* Full Name

Property Details

Are the premises built in brick, stone concrete and roofed with slate, title , metal
asbestos or concrete?

Client History

Have you suffered any losses in the last five years whether claimed for or not?

(This should include other trading names/ Premises and if a Limited Company all Directors loss experiences in the last 5 years . For other companies for which Directorship is/ has been held)

Yes No

If yes, please provide details of the claim.

YEAR ESTABLISHED

OCCUPATION

At the proposed premises are they occupied solely by the Proposer?

Yes No

If No, please list below all tenants (DSS / Working / Students / Residential) and where they are situated within the Building;

COVER REQUIRED

Your policy will cover the following, please add any extra covers required or delete as applicable

SECURITY PRECAUTIONS

If the premises are alarmed, what type of system has been installed:
(Please tick the applicable alarm type)

BT REDCARE DIGITAL COMMUNICATOR AUDIBLE ONLY

DIRECT LINE

Please provide security details of all external doors; i.e. type of locks (5 lever) wood/metal etc

Are any ground floor windows fitted with Grills//Bars?

Are any upper floor windows fitted with Grills/Shutters/Bars?

If any skylights, how are they protected

Please provide details of any other security measures that are in place:

SUMS INSURED

Main Building (This should represent full rebuilding cost) 

Wine / Spirits                      

For Employers / Products / Public Liability please provide: