Public House Insurance - Quotation Request

Proposer's Name

E-mail address

Trading as

Address to be insured

Postcode

Telephone No

Fax No (optional)

Contact Name

About the building

What cover do you require

select >>> buildings only contents only buildings and contents  

If buildings cover is required,
what sum insured?

Is the building...  (please complete even if only insuring contents)

Constructed of brick, stone or concrete and roofed with slates, tiles, concrete, metal or asbestos sheeting?

  Yes

  No

Maintained in a good state of repair?

  Yes

  No

Occupied by you in connection with your business and as a private dwelling?

  Yes

  No

Heated by low pressure hot water apparatus, fixed gas appliances or fixed electrical appliances?

  Yes

  No

If you have answered no to any of the above, please give details here

About the contents

Please give the sum insured required for each category 

Category

Sum insured (£)

Business equipment

Stock (excuding items below)

Tobacco, Cigarettes, Cigars

Wines & Spirits

Do you require cover for deteriation of stock?

  Yes

  No

if yes, please insert sum insured

About the insured

Has the Insured or any director or partner incurred any loss, destruction or damage or had any claim made against them in the last 5 years?

  Yes

  No

Does the Insured undertake to work away from the premises?

  Yes

  No

Does any other business occupy or operate from these buildings?

  Yes

  No

if the answer is yes to any of the above, please provide full details here

Insurance required from

Renewal Date (if applicable)

Preferred Payment Method

choose >>> Credit Card Debit Card Cheque Direct Debit