Home Office Insurance Issue Cover Request

Insurance2day Insurance Services Ltd are authorised and regulated by the Financial Services Authority and are members of:

Company Name:

Contact Name (inc Title):

Business Address:

Postcode:

Contact Number:

E-mail Address:

Nature of Business:

Example of Customers:

Number of Years Trading:

COVER REQUIRED

Contents Sum Insured (including computers)	Annual Premium (incl. tax) & Fee
up to £7,500 office contents	£160
up to £10,000 office contents	£195
up to £15,000 office contents	£255
up to £20,000 office contents	£325

Select Option:

Details of Any Other Cover Required:

Method of Payment

If Other, please give details

Inception Date:

N.B. No cover is in place until payment is received and you receive written confirmation of cover.

Additional Information

Estimated Annual Turnover (£):

Annual Wage Roll (£):

Details of Work Away From Premises:

Details of Work Outside of U.K.:

Premises

Are the premises built with brick, stone or concrete walls and slate, tile, metal or asbestos roofs?

Are the premises protected by a N.A.C.O.S.S. approved alarm?

Please detail any other security factors:

MINIMUM LEVELS OF PHYSICAL SECURITY:

All external entry/exit doors must be fitted with at least 5 lever mortice deadlocks & all accessible windows must be fitted with key operated window locks.

Claims/Losses

Please details of ALL and ANY losses you have suffered or claims you have made in the last five years (please advise date(s), cost(s) and circumstances:

Have you ever had an insurance policy cancelled or special terms imposed?

Any additional information/comments:

Thank you for completing your details - please press the submit button to request cover