Business Insurance Quotations Business Insurance Proposal Form

1. Your Name:
Company Trading Title:
Type of Company:
2. Address of your premises:
Post Code:
Telephone Number:
E-mail address:
Website address:
3. Description of Business:
4. Date Established:
5. Type of Premises:
If other, please give details:
6. THE CONSTRUCTION OF PREMISES (eg: Brick walls, Mild steel roof)
Is there a partial or full flat roof?	Yes No
If "Yes" describe in detail: (construction, waterproofing, access, security...)
Type of heating at premises
7. THE LOCATION OF PREMISES:
If other, please give details:
Are there any rivers, watercourses or sea near the premises?	Yes No
If "Yes" please give full details
Approximate distance from Police Station (Miles)
Approx distance from Fire Station (Miles)
8. YOUR BUSINESS:
Please provide a full description of all processes carried out:
Are any processes involving the use of heat carried out?	Yes No
If you use heat, please provide details:
Do you have a health and safety policy?	Yes No
Is all training recorded?	Yes No
Do you have an Electrical Installation Certificate?	Yes No
Is your Portable Electrical Equipment tested?	Yes No
Do you export?	Yes No
If "Yes" do you export outside the EU?	Yes No
If "Yes" indicate areas:
9. SECURITY AND FIRE PRECAUTIONS
Are the premises fitted with -
Fire Alarm?	Yes No
Sprinklers?	Yes No
Fire Extinguishers?	Yes No
Are fire extinguishers inspected annually?	Yes No
Are door locks 5-lever mortise deadlock type?	Yes No (eg Chubb locks)
Are window locks fitted?	Yes No
Are roller shutters fitted with lockable pins or electrical isolators?	Yes No No Roller Shutters
If you chose 'no' for any of the last three questions, please give details of what you do have for physical security.
10. BURGLAR ALARM
Is there a burglar alarm under your sole control?	Yes No
If "Yes" please indicate type -
- and signailling method:
11. INSURANCE HISTORY
Have you had any previous insurers?	Yes No
Have you ever been declined, cancelled, refused or had special terms?	Yes No
If "Yes" please give full details
Have you had any claims in the last 5 years?	Yes No

If "Yes" please give details:

Date of claims	What happened (eg fire, theft, storm, flood)	Total Payment
1.
2.
3.
4.

12. SUM INSURED
(Please estimate replacement cost, new for old)	SUM INSURED
Buildings (including outbuildings):	£
Stock in trade:	£
Stock in trust (customers goods):	£
Goods in production and finished goods:	£
Plant, Machinery, Fixtures and Fittings:	£
All other contents:	£
Computer Systems including software:	£
Tenants Improvements:	£
Loss of rent	£
Period for loss of rent above
13. LOSS OF PROFITS
Gross Annual Profit:	£
Period of indemnity for loss of profit
14. EMPLOYERS LIABILITY (Please give estimated annual wages)
Drivers and Warehouse persons:	£
Clerical, Admin and non-manual Wages:	£
Employees using woodworking machinery:	£
Employees using metalworking machinery:	£
All other employees:	£
15. PUBLIC AND PRODUCTS LIABILITY
Limit of Indemnity
Estimated turnover:	£
Of which percentage work is away from premises:	%
Do you use heat away? (eg welding)	Yes No
If "Yes" please give details:
16. GLASS BREAKAGE
Value of fixed glass and sanitary fittings	£
17. MONEY
Estimated annual cash carryings: (eg to and from bank)	£
Limit required in safe:	£
Limit required on premises during business hours:	£
Limit required in transit:	£

18. BELONGINGS OFF PREMISES (eg phones, laptops, tools)

Description:	Sum Insured	Location
	£
	£
	£
	£

19. GOODS IN TRANSIT
Limit required any one vehicle:	£
Numbers of vehicles:
Estimated total value of goods carried annually:	£

20. Current Insurance

Name of current insurers (so that we don't approach them!)

Expiry date of current insurance

Current premium (if known)

£