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Shop Insurance Quotation Form

Use the form below to request a shop insurance quote

About You

Your Name

e-mail address

Home address

City

County

Post Code

Telephone

About the Premises

Address of the shop (Including Postcode)

Enter Address Here

Trade(s)

Location (high street, shopping mall etc)

Construction

Walls e.g. brick

Roof e.g. slate - any flat?

Security

Doors : e.g. locks/ shutters

Windows : e.g. bars

Alarms

CCTV

Sums Insured

Buildings

£(Probably not needed if you are only a tenant)

Fixtures & Fittings

Standard Stock

£(Stock other than 'high risk stock)

High Risk Stock

High risk stock is stock that is attractive to thieves. e.g. jewelry, clothing

Type of Stock	Sum Insured
	£
	£
	£
	£
	£

Tenants Improvements

Glass

Additional Covers

Goods in Transit

Business Interruption

£if wanted enter gross profit (sales - purchase costs) over year

Subsidence?

Terrorism?

All Risks on equipment

(Please note that public and employers liability will be included automatically)

History

Date Established

Put in 'new venture' if appropriate.

Claims in 5 years

(Full details as to dates, circumstances and costs

Risk Assessments

What measures have you taken to minimise risk?

Renewal Date

Insurance Company

Target Premium

£(This will be used solely to keep the price down. May we remind you that in many cases we can do a transfer of agency on a fixed commission basis -which should save you money if your premium is over £500.00)

Any other demands and needs?

Declaration I have completed the form to the best of my knowledge and belief. I have made a full disclosure of all material facts. I have read and understood the Important information below. I understand that there is no cover in force until confirmed by B. Portwood & Co Ltd, a satisfactory proposal form completed and accepted and payment of the premium made - either in full or an instalment plan set up acceptable to B. Portwood & Co Ltd.

Note: Hit submit button once only