Property by Yutree

Quote Form

Date of submission

Insurance broker

Contact Info

Your name

Your email

Your phone number

The Insured

The Insured (full company name including any subsidiary companies)

Registered address

Business description

Year business established

Client website address

Has any proposer, director or partner of the business or practice ever been declared bankrupt/insolvent, or the subject of bankruptcy proceedings including CCJs?

Yes

Has any proposer, director or partner of the business or practice had any convictions, criminal offences or prosecutions pending other than motor offences?

Yes

Has any proposer, director or partner of the business or practice received any HSE enforcement notices, improvement notices or prohibition notices?

Yes

Has any proposer, director or partner of the business or practice ever had a proposal refused or declined or ever had an insurance policy cancelled, renewal refused or had special terms imposed?

Yes

If you answered ‘no’ to any of the above, please provide details:

Period of insurance required from:

Period of insurance required to:

Target premium (not incl IPT)

Premises addresses

Premises 1

Premises 2

Premises 3

Premises 4

Existing Cover

Current Insurer

Number of years insured with current insurer

Renewal date

Last renewal premium

Policy Sections Required

Buildings & Contents

Yes

All Risks Specified Items

Yes

Money

Yes

Goods in Transit

Yes

Deterioration of Stock

Yes

Business Interruption

Yes

Loss of Liquor Licence

Yes

Book Debts

Yes

Terrorism

Yes

Buildings & Contents Section

Premises 1

What activities are carried out at this premises (e.g. manufacturing, woodworking, warehousing):

Untitled

What fire protections are at the premises (please include alarm details, if applicable)?

What CCTV is there at the premises (please include whether this is monitored or recorded)?

What intruder alarm is at the premises (please include details of system, grade, method of communication, and police response)?

What is the construction of the premises (if not standard, please provide details)?:

What methods of heating are used at the premises (e.g. portable heaters, fixed heating systems etc.)?

Is the premises single occupancy (if not, please provide details)?:

Are there manufacturing processes operating unattended when no employees are present within the building?

Yes

Please provide details of any stock that is stored in the open, or in any open sided building?

Was the premises built before 1700?

Yes

Is there any storage in excess of 6 metres high?

Yes

Sum Insured 1

Buildings - Declared Value (£)

Sum Insured (£)

Sum Insured 1

Tenants Improvements - Declared Value (£)

Sum Insured (£)

Sum Insured 1

Contents (including computers) - Declared Value (£)

Sum Insured (£)

Sum Insured 1

Stock - Declared Value (£)

Sum Insured (£)

Sum Insured 1

Target Stock (£)

Sum Insured (£)

(Defined as perfumes, aftershaves, TV, video, DVD, audio and computer equipment and accessories, photographic equipment, jewellery and watches, mobile phones and phone cards, cigarettes, cigars and tobacco, spirits, musical instruments, oriental rugs, works of art, leather goods, sports goods and clothing.)

Sum Insured 1

Rent (months Indemnity Period)

Sum Insured (£)

Do you wish to add any more premises?

Yes

Premises 2

What activities are carried out at this premises (e.g. manufacturing, woodworking, warehousing):

What fire protections are at the premises (please include alarm details, if applicable)?

What CCTV is there at the premises? (please include whether this is monitored or recorded)?