Club Name:
Contact Name - Title & Surname:
Contact Name - First Name:
Type of Club:
Contact Number:
E-mail Address:
Does Anyone Live at the Premises:
Number of Years Trading (from current):
Number of Years Trading (from other):
Renewal Date:
Target Premium (£):
Cover Required
Buildings Sum Insured (£):
Is Subsidence Cover Required?
Fixtures, Fittings & Trade Contents (£):
Domestic Contents (£):
Stock (£):
Cigarettes/Tobacco (£):
Wines/Spirits (£):
Frozen Food (£):
Computer Equipment (£):
Optional Extensions
Stock In Transit (£):
Glass Cover (£):
Money Cover (£):
Business Interruptions Cover (£):
Loss of Licence Cover:
Any Other Cover Required:
Do You Have an ATM Machine?
N.B. Insurance cover cannot be provided for the money inside the machine.
Public Liability
Limit of Indemnity:
Estimated Annual Turnover (£):
Employers' Liability
Limit of Indemnity:
Clerical/Managerial Wage Roll (£):
Bar Staff & Others Wage Roll (£):
Annual Payments to Door Staff/Security (£):
Additional Information
Are the premises built with brick, stone or concrete walls and slate, tile, metal or asbestos roofs?
Are the premises listed?
Is any proportion of the premises roof flat?
Are you the sole occupants of the premises?
If multi-occupancy please give details:
If you have an extended licence please give details:
If you have a childrens play area please give details:
If you host any live entertainment, karaoke, discos etc 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.
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:
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