Business Name:
Contact Name - Title & Surname:
Contact Name - First Name:
Business Address:
Contact Number:
E-mail Address:
Type of Shop:
Number of Years Trading:
Renewal Date:
Target Premium (£):
Buildings Sum Insured (£):
Is Subsidence Cover Required?
Glass & Signs (£):
Tenants Improvements (£):
Fixtures, Fittings & Trade Contents (£):
General Stock (£):
High Risk Stock (if applicable)
Alcohol (£):
Cigarettes/Tobacco (£):
Designer Goods (£):
Leather Goods (£):
Electrical Goods (£):
Other (give details) (£):
Computer & Electronic Equipment (£):
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:
Estimated Annual Turnover (£):
Details of any Work Away from the premises:
Details of anyone living on/above the premises:
Are the premises protected by a N.A.C.O.S.S. approved alarm?
Is Police Response Operational?
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:
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