Please complete the following Office or Surgery Enquiry Form

General:
Company Name:
Address 1:
Address 2:
Post Code:
Telephone No:
E mail:
Business description:
Type of Firm: Limited Company
Partnership
Sole Trader
When established:    
Annual Turnover: £
Have you had any claims in the last 5 years: Yes   No
If Yes, please give details:
Premises:
Are your premises detached? Yes   No
Are you the only occupant? Yes   No
Non combustible construction? Yes   No
Do you have an intruder alarm under your sole control? Yes   No
Sums Insured:
Buildings £
Deeds,documents, photographs and computer software. £
Stock of samples £
Computers & Electrical Office Equipment £
Other Business Equipment £
Trade Specific Questions:
Do you require cover for work away from your premises other than non manual visits? Yes   No
Loss of Revenue:
Do you need an indemnity period longer than 12 months? Yes   No
If 'Yes', how long    
Your name: Position: