Name   email

Trading Name Tel & Fax:

Correspondence Address Post Code

Property to be insured: Post Code

Full Buisness Description:

How Long Trading at these premises: Other Premises yrs

Are the premises protected by an alarm system? Yes No

Is it Nacoss approved and under maintenance? Yes No

Please give details of system and method of signalling

Buildings Sum Insured Standard Building/Roof Construction Yes No

Age of building:

Plant, machinery, fixtures and fittings and all other contents excluding computers:

Computers: Glass: Money:

Business Interuption:

Employers Liability £10,000,000

Number of employees Annual Turnover

Estimated annual wage salaries and payments

Public & Products Liability 1,000,000 2,000,000 5,000,000

Claims History over last five years Leave blank if Nil claims

Commencement date of Cover