Company Name:
Contact Name - Title & Surname:
Contact Name - First Name:
Business Address:
Contact Number:
E-mail Address:
Nature of Business:
Example of Customers:
Number of Years Trading:
Contents Sum Insured
(including computers)
Annual Premium
(incl. tax) & Fee
up to £7,500  office contents
up to £10,000 office contents
up to £15,000 office contents
up to £20,000 office contents
up to £30,000 office contents
 up to £40,000 office contents
up to £50,000 office contents
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.:
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:
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:
Thank you for completing your details - please press the submit button to request cover