Commercial
& Industrial Insurance - Quotation Request
About you...
Proposer's name
Contact name
E-mail address
Company or trading name
Business address
Postcode
Telephone No
Fax No (optional)
Correspondence address (if different from the above)
Postcode
About the business
Please give details of:
Trade or business at your premises
Work or services undertaken away from your premises
Manufactured products
Other products sold or supplied
Insurance required from
to
Buildings & Contents Cover
Insured Item(s)
Declared value (£)
Buildings
Contents
Stock
Electronic Business Eqpt
Computers
Other property (please give a description and value)
Description
Declared value (£)
Buildings & Contents - General Questions
Are the premises:-
Built of brick, stone or concrete and roofed with
slates, tiles, concrete, metal, asbestos or sheets or slabs composed
entirely of incombustible mineral ingredients and plastic roof
lights?
In a good state of repair and will be so maintained?
In a position or area likely to be subject to flooding
or where flooding has occured?
Has the electrical installation been inspected
by a qualified engineer during the past 5 years?
Are you the sole occupier of the premises?
Are the premises protected by an intruder alarm?
if yes please state the name of the installer
and the method of signalling
select >>>
Bell Only
Digital Communicator
BT Red Care
Questions regarding subsidence
Do you wish to extend your cover to include subsidence?
if 'yes' please complete the following questions, if 'no'
please click here
Has the property or any adjacent property previously suffered
damage from subsidence?
Are there any visible signs of cracking?
Is the property erected on made up ground?
Business Interruption
and Loss of Accounts Receivable
Please state estimated gross profit
The standard indemnity period is 12 months, do you wish to increase
this by 24 months
Loss of accounts receivable is automatically included for a sum
insured up to £10,000. If this amount is inadequate please state
the extra amount of cover you require
Customers and Suppliers Extensions
Cover for an interruption to your business following an insured
loss at a customers or suppliers is covered up to £10,000. If
you wish to extend this please provide details below.
Name of customer
Amount required (£)
Name of supplier
Amount required (£)
Liability Cover
Employers Liability Please state limit required
Please give estimated annual wages, salaries and other earnings
for the next 12 months
Description of employees
Estimate (£)
Clerical Staff (including commercial travellers and managerial
employees who do not engage in manual labour)
Woodworking machinists and their labourers (employees whose work
with woodworking machinery is restricted to the use of lathes,
fret-saws, boring machines, sanding machines and mechanically
driven portable hand tools (other than pendulum and swing saws)
may be included under 'other employees'
Work carried out at a height of more than 10 metres above ground
or floor level
All other employees working on own premises
Description of work undertaken
Estimate (£)
All other employees working away from own premises
Description of work undertaken
Estimate (£)
Public/Product Liability
Please state limit required
Wages of all your employees (including working principals,
directors, partners, etc)
Description
Estimate (£)
working on your premises
working away from your premises and involving the use of heat
working away from your premises and not involving the use of
heat
Other payments
Estimate (£)
Payments to sub-contractors working away from your own premises
Charges for plant/equipment hired in
Turnover of your business for sales
and/or services
Estimate (£)
within the UK
within the USA and Canada
Elsewhere in the World
Liability Section - General Questions
Has any prosecution, prohibition notice or improvement order
been placed on the company under any health and safety legislation
during the past 5 years?
Do you or any of your employees operate fixed powered woodworking
machinery?
if Yes' please state the number of machines in operation
at any one time
Does your trade or business involve the discharge of effluent,
fumes or anything of a noxious nature?
Do you work on or in aircraft operational areas, water-borne
craft, offrshore or in nuclear installations, petrochemical works
or power stations?
Do you undertake to provide design specification, formula or
advice
(a) in connection with your product?
(b) separately for a fee?
Do you import materials, components or products from outside
the European Community?
Do you have a system in force for checking quality control?
Are any products intended for installation in or to form part
of an aircraft, water-borne craft, offshore installations, nuclear
installations, petrochemical works or power stations?
Do you enter into any contracts or agreements which may affect
your liability under statute or common law?
Goods
in Transit (optional cover)
Do you require this cover?
if 'yes' please complete the section below, if 'no' please click
here
Please state the type of property carried
Please state the number of vehicles and sums insured per vehicle
and trailer
No of vehicles
Sum Insured per vehicle
Sum Insured per trailer
General
Information
How long has the business been established?
Have you or any of your partaers or directors either personally
or in connection with any business which you/they have been involved:
Previously held insurance for any of the covers to which this
Proposal relates at these premises or elsewhere?
Held any insurance (in respect of the covers to which this Proposal
relates) which has subsequently been:
i) declined?
ii) terminated?
iii) refused renewal?
iv) subject to special terms?
if 'yes'please give details
Ever been convicted or charged (but not yet tried) with a criminal
offence other than a motoring offence?
Ever been declared bankrupt or are the subject of any current
bankruptcy proceedings or any voluntary or mandatory insolvency
or winding up procedures?
Are any additlonal interests to be endorsed on the policy?
if 'yes' please give details
Has there been any incidents in the last five years which have,
or could have given rise to any claims under this section?
if yes, please give full details in the box below including dates,
details of claims, any monies paid and outstanding
Insurance required from
Renewal Date of present insurance (if applicable)
Preferred Payment Method
choose >>>
Credit Card
Debit Card
Cheque
Direct Debit
