| CLIENT DETAILS |
* Name of proposer or company
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* Risk Address
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* Postcode
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* Contact Name
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Different Contact Address
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* Contact Address
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* Contact Postcode
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* Telephone
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Fax
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* Email Address
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| BUSINESS DETAILS |
* Full description of your business
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* Date established (YYYY-MM)
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| PREMISES DETAILS |
* Are the premises built of brick, stone, concrete and entirely of non combustible materials?
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* Details
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* Are the roofs built of slates, tiles, concrete and entirely of non-combustible materials?
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* Give details and % of any flat roof
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* Are the premises listed?
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* Is the premises fully occupied?
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* Details
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* Please select the current security
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Nacoss approved redcare alarm
Nacoss approved central station alarm
Other audible alarm
Shutters / grills
Mortice dead-locks
Night watchman / guard
Live on premises
Other
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If other then specify here
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* Do you have a sprinkler system?
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| SUMS INSURED |
* Buildings (£)
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* Tenants improvements (£)
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* Stock (£)
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* Machinery and Plant (£)
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* Contents (excluding electronic business equipment) (£)
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* Electronic business equipment (£)
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* Laptop computers (£)
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* Loss of rent payable (£)
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* Indemnity period
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* Glass (£)
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* Money (£)
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* Goods in Transit (£)
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* Loss of Profit/ Business Interruption (£)
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* Additional Cost of working (£)
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| MARINE RISKS |
Marina Installation (e.g. jetties, piers etc)
Please indicate Location, age,construction, nature and type
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Vessels as stock and for sale (£)
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Engines as stock and for sale (£)
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Trailers as stock and for sale (£)
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Craft owned (£)
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Trailers owned (£)
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Hire craft (£)
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Chartered
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Deliveries
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Builders Risks
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Maximum Value all hulls at any one time (£)
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Maximum value any one location (£)
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Estimated no. constructed per annum
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Hotwork undertaken (% of turnover)
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| LIABILITY |
| Employers Liability: £10,000,000 |
* Estimated Wageroll: Clerical (£)
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* Estimated Wageroll: Manual (£)
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* Public/products liability (£)
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* Estimated Turnover (£)
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| CLAIMS |
* Have you made any claims within the past 5 years?
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* Details
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* Has a policy ever been cancelled or have special terms been imposed?
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* Details
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* Renewal Date (YYYY-MM)
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If you have any further insurance requirements or material facts which should be disclosed to underwriters please give details
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