QUOTATION FORM

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PRINT THIS FORM AND FAX TO 01604 615407 OR COPY AND EMAIL TO carl.tero@insurance-world.co.uk


Questions

Name :

What is the full trading name of your business? E.g. John Smith trading as John Smith and Sons

Contact Telephone Number :

Which of the following best describes your business?

Individual - self employed

Individual(s) - Trading as...

Partnership

Company - Trading as...

Company (Public or Private)

Trustees for the time being

When do you want cover to begin (dd/mm/yyyy)?


Current Insurer?


Renewal Premium?

Last years premium?

How many people do you employ?

Wageroll?

What is your estimated annual turnover?

How many losses have you suffered, for any of the risks you want to insure within the last three years? Please provide details on a separate page, if any.

How many complete years have you been in business?

Do you need cover for Terrorism ? Yes / No

Is the building of standard construction?
(eg brick with slate roof) if not please advise

Property Details

What is the name or number of this property?

What is the FULL postcode of this property?

What is the nature of the business at this property?

Do you need cover for buildings?
Yes / No

How much cover do you need for buildings? £

How much cover do you need for loss of rent? £

Do You need cover for Contents?  yes/no

What locks are on the premises?

Do you have a fully operational alarm fitted by a company which is a registered member of an intruder alarm inspectorate which is UKAS accredited? If so please identify it.      Yes/ No



REDCARE

Digital Communicator

Other

Please tell us how much cover you require for the following (enter amount in pounds sterling):


Gifts? £

Stock in the building, including frozen foods? £

Fixtures and fittings? £

Clothing? £

Electrical equipment, eg autoclave, ultrasonice etc? £

Goods in transit? NIL £1,000 £2,500 £5,000

How much cover do you need for Gross Profit? £

How many months cover do you want?

12

24

36

Do you need cover for work or property away from the premises?
ie at conventions?

If Yes, how much cover do you need ?


Do you need cover for legal expenses?
Yes / No

Employers Liability?
Yes / No - £10 million

Public Liability?
Yes / No - £1 million £2 million £5 million

Products Liability?
Yes / No

Treatment Risks Cover?

Yes / No



PRINT THIS FORM AND FAX TO 01604 615407 OR  EMAIL carl.tero@insurance-world.co.uk