| Name: |
|
| Email : |
|
| Business Postcode : |
|
| Phone No : |
|
| Main trade :
|
|
| Business Address : |
|
| When do you want the cover to start? : |
 |
| What is the second trade on the premises? : |
|
| What is the third trade on the premises? : |
|
| Please state the material used for construction of floors : |
|
| Buildings sum insured amount? £ : |
|
| Do you require contents cover? : |
|
| Landlords contents sum insured amount? £ :
|
|
| Contents of common parts sum insured amount? £ :
|
|
| Rent sum insured amount per month? £ :
|
|
| Please select the numbers of months you require rent cover? : |
|
| Do you need to increase the cover for alternative accommodation above the standard £10,000? £ : |
|
| Book debts 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? : |
|
