Title		-Choose- Mr Mrs Miss Dr
Forenames
Surname
Company Name/Trading Name
No and street		address of the premises to be insured
Address 2
Town
County
Postcode		of the business premises
Telephone		Mobile
Email Address		quotes are sent by email
Date of Expiry of existing insurance/ or required from
Business Description				Night Club Late Bar Lap and Table Dancing Other see below
if unlisted please specify otherwise leave blank
Please describe the nature of live entertainments.
Do you charge an admission fee for entrance?				Yes No
Who else occupies the premises?				-Choose- Shop - Proposer lives on premises Shop- Employee Lives on Premises Shop - Manager Lives on Premises Lock up Shop Lock up shop with dwelling upstairs
Date Business Established				DD/MM/YY
Opening Hours (if closed all day enter closed in the open box)			Open			Closed
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
The Premises
-Walls- Brick Brick/Steel Steel Wood Concrete Other -Roof- Slate Steel Concrete Timber/Felt Other -Floors- Concrete Stone Wood Other ATM/Cash Machine No ATM Cash Machine Yes-inside premises Yes-outside premises
-Heating- Gas CH Electric Oil Portable Heaters None -Electrics Checked- Less than 12 months Less than 3 years Less than 5 Years Other -Intruder Alarm- NACOSS Approved BT Redcare SSAIB Approved BT Redcare NACOSS Approved Digital Commmunicator SSAIB Approved Digital Communicator Bells Only Alarm None
Shop Front Protection   -Choose- Roller Shutters External Grilles Internal Grilles None				Accessible Windows Protection   -Choose- Grilles and Window Locks Window Locks Internal Grilles None
Childrens Play Area No Yes -Food Please Choose- No Food Sandwiches and Cold Snacks Bar Meals No Deep Fat Frying Bar Meals inc Deep Fat Frying Full Restaurant Facilities -Accomodation Please Choose- None 1 Guest Bedroom 2 Guest Bedrooms 3 Guest Bedrooms 4 Guest Bedrooms
Sums Insured
Buildings				£Full rebuilding cost Year Built (Approx)
Landlords Fixtures and/or Tenants Improvements				£
Stock excluding items below				£
Wines and Spirits				£
Cigarettes and Tobacco				£
Shop Fronts and Fascia				£includes neon signs
All other contents				£Fixtures and fittings and any plant and equipment
Electronic Business Machines				£Tills, cash registers, computers etc
Business Interruption				£Estimated Gross Profit for 12 months
Loss of Money	Cash in Transit			£	Cash in Safe			£
Loss of License				Choose Yes No	Sum Insured			£
Frozen Foods Cover				Choose Yes No	Sum Insured			£
Goods in Transit				Choose Yes No			Please Select £1,000 £2,500 £5,000
Claims Have you had any losses in the last three years?	Yes No			Claim Details. Please include type of claim, dates and amounts paid
Please use this space to provide any other information that you feel may be important or relevant.