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Business Insurance Quotation Form

Personal Info

Business Ditails

Additional Ditails

Online Phone

How did you hear about us?

If by a friend, family or referrer please state their name

“Registered with the ICO, all your personal information is protected under the Data Protection Act 2018”

Personal Information

Title *:

First Name* :

Surname (Including any mie names)* :

Date Of Birth * :

House Name / Number* :

First Line of Address* :

Postcode* :

Marital Status *:

Employment Status *:

If Employed/Self Employed, What is your occupation:

If Employed/Self Employed, What is your Business:

Contact Information

Email * :

Mobile* :

Telephone :

Please Contact Me Via :

Email Phone Text

Business Ditails

Business/Trade Address

Building Number / Name * :

First Line of Address * :

Postcode * :

Year Established at This Address Since :

Company Details

Current/Previous Insurer :

Company Status *:

Business, Company or Partnership Name * :

Business Description *:

If other, Specify the Business

What date was your business established?

Total number of employees including partners, principals and directors * :

What is your Estimated Annual Turnover? * :

What is your Estimated Annual Wages? * :

Premises

Where is the premises located? *:

What are the opening hours for your business? * :

Any CCTV camera inside this premises *:

Is this premises entitled as a listed building *:

The roof of this premises, is it flat or slope *:

The floor, is it made of concrete or wood *:

The Walls, are they made of bricks or wood *:

Does anyone live upstairs and if yes who are they?

The back door, is it secured enough, any shutters or grilled*:

When is the premises occupied? *

Does the property have a roller shutter which covers all ground floor exposed glazing? *

Does the property have grilles fitted which cover all ground floor exposed glazing? *

Do you have any Beat of alarm in the premises? *

If yes, Type or name/brand of the alarm?

Does the alarm notify you along with police or only you? *

Is the alarm being checked regularly by any organization?

Do you have use of kitchen in the premises for commercial use?

Are you running a: Café, Take Away and Restaurant?

Percentage of collection :

How many persons could be dined at a time?

How often the kitchen extractor fan is cleaned?

Is your fryer a standing fryer or just a small basket fryer?

Maximum how many liters of oil the fryer can occupy?

Cover Details

Is the Premises’ Owned / Leased / Rented by you? *

Do you require buildings cover? *

What’s the maximum cash amount to be covered during the business hours?

Do you want any cash sum to be covered outside the premises? *

Stock to be insured

Cigarettes, Cigars and tobacco sum insured amount :

Wines, Fortified Wines and Spirits sum insured amount :

Frozen items to be insured :

Other Stock (other than target stock shown above) to be insured :

Contents (Fixtures & Furniture’s) sum insured amount :

Contents (If any Till, Computers & other electrical Equipment’s) sum insured amount :

Have you had any losses or incidents that have or could have given rise to claims (whether insured or not) in the past 5 years in connection with your current, or previous, business? *

If Yes, Explain what happened

Employer Reference Number Details

Are you exempt from paying PAYE? *

Please provide your Employer Reference Number

When would you like the cover to start? *

Additional Information

Additional Comments

Do you give me the consent to agree to our 'Terms & Conditions' on your behalf however, i will send you that to you in an hour with a link by text or email? (Office Use Only) : *

I Agree Terms & Conditions and Privacy Policy

By clicking submit, you agree your explicit consent for us to use the data provided in accordance with the Data Protection act 2018, this data will be used to provide the cheapest possible quote while being shared with both offline and online markets.

Please Note, all the information (including mobile number and email) you provide us here is accurate. Don’t worry’ we do not make nuisance calls or emails.

Opening Time

Email address

Phone

Business Insurance Quotation Form

Personal Information

Contact Information

Business Ditails

Business/Trade Address

Company Details

Premises

Cover Details

Stock to be insured

Employer Reference Number Details

Additional Information