Business Combined quotation form:
Full name of proposer (Please show names of all companies to be insured including all subsidiaries;
If not a limited company, full names of all partners)
Trading Name:
Contact Name:
Company registration
number:
Postcode:
Tel number:
Postal Address
Email:
Fax No:
Website address:
There is no need for you to complete the rest of this form if your enquiry is of a general nature
and one of our technicians will get back to you.
Alternatively continue and we wll get back to you with a premium indication for you to consider.
This questionnaire can be used for most types of businesses, not restricted to but including shops,
offices, Restaurants, Engineers, Manufacturers and many others
Full Description of trade or business:
(Please include any details of work carried out away from the premises)
Risk Address if different from above:
Post code:
Date business established:
Please indicate sections required and complete relevant questions:
Property Damage:
Buildings (Cost of replacement)
Yes
No
Plant / Machinery (Full cost of
re-instatement)
Yes
No
Computer Equipment (Full cost
of re-instatement)
Yes
No
Stock (Market Value)
Yes
No
All other contents (Full cost of
re-instatement)
Yes
No
Are the Buildings of
standard construction:
Yes
No (Provide details)
Details:
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Money:
Yes
No
Maximum in safe:
Max out of safe:
What year was the building
constructed:
Does the premises have an
alarm system:
Yes
No
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Goods in transit:
Yes
No
No of vehicles used
for transit:
Max value of any one
transit:
Annual value of goods in
transit
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Business interruption:
Yes
No
Annual Gross profit:
Indemnity period:
Months
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Employers Liabillity:
Yes
No
Clerical wage roll:
Manual wage roll:
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Public Liabillity:
Yes
No
UK Annual Turnover
Uk Annual Turnover
(Work away)
USA / Canada Annual Turnover:
All other Annual Turnover:
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3 year claim history:
Details:
Year
Amount
Please note that the above information will be used to obtain an indication of the premium required.
It may be nessecary to obtain further details in order to confirm the premium and any conditions to the cover.
