Commercial Combined Enquiry

Please fill this form as completely as possible for an accurate response.
Fields marked * (and shown in red) are mandatory.

Broker Name : *
Contact Email : *
Broker Phone : *
Broker Address : *
Proposer : *
Client Address: *
Client Postcode: *
Business Description : *
Renewal Date : (dd/mm)
Current Insurers :
Target Premium : £
Date Established : * (dd/mm/yyyy)


Sections Insured

Property Damage - Cover Required : Yes No

Sums Insured Buildings : £
Rent Payable : £
Rent Receivable : £
Stock of Wine Spirits and Tobaccos : £
Other Stock : £
Computer and Ancilliary Equipment : £
Machinery Plant Fixtures and Fittings : £
Glass (If Building not Insured) : £
Target Stock : £
* This is finished electrical goods, jewellery and the like, non ferrous metals, designer clothing, leather and fur goods, watches, power tools, tvs and other electrical entertainment goods and discs or tapes.

Business Interruption - Cover Required : Yes No

Gross Profit : £
Indemnity Period :

Employers Liability - Cover Required : Yes No

Clerical Wages : £
Woodworking Wages : £
All Other Wages : £
Work Away Wages : £
Health and Safety Policy in Force? : Yes No

Public Liability - Cover Required : Yes No

Limit of indemnity any one occurance
including costs and expenses :
Is work away undertaken : Yes No
Work away involves heat : Yes No
Work away involves work airside,
off-shore or petrochemical industry :		 Yes No

Products Liability - Cover Required : Yes No

Limit of indemnity any one period of insurance :
Estimated annual turnover
(exc. USA/Canada) : £
Estimated annual turnover USA/Canada : £
Product Details :

If products are used in the auto, aviation, marine, railway or petro-chemical industries, please give full details in "Extra Information" section below.

Money Cover - Cover Required : Yes No

In approved safes : £
In machines : £
On Premises outside business hours : £
In private dwellings : £
Any other loss : £
Estimated annual carryings : £

All Risks - Cover Required : Yes No

Tools : £
Laptops : £
Other : £

Goods in Transit - Cover Required : Yes No

Load, any one vehicle : £
Estimated annual carryings : £
Number of vehicles :

Premises Details

Approximate age of buildings : *
Approximate size of buildings : sq. ft.
Number of storeys : *
Occupancy : *
Please confirm Full construction details including the following :
Walls Brick/Stone : * Yes No
Composite Panels : * Yes No
Floors Concrete : * Yes No
Roof Slate/Tile : * Yes No
Is the building multi-tenure : * Yes No
Is the heating Fixed, Gas or Oil : * Yes No
Intruder Alarm : *
Is physical security to standard : * Yes No

Claims Experience

Details of claims in last 5 years : *

 

Extra Information

Information you feel may be appropriate :