| Your Details |
| First name * |
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| Surname * |
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| Company name (if applicable) |
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| Address * |
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| Postcode * |
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| Telephone number * |
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| Email address * |
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| Please select your client's Company Status |
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| Please select the Trade description that best describes your business. Only those Trades that are acceptable are in the trade list. |
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Do you carry out any trades in addition to the main trade?
If so please give details |
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| From which date has the business operated from the address above? (dd/mm/yyyy) |
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Have you sustained any loss, damage, injury or disability or incurred any liability (whether insured or not) during the past 5 years in connection with any of the risks now proposed?
If so please give details |
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| Please state the maximum value of the following on the premises at any one time (excluding items insured under the "Specific All Risks" section below) Items marked ** should be insured for their value to replace as new:- |
Stock and Customers' Goods
(excluding Attractive Stock shown below) |
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| Attractive Stock (i.e. Stock and Customers' Goods which may be attractive to thieves) |
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- Electronic Equipment (Audio/Video/Mobile telephones/Computers/Software/Radios/Accessories/CD/DVD)
- Alcoholic Drinks/Cigarettes cigars & tobacco
- Clothing
- Computer equipment/software
- Curios pictures/works of art
- Drugs and medicines
- Jewellery and watches
- Non-ferrous metals
- Photographic equipment/binoculars
- Tools - power driven tools
- Video tapes - pre-recorded/blank
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| Internal Decorations, Tenants Improvements, and Landlords Fixtures and Fittings (only needed if your responsibility but you are not insuring buildings) |
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| **Electronic Business Machines (incl. computers, printers etc.) - not stock |
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| Maximum value any one computer (i.e. central processing unit, monitor and keyboard) |
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| **Plant, machinery, trade fixtures and fittings, tools, office equipment etc. and all other contents (other than Electronic Business Machines & household contents) |
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| Buildings Sum Insured |
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| Your property will be insured (unless otherwise specified) against loss or damage caused by: Fire and Specified Perils: fire, Lightning, Explosion, Earthquake, Storm or Flood, Escape of Water, Riot, Civil Commotion, Malicious Damage, Impact, Theft following violent and forcible entry or exit, Escape of Oil, or All Risks; All the Specified Perils mentioned above plus Accidental Damage cover (subject to standard All Risks Exclusions) |
Standard
All Risks |
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| Do you wish to insure any of the following:- |
| Business Food in Freezers sum insured |
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Specified All Risks Items
(Please give description and value) |
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| Public/Products Liability Indeminty Limit |
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If you wish to insure in respect of Employers Liability, please enter the number of employees for the following:
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| Please enter the number of partners or principals active in the business |
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| Please enter the number of directors and employees active in the business |
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| In respect of people working away from the premises on manual duties (other than collection and delivery work) what is the maximum number of people doing this at any one time? |
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| If power driven woodworking machinery other than portable tools used in the business, please state the number of persons using such machinery |
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| Business Money |
| Please select the maximum amount of money to be covered on your premises at any time, or whilst in transit, or in a safe at your premises, or in a bank night safe (Standard Cover is £2500) |
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| Personal Accident (Assault) |
| What level of benefits is required for Personal Accident (Assault) / Death or Permanent Total Disablement and Temporary Total Disablement (Payable for 2 years)? |
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| Business Interruption |
| Increased Cost of Working cover is automatically included for an amount equal to your total Business Contents Sum Insured. If you require a higher amount please state total required (Maximum £75,000) |
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| If you require cover for Loss of Gross Income after a loss, please select limit of indemnity required. Standard Indemnity Period is 12 months. |
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| What is the maximum outstanding debit balances owed to you at any one time by your customers? |
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| Goods In Transit |
| What is the maximum value of goods carried in any one vehicle at any one time (other then items insured under the Specified All Risks section)? |
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| What is the maximum number of vehicles used at any one time for business purposes? |
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| Is cover for goods required at exhibitions and fairs? If 'yes', what is the maximum number of days spent at exhibitions and fairs in any one period of insurance? (maximum 50 days) |
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| Commercial Legal Expenses |
Commercial Legal Expenses?
If you, your business or your employees have been involved in any legal dispute, prosecution(other than motoring offences) or Inland Revenue investigation in the last five years then cover is not available |
No
Yes |
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Further Information
(Please enter any further relevant information about your business here) |
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| Cover start date * |
(dd/mm/yyyy) |
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| Keep me informed |
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| Add me to the mailing list |
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| Tell me about offers from selected partners |
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| * Required field |
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