Proposer's Name
Contact Name
Address
Postcode				Telephone
				Email
Business Description
No of Years In Business				Number of Employees
Renewal Date				Renewal Premium
Premises Information and Cover					Number of properties				One Two Three Four
Address of Property if different
Construction of the premises.
-Walls - Brick Brick/Steel Steel Wood Concrete Other - Roof - Slate Steel Concrete Timber/Felt Other - Floors - Concrete Stone Wood Other - 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 - BT Redcare Digital Commmunicator Bells Only None - Alarm Maintained - Yes No - Other Occupants - Yes No
Other occupants		No Yes				if yes
Approved Alarm		No NACOSS SSAIB				Alarm Signalling		None Bells Only Digicom Redcare
Property Sums Insured
Buildings							£
Loss of rent							£
Stock (ex non ferrous metals)							£
Stock of non-ferrous metals							£
Contents (ex Computers)							£
Computer Equipment							£
Tenants Improvements							£
Deterioration of Frozen Stock							£
Residual Computer Breakdown (additional costs)							£ Nil £20,000 £30,000 £40,000 £50,000 £100,000
Non Specific Cover Detail and Sums Insured
Business Interruption (Automatic Cover Twice Trade Contents)							£
Business Interruption Indemnity Period							Months
Book Debts							£
Turnover							£
Clerical and Sales Wages							£
All Other Employee Wages							£
Manual Work Away Wages (ex bona-fide sub-contractors							£
Payments to bon-fide sub-contractors							£
Heat Work Away							£
% of manual work relating to heat work away							%
Goods in Transit							£
All Risks
Description of Items			Europe or Worldwide				Sum Insured
			Europe Worldwide
			Europe Worldwide
			Europe Worldwide
			Europe Worldwide
			Europe Worldwide
Legal Expenses							No Yes
Contract Cover							No Yes
Claims Experience
Date			Cause				Amount
Please use this space to tell us about any other factors that you may feel are important or may affect the opinion of underwriters in assessing the risks associated with the insurance proposed.