Please complete the following Small Business Package 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
Other
If 'Other' please specify:
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
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 £
Portable Hand Tools £
Other Business Equipment £
Number of vehicles operated by you    
Public Liability limit of indemnity required    
Employees:
Clerical, Admin & Sales only Total Annual wage roll £
Manual workers at your premises Total Annual wage roll £
Manual workers away from your premises Total Annual wage roll £
N.B. if you use labour only subcontractors these must be treated as employees.
Do you use fixed woodworking machinery? Yes   No
Annual wage roll for such employees £
Do you use heat equipment away from your own premises? Yes   No
Annual wage roll for such employees £
Are your products used or do you work in manufacturing premises for the following industries:
Petrochemical, Pharmaceutical, Aviation, Marine, Automotive, Oil, Gas or Nuclear? 		Yes   No
Your name: Position: