Business at Home Insurance - Quotation Request

Proposer's name

E-mail address

Contact telephone no.

Contact fax no.

Marital status

select >>> married single partnered divorced separated widowed  

Occupation

Date of birth

Employer's business

Spouse/Partner/Joint Proposer

Name

Marital status
(please select)

select >>> single married partnered divorced separated widowed  

Occupation

Date of birth

Employer's business

About the business/contact information

Your postal address

Postcode

When did you move to
this address?

Month

Year

Address to be insured
(if different to the above)

Postcode

Trading name of business

Names of Directors or Partners

Is the business VAT registered?

  Yes

  No

Business description or Trade
(please describe all activities to be insured)

Year business established at these premises

Contact name
(if different form Proposer)

General Questions

Have you or any member of your family living with you...

Had an application for insurance declined, renewal refused, cover terminated, increased premium required or special conditions imposed by any insurer?

  Yes

  No

Been convicted, or charged but not yet tried, for any offence other than a driving offence?

  Yes

  No

ever been decared bankrupt or insolvent?

  Yes

  No

if you have answered 'yes' to any of the General Questions above please give details below

About the premises

Is the home a

please select >>> house bungalow maisonette flat other  

if 'other' please describe

If a house or bungalow is it

please select >>> detached semi-detached end terraced mid terraced  

If a flat is it

please select >>> purpose built converted  

Is the home

please select >>> owned by you rented -furnished rented - unfurnished  

Approximately, when was the property built?

Please confirm the following about the property...

The property is built of brick, stone or concrete with a slate, tile, metal, concrete, asbestos or asphalt roof

  Yes

  No

The property is in a good state of repair

  Yes

  No

The property is not regularly left unoccupied throughout the day or night or left unoccupied for longer than 30 days

  Yes

  No

The property is not in an area susceptible to flooding

  Yes

  No

The property is in an area free from subsidence, heave and landslip

  Yes

  No

The property is free from cracks to external walls

  Yes

  No

if you have answered 'no' to any of the above please give details below

About the property's security

Does the property have an alarm system installed and maintained under contract by a NARCOSS or SSAIB registerd company?

  Yes

  No

When was this system installed

Who were the installing company

Have you fitted the required door and window locks/bolts?

  Yes

  No

Core Covers

(The cover chosen under domestic contents will also apply to the Business Contents section.
*Valuables are classed as jewellery, gold and silver items (including plated items), watches, clocks, furs and collections of medals and coins, pictures, sculptures and other works of art and stamp collections). The excess amount chosen will also apply to the Business Contents section.

Domestic Contents

Do you require standard cover or accidental damage cover?

please select >>> accidental damage standard  

Sum insured (min £15,000)

Does the total value of valuables *(see note above) exceed 25% of the amount to be insured?

  Yes

  No

if yes please state the total value of valuables*

Please select your desired excess amount

select >>> £100 £250 £500 £1,000  

Business Contents

Please state the sums insured  you require for the following;

Business contents

Business stock

What is the replacement value of electronic office equipment used in connection with the business

Business Liability

Please state the level of cover required for the following;

Employers Liability

Public Liability

Do you do any work away from your own home that involves the use of heat?

  Yes

  No

if 'yes' to the above please give details

Do you wish to include Product Liability cover?

  Yes

  No

if  'no' please click here, if 'yes' please complete the following

Annual turnover of your business

Now, please give details of the following

Products manufactured

Products sold or supplied

Other work or services

Will any of your products be supplied directly or indirectly to the USA or Canada?

  Yes

  No

if 'yes' please give details below

Optional Covers

Buildings

Do you require cover for the Buildings of your home?

  Yes

  No

if 'no' please click here, if 'yes' please complete the following;

Do you require

please select >>> standard cover accidental damage cover  

Sum Insured

Please state your desired excess

please select >>> £50 £100 £250 £500 £1,000  

Is the home a listed building?

  Yes

  No

if 'yes' to the above please give details including the listed grade

Personal & Business Possessions

Do you require this cover?

  Yes

  No

if 'no' please click here, if 'yes' please complete the following;

Unspecified Items - Personal Possessions Only
The amount to be insured for clothing, baggage, other items of personal use normally worn or carried (including gold and silver items), jewellery, watches, musical instruments, photographic equipment, binoculars, telescopes, furs, sports equipment, tools, contact lenses, telephones (but excluding hands free accessories and airtime) and pedal cycles not exceeding £400 each. Please note any one item may not exceed £1,000

Sum insured

Please detail below any other items you wish to insure e.g. pedal cycles over £400. Please state item and value

Business Interruption
Do you require this cover

  Yes

  No

Please insert the gross profit figure you require

Additional Question for Hairdressers Only

Are all dyes, bleaches and tints used of proprietary brands only

  Yes

  No

Claims History

Has any incident occured in the last five years which has or could have given rise to a claim in relation to the risks proposed?

  Yes

  No

if 'yes' please give details below, if 'no' please click here

Cause

£ Amount

Date

Renewal Date of present insurance (if applicable)

Insurance required from

Preferred Payment Method

choose >>> Credit Card Debit Card Cheque Direct Debit