Post Code:

        Tel. Number:  

e-mail (if you have any):

Semi-detached Detached Bungalow Flat Terraced Other       If other, please state:

Yes No

7. THE CONSTRUCTION OF PREMISES (ie: Brick walls, Mild steel roof)

7.1 Is there a partial / full flat roof

Yes No

If "Yes" describe in detail:

7.2 Type of heating at premises:

Industrial Mixed residential/commercial Rural Other

8.1 If other, please state:

8.2 Approx distance from Police Station (Miles):  

Approx distance from Fire Station (Miles):

9.1 Please provide a full description of all processes carried out:

9.2 Do you have a deep fat fryer or a basket fryer?

Yes No

If "Yes" describe in detail:

9.3 Total Estimated Turnover:

9.4 Restaurants only, number of seats:

9.5 Do you have a children’s play area?

Yes No

If "Yes" please describe in detail:

10.1 Are the premises fitted with a:

Fire alarm : Yes No

Sprinklers: Yes No

Fire Extinguishers: Yes No

10.2 Are there any rivers or watercourses near the premises

Yes No

If "Yes" please give full details

10.3 Physical Security:

(eg. mortice deadlock, roller shutters)

11.1. Is there a burglar alarm under your sole control

Yes No

If "Yes" please state:

12.1 Have you had any previous insurers:

Yes No

12.2 Have you ever been declined, cancelled, refused or special terms:

Yes No

If "Yes" please give full details

12.3 Have you had any claims?

Yes No

If "Yes" please state here:

Date of claim:

What happened:

Total Payment:

1.

2.

3.

4.

SUM INSURED

Buildings (including outbuildings):

£

Stock in trade (exc wines/spirits):

£

Stock (wines & spirits):

£

Fixtures & Fittings:

£

All other contents:

£

Computer Systems:

£

Do you require Accidental Damage to apply on contents?

Yes No

Do you require Accidental Damage to apply on buildings?

Yes No

If you live on the PREMISES & would like a Quote for Personal Contents, please advise

Yes No