Contact Name - Title & Surname:
Contact Name - First Name:
Contact Number:
E-mail Address:
Renewal Date:
Target Premium (£):
Property Details
Risk Address:
Approx. Date Property Built:
Property Type:
Details if Other:
Why is the Property Used By?
Frequency of Use:
Cover Required
Buildings Sum Insured (£):
Property Owners Liability:
Optional Extras:
Contents Sums Insured (£):
Employers' Liability:
Additional Information:
Are the premises listed?
Is any proportion of the premises roof flat?
Self-contained (i.e. no shared facilities) with own lockable entrance?
In a good state of repair?
Constructed of brick, stone or concrete and roofed with slates, tiles, concrete or rigid metal?
In an area free from subsidence, ground heave, slip etc
In an area free from flooding
Additional Information:
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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