| 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 Company Status |
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| Please select the Trade description that best describes your business. Only those Trades that are acceptable for the Licensed Trade contract are in the trade list |
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| On which date did the business to be insured begin trading? (dd/mm/yyyy) |
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| From which date did you gain experience in this Trade, e.g. as an employee of another business etc? (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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| Accomodation |
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| If you provide accommodation, please indicate how many rooms |
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| What level of cover is required for guests' effects? |
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| What is the maximum number of guests which can be accommodated at any one time? |
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| Buildings |
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| Type of cover required |
Standard
All Risks |
| Buildings (including shop fronts but EXCLUDING outbuildings) when your responsibility is as owner |
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| Shop fronts (including glass, shop blinds & fitments) when your responsibility is as occupier/tenant |
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| Internal decorations & tenants improvements effected by you as occupier/tenant |
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| Trade outbuildings detached or non-communicating with the main shop premises |
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| In what year were the main premises built? |
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| Please state the area of any felt on timber flat roof as a percentage of the total roof area |
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| Do you wish to extend the basic policy to include Subsidence, ground heave and landslip on the Buildings? |
No
Yes |
If 'yes' please state whether:
- the Premises suffered or are showing signs of damage from these perils
- the properties either side of your own have suffered or are now showing signs of this damage
- to your knowledge the vicinity is susceptible to this damage
- the Premises are in the immediate vicinity of any river bank, railway cutting or embankment, cliff, quarry, mine or other underground working or on made up ground?
- there are any trees or shrubs over 20ft in height within 30 ft of the Premises?
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No
Yes |
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| Licenced Premises |
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| Do you provide any live entertainment e.g. discos, dancing, live music? |
No
Yes |
| Do you have a Deep Fat Frying Range? |
No
Yes |
| Do you or a responsible employee reside at the premises? |
No
Yes |
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| Household Contents |
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| Please enter sum insured for Household Contents |
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| Please enter value of Unspecified Valuables requiring cover away from the premises |
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If cover for Specified Personal Possessions
(Please give description and value) |
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| Trade Contents |
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| Type of cover required |
Standard
All Risks |
| Stock in Trade |
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| Customer Goods, trade fixtures, fittings, plant machinery, utensils, office equipment etc |
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| Cigarettes, cigars and tobacco |
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| Wines and Spirits |
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| Perishable Goods following breakdown of storage equipment |
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| All Risks |
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| Signs |
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| Mobile Telephones Sum Insured |
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| - Geographical Limit of cover |
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| Laptop Computers Sum Insured |
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| - Geographical Limit of cover |
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| Public and Employers Liability |
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| Public/Products Liability Indemnity Limit |
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| If you require Work Away Liability, please advise number of employees who work away |
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| The standard cover for employers liability is £10,000,000 |
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| Loss of Income and Loss of Book Debts |
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| Gross Income Sum Insured |
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| Maximum Indemnity Period |
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| Book Debts Sum Insured |
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| Goods in Transit |
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| Wines, spirits & tobacco Sum Insured |
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| Trade Contents Sum Insured |
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| Loss of Money |
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| Negotiable Money Sum Insured |
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| Personal Accident Assault |
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| Compensation is provided for injury caused by assault during robbery as follows: |
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| Death and permanent disablement |
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| temporary total disablement |
£100 per week |
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| Optional Covers |
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Loss of Licence
If you lose your liquor licence cover is provided for:
- Loss of income for up to 12 months from the date of the loss of licence
- Depreciation in value of the premises
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| Please state sum insured required |
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| During the past 5 years has there been any opposition to the grant, renewal or transfer of the licence? |
No
Yes |
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| Personal Accident |
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| Compensation is provided for accidental injury whether at work or not, in Units as follows (up to 5 Units available): |
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| Death, loss of sight, hands or feet, or permanent disablement: |
£10,000 |
| Disablement from attending to usual business :
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£50 per week |
| Please enter number of employees who require cover |
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| Please select the number of Units of cover required |
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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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