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Retail Shops Premium Enquiry Form

Please complete the following (mandatory fields are marked with *):
Contact Details
Contact Name *
Contact Address *
Contact Postcode *
Email Address
Company Website URL
Contact Telephone *
When is the best time to reach you? * Between 9:00am and 1:00pm
Between 1:00pm and 5:30pm
Business Details
Business Description *
Details of all goods and/or services sold/provided *
Are you solely a retail outlet? * Yes
No
Do you undertake any manual work away from the premises? * Yes
No
Please select your business type * Sole Trader
Partnership
Limited Company
Business Address (enter only if different to contact address)
Business Address
Business Postcode
How long have you been trading? *
Renewal date of existing insurance or start date if new venture*
Who are your present insurers?*
Are they inviting renewal?* Yes
No
Please indicate this years renewal premium or the cheapest quotation you have had to date if a new venture
Claims Details
Detail all losses, whether claimed for or not, in the last 5 years (if you have had no losses and made no claims enter NONE) *
Are the premises to be insured in an area which has a history of flooding? * Yes
No
Are the premises to be insured in an area which has a history of subsidence? * Yes
No
Premises Details
How old are the premises? *
Type of premises * Detached
Semi-detached
Terraced
Are the premises located in a shopping mall? * Yes
No
Type of walls * Brick
Concrete
Stone
Timber
Type of roof * Tile
Slate
Concrete
Asphalt
Corrugated asbestos
Are there any areas of flat roofing? * Yes
No
Type of floor * Concrete
Timber
Do the premises have any floors beneath ground level? * Yes
No
Are the premises heated? * Yes
No
Security Details
Please indicate the security features your premises include * CCTV
NACOSS alarm with Redcare signalling
Key operated window locks to accessible windows
5 lever mortice deadlocks to BS3621 to all final exit doors
Do you or the shop manager live on the premises? * Yes
No
Details of Property to be Insured
Do you wish to insure the building? * Yes
No
Do you wish to extend buildings cover to include the risk of subsidence? * Yes
No
Please provide the sums to be insured in respect of:
Stock in trade (excluding frozen foods)* £
Frozen food stock * Yes
No
Wines & spirits *
(enter NIL if not required)
£
Tobacco goods *
(enter NIL if not required)
£
Video tapes *
(enter NIL if not required)
£
Non ferrous metals stock *
(enter NIL if not required)
£
Trade contents (including employees' personal effects) * £
Fixtures & fittings and interior decorations * £
Electronic office equipment *
(enter NIL if not required)
£
Do you have any other stock not detailed above? * Yes
No
Loss of income sum insured if in excess of £500,000 over 12 months £
Money in safe sum insured if in excess of £1,000 £
Money in transit and on the premises during business hours sums insured if in excess of £2,000 £
Do you operate a building society agency from the premises? * Yes
No
Do you have an ATM (cash dispenser) on the premises? * Yes
No
Do you require Loss of Liquor Licence cover? * Yes
No
Do you require cover against theft by employees? * Yes
No
Do you require Legal Expenses cover? * Yes
No
TO SUBMIT THIS ENQUIRY FIRST PLEASE INDICATE YOU HAVE READ OUR TERMS OF BUSINESS BY CHECKING THIS BOX
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