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 your premises in an Arcade or Shopping Centre? Yes   No
Non combustible construction? Yes   No
Do you have an intruder alarm? Yes   No
Sums Insured:
Buildings £
Stock of High Risk Items
(Cigarettes, tobacco, wines, spirits, precious metals and stones, non-ferrous metals & portable hand tools) 		£
Other Stock £
Computers & Electrical Office Equipment £
Other Business Equipment £
Frozen food £
Trade Specific Questions:
Do you require cover for work away from your premises other than collection or delivery? Yes   No
Do you require cover for Treatment Risk? Yes   No
If 'Yes' number of staff for cover:
Do you have Sun Beds? Yes   No
If 'Yes' how many:
Do you hire out equipment? Yes   No
If 'Yes' what type:
Loss of Revenue:
Do you need an indemnity period longer than 12 months? Yes   No
If 'Yes', how long    
Your name: Position: