Your name
Trading Name
Business Type
Business Type
Sole Trader
Partnership
Ltd Liability Company
E-mail address A
status disclosure document will be sent to this address
Your Address
Shop Address
Post Code of shop (Essential)
Trade (give all)
How long have you been
established? years
(enter '0' for new venture)
Renewal Date
Annual Turnover £
No Of employees
Construction of Property
Standard
10% non standard
25% non standard
More than 25% non standard
Standard = brick/ stone
and roofed with slate/tiles
Is property self contained with
its own separate exit/ entrance?
Yes
No
Sums Insured
Buildings
Landlord Fixtures
Shop Front (Ignore Glass - Glass cover
is provided automatically)
Contents (other than below)
Fixtures/Fittings
Stock : Other than:- Enter stock value
Babywear
These items are 'Target Stock'. If your shop sells
them
Clothing
as part of its main trade e.g. a clothing shop sells
clothing
Computers
or a mobile phone shop sells mobile phones, then you
do not
Clothing
have to declare them as 'Target Stock' merely normal
stock.
Electronic equipment
If, however, the stock is incidental e.g. a newsagent
selling
Jewellery
& Watches wines/ spirits, then they should be declared.
Leather
Goods
Mobile
Phones
Music
Non-Ferrous
Metal
Office
Equipment
Oriental
Carpets
Photographic
Equipment
Power
Tools
Tobacco
Video
Tapes and DVDs
Wines
& Spirts
Works
of Art
Shop insurance policy
benefits
Money in Safe
Cash on
Premises
Book Debts
Business
Interruption (24 months)
Goods in transit
If you do require any specific sums insured,
please fill in the
Loss of licence
appropriate field and we will ensure that our
quote meets
Frozen Food
your requirements if possible.
Public Liability
£2,000,000
£3,000,000
£4,000,000
£5,000,000
Optional Covers
Accidental Damage on Contents
No
Yes
Fidelity Guarantee
No
Yes
covers staff dishonesty
Personal Accident cover for
employees
No
Yes
No employees
Policy Excess
£100.00
£250.00
£500.00
£750.00
1000.00
Security Features
(Select all those
applicable by ctrl + click)
NB For some trades and locations the policies we
offer may require a certain level of security.
5 Lever Locks on all external doors
Window locks on all accessible windows
Burglar Alarm - Bells Only
Burglar Alarm - Cenral monitoring (non nacoss)
Burgalr Alarm - central monitoring - NACOSS
CCTV outside shop (24 hour)
CCTV inside shop (24 hour)
Grills on windows
Shutters on windows and doors
Policyholder Lives on premises e,g, flat above
Other person lives on premises
Enclosed Shopping centre
Side Bars
REDCARE
PAKNET
DUAL COM
REDCARE GMS
If you have an alarm
will police respond?
No
Yes
CLAIMS DETAILS
Current Insurance company Renewal Date
Premium
GENERAL QUESTIONS
(Give details if necessary)
No Director/Partner has been made bankrupt or insolvent.
A director/partner HAS been made Bankrupt
No-one has any convictions (ignore motor)
A Director/ Partner has criminal convictions
No one has had special terms imposed, renewal refused, or policy cancelled
Soemone has had a policy cancelled - non disclosure
Someone has had a policy cancelled - claims
Someone has had a policy cancelled - Other
Someone has had a policy renewal refused - Claims
Someone has had a policy renewal refused - non disclosure
Someone has had a policy renewal refused - other
Someone has had special terms imposed - claims
Someone has had special terms imposed -other
I have declared all material facts - including information below
Please
send me an initial quotation. I realise this will be
an approximate guide to the actual premium payable
which can only be confirmed when I have completed a
proposal form.
Other
information / material
facts e.g. non-standard construction details, criminal
convictions, bankruptcy etc
Material Facts A material fact
is one that could affect the insurance in any way. Examples of
material facts are: convictions, claims etc. You have a duty to
disclose all material facts before you take out a policy, if they
should change and at each renewal. If you are in doubt
whether a fact is material it should be disclosed. Failure to
disclose a material fact could result in your policy being
declared void or having a claim refused. We accept no liability
should a claim be refused or a policy voided due to non disclosure
of material facts.
