover

Is cover required for theft by employees?Yes     No
Are written references confirming
the integrity of the employees obtained?
Yes     No
Is there a system whereby a least two employees check
stock, money and other business records at least monthly?
Yes     No

Legal Expenses Cover

Is commercial legal expenses cover required?
(£100,000 limit of indemnity)
Yes     No  Help?
Has the business and/or its directors been
involved in any legal dispute, tax investigation
or any other court or tribunal action in the last 5 years?
Yes     No
Please provide details of the dispute including dates:

Additional Information/Covers
If there is any more information that you wish to
disclose or cover that you require, please provide details:
You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.
Details Of Current / Previous Policies

Date Cover Required / Renewal Date:   (dd/mm/yyyy)
Current Annual Premium / Best Quotation: 
This may help us to get you a better quote.
Name of Current / Previous Insurer:
e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.

Request Quotation

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.

Estimated Quote Time: 1 to 72 hours