Name of Restaurant:
Contact Name - Title & Surname:
Contact Name - First Name:
Address:
Postcode:
Contact Number:
E-mail Address:
Number of Years Trading (current premises):
Number of Years Trading (other premises):
Does Anyone Live on the Premises?
Type of Restaurant:
If Other, please give details:
Do You Have a Deep Fat Frying Range?:
If Yes, what Age:
If Other, please give details:
Maximum Seating Capacity:
Any Additional Information:
Renewal Date:
Target Premium (£):
COVER REQUIRED
Buildings Sum Insured (£):
Is Subsidence Cover Required?
Glass & Signs (£):
Fixtures, Fittings & Trade Contents (£):
Domestic Contents (£):
Stock (£):
Cigarettes/Tobacco (£):
Wines/Spirits (£):
Frozen Food (£):
Computer Equipment (£):
Guests Effects (£):
STANDARD POLICY COVER - Please give details of any additional cover required
Stock In Transit - Standard Cover: £1,500
Frozen Food - Standard Cover: £1,000
Money Cover - Standard Cover: £2,000
Business Interruptions Cover - Standard Cover: £100,000
Loss of Licence Cover - Standard Cover: £100,000
Public Liability - Standard Cover: £1,000,000
Employers Liability - Standard Cover: £10,000,000
Any Other Cover Required:
ADDITIONAL INFORMATION
Estimated Annual Turnover (£):
Details of any Work Away from the premises:
Are the premises protected by a N.A.C.O.S.S. approved alarm?
Are the premises protected by CCTV?
Please detail any other security factors:
Details of ALL and ANY claims or losses in the last five years:
STATEMENT OF FACT
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