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Company Name:
Contact Name - Title & Surname:
Contact Name - First Name:
Address:
Postcode:
Contact Number (optional):
Business Description:
Date Business Established:
E-mail Address:
Renewal Date (if applicable):
Risk Details
Description of Goods to be Insured:
Details if Goods are not New (i.e. second hand or refurbished):
Estimated Annual Turnover (£):
Goods to be Insured & Estimated Value of Goods
Maximum Value Any One Vessel/Air Transit/Post/Road Vehicle (£)
Is coverage required for DOMESTIC TRANSIT where goods are NOT being imported or exported?
If Yes, Annual value of goods domestic transit (£)
Maximum value any one vehicle - Hauliers (£)
Maximum value any one vehicle - Owned or operated by the Assured (£)
Is coverage required for Warehouse/Storage Risks (OTHER than in the ordinary course of transit)?
If Yes, Details of Location and Maximum Value of Goods Stored
Maximum Value Any One Location (£)
Is coverage required for Exhibitions?
If Yes, Estimated number per annum and locations
Maximum value of goods at exhibitions (£)
Estimated Annual Imports/Exports
Imports to UK (£)
E.U.
East Europe
North America
Africa
Asia Pacific
Australasia
Others
Details
UK:UK Transit
Exports from UK (£)
E.U.
East Europe
North America
Africa
Asia Pacific
Australasia
Others
Details
Details of any other types of movement:
Claims, Losses & Additional Information
Details of ALL and ANY claims or losses in the last five years:
Details of any other material facts that may affect an insurers willingness to offer cover:
Comments/Additional Information
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