Office/Surgery Insurance Quotation Form

Please complete as much of this form as possible as it will allow us to provide you with the most competitive quotation. Fields marked with an * are required.


Name and Trading Title*

Risk Address

Building Number or Name*

Street Address*

Postal Town*

County

Post Code*

Contact*

Telephone Number*

Email Address*

Best method to contact you

Contact me by

Telephone E-Mail

If by Telephone please select

Best Days

Monday Tuesday Wednesday Thursday Friday Saturday

Best Time

Any Time 9am - Noon Noon - 3:00pm 3:00pm - 6-00pm


Business Details

Nature of the business*

Date Established*

Building Cover (if Required) £

Tenants Improvements ( if Applicable) £

General Contents/Fixtures and Fittings £*

Computer and Ancillary Equipment £*

Other Electronic Business Equipment £*

Stock Value (if required) £

Number of Employees*

Estimated Annual Turnover £*

Clerical Wageroll (per annum) £*

Work Away

Yes No


Building Information

Wall Construction*

If other please give details

Roof Construction*

If other please give details

Flat Roof

Yes No

Flat Roof Percentage

Year Built*

Number of Stories

1 2 3 4 5 6 plus


Security Details

Shutters on Office/Surgery Front

Yes No

Grilles on Office/Surgery Front

Yes No

Grilles or Shutters on other doors/windows

Yes No

Give details (if applicable)

Alarmed

Yes No

If Yes Type

Audible Digicom Redcare Packnet

Installer*

Annual Maintenance Contract

Yes No

Physical Securities

Yes No

If Yes Please give details

Any Additional Information


Current Insurance Details

How many claims in the last 5 years

0 1 2 3

Brief details of claim(s)

Current Insurer*

What is the renewal date of your current policy?*

Renewal/Expiring Premium £*


Please confirm you have read the Fair Processing Notice before submitting this quotation request*

Please enter the phrase as it is shown in the box above.   

Henderson Insurance (NE) Limited Fair Processing Notice

In your dealings with us you may provide information that includes data that is known as personal data.
The personal data we collect will include data relating to your name, address, date of birth, wider contact details and data relating to health or criminal offences.

We will process your personal data to allow us to provide you with our services as your insurance broker in quoting for, arranging and administering your insurances and in arranging insurance premium finance, where applicable.

It will also be used to manage future communications between ourselves and communicate about our products and services. You can opt out from receiving such communications services by emailing info@hendersoninsurance.co.uk.

We will only use your data for the purpose for which it was collected. We will only grant access to or share your data within our firm, with authorised partners, and our market service providers such as insurers and premium finance providers where we are required or entitled to do so by law under lawful data processing.

If you require further information on how we process your data and our lawful basis for doing so, please contact our data privacy representative by emailing info@hendersoninsurance.co.uk or view our Privacy Notice at www.hendersoninsurance.co.uk.