Octagon House, 18 Nash Green, Hemel Hempstead, Herts. HP3 8AA        Phone :   01442 242 400
Shop
 
Name:
Email :
Business postcode :
Phone No :
Business Address :
Main trade :
Cover start date:   
Insure structure of the premises : Yes No
Do you own the building? : Yes No
Buildings sum insured amount? £ :  £
Shop fronts sum insured amount? £ :  £
Tenants improvements sum insured amount? £ :  £
Stock in trade sum insured amount? £ :  £
Cigarettes, cigars and tobacco sum insured amount? £ :  £
Wines and spirits sum insured amount? £ :  £
DVD's/CD's Video Tapes sum insured amount? £ :  £
Trade contents sum insured amount? £ :  £
Have you sustained any loss, damage, injury or disability or incurred any liability (whether insured or not) during the past 3 years in connection with your business? £ : Yes No