SHOP QUOTE FORM

Your Email:

Company Name:

Status of Entity:

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

Turnover for next 12 months:

Number of Employees:

Intruder Alarm:

Additional security details i.e. Shutter/Grills/CCTV:

Buildings Inc Subsidence:

Shop front required:

Yes No

Tenants Improvements:

Yes No

Purpose Built:

Yes No

Standard Construction - Walls are built of brick, stone, Slate or concrete and the roof is Tiled, slate or concrete.

Yes No

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.

Location:

High Street Business Park Market Shopping Arcade Parade Covered Shopping Centre

Occupancy:

Business Hours Day Night 24HR

ATM on Premises:

Yes No

Public Liability:

Included

Employers Liability :

Included

Contents :

Computers:

Electronic Equipment:

Fixtures & Fittings:

Gross Profit:

Money:
During business hours, bank night safe, in safe out of hours, in transit, out of safe out of hours and in safe.

Yes No

Previous Claims:

Renewal Date:

Current Insurer:

Target Premium: