Shop 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 your business / trade?*

Date established at this address?*

Building Cover (if Required) £

Tenants Improvements ( if Applicable) £

General Contents/Fixtures and Fittings £*

Value of Electronic Equipment within the above £*

Stock Value (Exc High Risk Stock) £*

Target or High Risk Stock

Yes No

Target / High Risk Stock Type

Target / High Risk Stock Value £

Number of Employees*

Estimated Annual Turnover £*

Wageroll (per annum) £*

Do you carry out any Work Away from the premises?

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 Shop Front

Yes No

Grilles on Shop 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 enter the phrase as it is shown in the box above.