Shops, Cafe & Retailers

Pesonal Information

For What Date is the Insurance Required	Title
First Name	Surname
Business (Company) Name/Trading Name
Business Address	Email Address
Daytime Telephone No.	Mobile Telephon No.
What is the Legal Status of Business?	Is there a secondary trade or Occupation
Please Note: There is no need to specify a second trade unless work is undertaken that is distinct or separate the main trade and you need it to be covered by this policy
When was the business established?	How long have you held a responsible position working in this trade	YearsMonths
Losses
Have you had any losses or incidents that have or could have given rise to claims in the last 3 years		YesNo

Details

Premises (Retailers)

Does the security at the premises meet the Minimum Standards of Security	YesNo	Is there are an intruder alarm fitted to the premises which is in working order and is under your client's control	YesNo
In approximately what year were the premises built?		Where is the premises located
If the Buildings are listed or subject to a Building Preservation Notice, please specify the nature of the listing
Are the Premises located in an area with a history of flooding	YesNo	Are the premises heated solely by fixed systems?	YesNo
What are the floors constructed of		Are the premises occupied overnight by the Propprietor or a responsible employee	YesNo
Are your premises of Standard Construction built of brick, stone or concrete and roofed entirely with slates, tiles, metal or concrete?	YesNo	Approximately what percentage of the roof is flat?
Is the premises protected by any of the follwoing
Closed Circuit TV?	YesNo	24 hour site security?	YesNo
Do you use deep fat frying equipment at the premises	YesNo

Security (Retailers)

Cigraettes, cigars, and tobacco: (£)		Wines and Spirit: (£)
Video Taps, DVDs, CDs: (£)		Radio, TV, Audio & Video equipment: (£)
Computers, Computer Equipment & Games: (£)		Jewellery, Watches, Precious Metals & Stones: (£)
Cameras, Binoculars, & Photographic Equipment: (£)		Mobile Phones & Equipment: (£)
Prescription Drugs: (£)

All other stock not included in High Risk Stock entered above

All other stock in Trade: (£)

Customer goods in your custdy and control: (£)

Contents

Trade, Fixtures and Fittings: (£)
Please state total value of computers and Electroninc Business Equipment included within the Trade Fixtures and Fittings: (£)
All othe Contents: (£)

Buildings

Is cover for Buildings required?: (£)

Wines and Spirit: (£)

Other

Tenant's Improvements: (£)

Shop Fronts including glass, blinds and fittings: (£)

Business Interruption

Gross Profit: (£)		Maximum Indemnity Period: (£)
Account Receivable : (£)

Liability

Public and Products Liability: (£)

Maximum Indemnity Period: (£)

Working Away

Does the business undertake any work at customer or third party premises other than the delivery and collection of goods sold by the business?

YesNo

Business Money

Money in Transit, In a bank night safe and Money in the Premises during business hours:

Optional Extensions (Retailers)

Is Subsidenc Cover Required?	YesNo	Is cover required for business equipment whilst away from the premises?	YesNo
Are the premises to be insured License to sell alcohol?	YesNo	Is cover required for Theft by Employees? The limit of cover for this additional cover is restricted to £ 50,000 in respect of any one period of insurance	YesNo
Is cover required for Terrorism?	YesNo

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