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 Ltd. company)
Trading name:(if different to the above)
Trading status:
- - - - - - Please Select - - - - - -
Sole Proprietor
Partnership
Ltd. Company
Limited Liability Partnership (LLP)
Charity
Shop address:
Shop postcode:
Is the correspondence address different to the shop address? Yes No
Correspondence address:
Correspondence postcode:
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.
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.)
Have you, or any other partner or director ever been prosecuted under any health and safety regulations or the Factories Act? Yes No
If yes, please provide details:
Has any insurer ever refused, declined, cancelled or imposed special terms in respect of your shop insurance? Yes No
If yes, please provide details:(i.e. name of insurer, reason for refusal/special terms, 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
Business Details
Full details of goods sold/supplied at your shop:(please describe as fully as possible)
Do your business activities only involve retail and not any wholesaling of goods? Yes No
If no, please confirm, the percentage of your turnover derived from wholesale activities: %
What percentage of your turnover is derived from the sale of second hand goods?
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Year Business Established
In what year was the business established? (yyyy)
If a new venture, please state the number of years previous experience (if applicable) :
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
30+
years
Construction of Shop Premises
Construction of walls (e.g. brick, stone, etc.) :
Construction of roof (e.g. tile, slate, concrete, felt, etc.) :
Is there any flat roof? Yes No
If yes, please confirm percentage flat roof: %
Please confirm the type of flat roof(e.g. 'felt on timber' or 'concrete', etc.)
Construction of floor(s):
Both Timber and Concrete
All Concrete
All Wooden
Other
Number of storeys in the building?
1
2
3
4
5
6
7
8
9
9+
What year were the premises built? (yyyy)
Are the premises of listed construction?(e.g. Grade I, Grade II, etc.)
Please Select
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Has the property ever suffered from ground movement (e.g. subsidence) or flood damage? Yes No
If yes, please provide details:(e.g. type of damage, date of damage, amount of damage, etc.)
Distance from nearest water, river, stream, canal, etc.:
Are the premises only heated by fixed heating and not by any portable heaters? Yes No
If no, please provide details of portable heaters:
Security
Are all your external doors fitted with a minimum of 5-lever mortise deadlocks (BS3621) or equivalent and all accessible windows and skylights fitted with key operated window locks? Yes No
Are all accessible windows protected by either solid steel bars or grilles? Yes No
Are the shop front windows protected by metal roller shutters? Yes No
Do the premises have recorded CCTV? Yes No
Please confirm the coverage area of the CCTV:
Internal Only
Internal and External
External Only
None
Location of the premises:
- - - - - Please Select - - - - -
Arcade
Business Park
Covered Shopping Centre
Domestic Premises
High Street
In Office Premises
Industrial Estate
Market
Market Hall
Parade
Precinct
Warehouse
Are your premises protected by an intruder alarm? Yes No
If yes, is the alarm NACOSS/NSI/SSAIB accredited? Yes No Not Known
Type of intruder alarm signalling:
- - - - - - Please Select - - - - - -
Audible - Bells or Siren
Digi-Comm to Central Station
Dual-Comm to Central Station
Dialler to Proprietors Phone
RedCare to Central Station
RedCare GSM to Central Station
Does the alarm incorporate confirmable technology? Yes No
Is the alarm maintained annually? Yes No
Level of Police response to alarm:
- - Please Select - -
Level 1
Level 2
Level 3
No Police Response
Unknown
Please provide details of any other security arrangements:(This may entitle you to additional discounts)
Overnight Occupancy
Does anybody reside at the premises overnight?(e.g. proprietor, manager, family member, tenant, etc.) Yes No
Is the residential section self-contained with it's own lockable entrance/exit? Yes No
If the residential section is occupied by flats, please indicate the number of flats:
Please confirm the tenancy type:(e.g. Professional Working Tenants, etc.)
- - - - - - - - Please Select - - - - - - - -
Professional Working Tenants
Owner / Proposer Living At Premises
Retired
Asylum Seekers
Council Support
DSS Tenants (Benefits Assisted)
Leaseholder
Student Tenants
Unoccupied / Vacant
Family Members
Type of residential accommodation:
- - - - - - - - Please Select - - - - - - - -
Single Self Contained Flat
Multiple Self Contained Flats
Single Flat Not Self Contained
Multiple Flats Not Self Contained
House In Multiple Occupation (HMO)
Bedsits
Bed and Breakfast Accommodation
Other
Is a lease / tenancy agreement in force for a minimum period of 6 months?(other than where disclosed above as occupied by owner/proposer or unoccupied/vacant) Yes No
If No, please provide reason:(e.g. Owner occupied, occupied by family, etc.)
ATM (Cash Machine)
Is there an A.T.M. (cash machine) on the premises? Yes No
Are you responsible for the cash? Yes No
What is the maximum value of cash held in the machine?
Fire Protection
Is there a fire alarm on the premises? Yes No
If yes, type of fire alarm?
Manual Only
Automatic with detectors
Is the fire alarm linked to a central station? Yes No
Occupancy of Shop
Are you the sole occupant(s) of the business premises you occupy? Yes No
If No, please provide details of other occupants:
Is your portion of the premises self- contained with their own means of access: Yes No
If No, please provide details:
Are any parts of the building at present unoccupied? Yes No
If yes, please provide details:(i.e. percentage unoccupied, which floors are unoccupied, etc.)
Are the premises ever left unoccupied or closed for more than 30 consecutive days? Yes No
If yes, please provide details:
Does the shop have a workshop area? Yes No
If yes, what percentage of the overall area? %
Claims Experience/History
Have you or any other director or partner (in this or any other trading name) suffered any loss or had any claims made against you in the last 5 years? Yes No
If yes, please provide claim details:(i.e. date of claim, circumstances of claim, amount claimed, etc.)
Premises where cooking is carried out
Do you use Deep Fat Frying Equipment? Yes No
If yes, please confirm the type:(e.g. Tabletop, Freestanding, Full Frying Range, etc.)
If a full frying range, please state No. of Ranges, Manufacturer(s) and Age(s):
Is the frying equipment fitted with a thermostat designed to prevent the temperature of oils/fat from rising above 205°C? Yes No
Cover Type
Standard cover is for Fire, Theft and Special Perils.
Do you wish to extend your cover to include accidental damage for an additional premium? Yes No
Do you wish to extend your cover to include cover for terrorism for an additional premium? Yes No
Buildings (if owner occupied and required)
Buildings sum insured (if required) :(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
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
If yes, please state the sum insured:
Contents
Shop front glass sum insured (£'s) :
Electronic business equipment (e.g. tills, etc.) (£'s) :
Contents / fixtures & fittings sum insured (£'s) :
Property Away From The Premises
Is cover required for business equipment temporarily taken away from the premises? Yes No
All Risks Sum Insured (£'s):(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:
UK
Europe
Worldwide
Stock
Total stock sum insured required (£s) :
Does your stock include any tobacco/cigarettes/cigars, wines/spirits, DVDs/CDs and computer games, camera's/photographic equipment, clothing, computers/electronic equipment, electrical goods, jewellery/watches or mobile phones? Yes No
If yes, within the total stock sum insured indicated above, please state the value of this stock below:
Tobacco, cigarettes & cigars:
Wines and spirits:
DVD's, CD's and computer games:
Camera's and photographic equipment:
Clothing incl. babywear, sports and leisure wear:
Computers / electronic equipment:
Electrical goods (other than electronic equipment and mobile phones) :
Jewellery and watches:
Mobile telephones:
Refrigerated Stock Cover (if required)
Freezer contents sum insured:(cover for deterioration of frozen food)
Goods In Transit (if required)
Goods in transit sum insured (own vehicles) :
Money
Money during business hours/in transit to bank:(please amend if greater cover is required)
Money outside business hours in locked safe:(please amend if greater cover is required)
Do you require business interruption cover? Yes No
If yes, please confirm your annual Gross Profit (£'s):
Do you require cover for loss of liquor licence? Yes No
If yes, please provide a sum insured (£'s):
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 (£'s):
Public / Product Liability limit of indemnity:(£2M automatically included)
£2,000,000
£5,000,000
Is there any manual work carried out away from the premises other than collection or delivery? Yes No
If yes, please provide details:(i.e. type of work and number of employees involved)
Employers' Liability limit of indemnity:(£10M automatically included)
Please confirm the total number of employees:
Please confirm the annual wages of your employees (£s):
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available) : (e.g. 123/AB12345 or 'Exempt')
Turnover
Annual turnover (£s):
Is commercial legal expenses cover required?(£100,000 legal defence costs for contract disputes, employment disputes, VAT investigations, etc.) Yes No
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:
If there is any other cover that you wish to include, or if you are aware of any information that you wish to disclose, 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.
Renewal date / date cover required:
Current annual premium: This may help us to get you a better quote
Name of current / previous insurer: e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.