Office 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	£250
up to £10,000 office contents	£290
up to £15,000 office contents	£340
up to £20,000 office contents	£415
up to £30,000 office contents	£535
up to £40,000 office contents	£690
up to £50,000 office contents	£840

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?

Is any proportion of the premises roof flat?

Are you the sole occupants of the premises?

If multi-occupancy please give details:

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