Your Email:
Name of Proposer:
Status of Entity:
Correspondence Address:
Postcode:
Telephone Number:
Date business was established:
Can you comply with the following
Material Facts statement?
Not been declared bankrupt/insolvent:
Yes
No
Not been the subject of bankruptcy proceedings:
Yes
No
Not had a proposal refused or declined:
Yes
No
Not had a renewal refused:
Yes
No
Not had insurance cancelled:
Yes
No
Not had special terms imposed:
Yes
No
Has no non-motoring convictions or criminal offences:
Yes
No
Has no non-motor prosecutions pending:
Yes
No
Address of Property to be insured:
Is the property listed:
Yes
No
Year of build:
Standard Construction - Walls are built of brick, stone,
Slate or concrete and the roof is
Tiled, slate or concrete.
Yes
No
Date of purchase:
Number of floors of concrete construction:
Number of floors of wooden construction:
Any flat roof area?:
Yes
No
Any history of Subsidence
Yes
No
What method of heating is used?:
Minimum Security
Yes
No
The Final Exit door of the premises to be fitted with a mortice deadlock which has 5 or more levers and or conforms to British Standard.
All other external doors and all internal doors giving access to any part of the buildings not occupied by the Policyholder for the purpose of the business be fitted with either:
A mortice deadlock with matching boxed striking plate
Or
Two key – operated security bolts for doors
All ground floor and basement opening windows/sky lights and other opening windows/skylights accessible from roofs, decks, balconies, fire escapes, canopies or down pipes be fitted with key-operated window locks.
Buildings Sum Insured:
Landlords Contents:
Included at £10,000
Do you wish to increase this amount?:
Yes
No
If yes, please provide amount and brief
description :
What is the type of property i.e.
Detached, semi-detached etc :
Is the property occupied:
Yes
No
What is the type of resident i.e.
Private rental, student, commercial.
Property Owners Liability :
Included at £2m
Previous Claims:
Renewal Date:
Current Insurer:
Target Premium:
