Commercial Business Quotation Form

Please fill out the form below in as much detail as possible. Fields marked with a RED asterisk are mandatory - and will enable us to complete a valid quote for you.
Proposers Details
Title
Full name

Address of   business/property to be insured
(if different from left)
Name company
Address

Postcode

Postcode

Telephone

Telephone

Fax

Fax

Mobile

Mobile

Email address *
Trading Since
Renewal/
Inception date
Property Details

Approx age of building

Built of

Roofed with

Floors

Ground     Upper

Basement

Yes  No

No of storeys (excl. basement)

Details of fire protection equipment

Method of heating

State any hazardous goods stored or used

Are the premises to be insured occupied at night ?

Yes  No

 

Are you the sole occupier of the premises ?

Yes  No

If  NO give details

Basement

Ground

First

Second

Third & above

 

Giver details of
Burglar alarm system
Is the alarm on maintenance agreement ? Yes  No
Is the alarm Nacoss approved ? Yes  No
Type of locks on external doors   * minimum BS3261
Window security         Locks fitted     Yes  No
Any other means of access
Shutters fitted to

 

Has any underwriting/insurance company ever
Declined you proposal ? Yes  No
Refused to renew or cancelled your policy ? Yes  No
Required any special restrictions / conditions ? Yes  No
If you have answered YES to any questions. Give full details.

Give full details of ALL claims or losses made by you or your business

Date of claim

Claim description

Payment received

£

£

£
Any other helpful information
Number of claim free years *
Give details of sums insured required       Tick box if accidental
damage required
Buildings £               if available
Fixtures and fittings £               if available
Plant & machinery £               if available
Office equipment £               if available
Stock £
Frozen food £
Beer £
Wine & spirits £
Tobacco & cigarettes £
Non ferrous metals £
Watches £
TV/video £
Video tapes £
Breakage of glass            

Shop front

 £               if available

Internal

 £               if available
Tenants improvements £
Interior decoration £
Goods in transit £
Loss of rent £
Loss of profit            

Loss of profit

 £            

Gross annual profit

 £            
Loss of cash whilst            

open

 £            

in transit

 £            

at home

 £            

in safe

 £            

anytime

 £            

Employers liability

            

Annual wage role

 £            
Part time   Full time   Wages

No and type of staff

 £       

    £

Shop assistants
£           £

Office staff / management

£           £

Sales representatives
£            £

Manual workers
£           £

Sales staff
£            £

Check-out assistants
Public liability            

Apprx annual turnover

 £            
Products liability            

Please ensure that all questions are fully answered as this is the only way an accurate quote can be produced.

In accordance with ABI regulations the quote will be sent to you by post with
a prospectus and proposal form.