| Business
at Home Insurance - Quotation Request
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Proposer's name
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E-mail address
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Contact telephone no
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Contact fax no
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Marital status
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Occupation
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Date of birth
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Employer's business
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| Are you an existing Rowett Insurance
client? |
Yes
No |
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Spouse/Partner/Joint Proposer
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Name
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Marital status
(please select)
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Occupation
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Date of birth
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Employer's business
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About the business/contact information
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Your postal address
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Postcode
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When did you move to
this address?
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dd/mm/yyyy
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Address to be insured
(if different to the above)
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Postcode
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Trading name of business
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Names of Directors or Partners
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Is the business VAT registered?
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Yes
No
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Business description or Trade
(please describe all activities to be insured)
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Year business established at these premises
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Contact name
(if different form Proposer)
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General Questions
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Have you or any member of your family living with you
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Had an application for insurance declined, renewal refused,
cover terminated, increased premium required or special
conditions imposed by any insurer?
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Yes
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No
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Been convicted, or charged but not yet tried, for any offence
other than a driving offence?
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Yes
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No
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ever been decared bankrupt or insolvent?
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Yes
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No
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if you have answered 'yes' to any of the General Questions
above please give details below
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About the premises
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Is the home a
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if 'other' please describe
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If a house or bungalow is it
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If a flat is it
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Is the home
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Approximately, when was the property built?
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Please confirm the following about the property
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The property is built of brick, stone or concrete with
a slate, tile, metal, concrete, asbestos or asphalt roof
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Yes
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No
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The property is in a good state of repair
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Yes
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No
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The property is not regularly left unoccupied throughout
the day or night or left unoccupied for longer than 30 days
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Yes
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No
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The property is not in an area susceptible to flooding
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Yes
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No
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The property is in an area free from subsidence, heave
and landslip
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Yes
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No
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The property is free from cracks to external walls
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Yes
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No
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if you have answered 'no' to any of the above please
give details below
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About the property's security
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Does the property have an alarm system installed and maintained
under contract by a NACOSS or SSAIB registerd company?
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Yes
No
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When was this system installed
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Who were the installing company
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Have you fitted the required door and window locks/bolts?
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Yes
No
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Core Covers
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The cover chosen under domestic contents will also apply
to the business contents section.
*Valuables are classed as jewellery, gold and silver items
(including plated items), watches, clocks, furs and collections
of medals and coins, pictures, sculptures and other works
of art and stamp collections). The excess amount chosen
will also apply to the Business Contents section.
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Domestic Contents
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Do you require standard cover or accidental damage cover?
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Sum insured (min £15,000)
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Does the total value of valuables *(see note above) exceed
25% of the amount to be insured?
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Yes
No
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if yes please state the total value of valuables*
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Please select your desired excess amount
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Business Contents
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Please state the sums insured you require for the
following;
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Business contents
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Business stock
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What is the replacement value of electronic office equipment
used in connection with the business
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Business Liability
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Please state the level of cover required for the following;
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Employers Liability
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Public Liability
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Do you do any work away from your own home that involves
the use of heat?
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Yes
No
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if 'yes' to the above please give details
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Do you wish to include Product Liability cover?
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Yes
No
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if 'no' please click here,
if 'yes' please complete the following
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Annual turnover of your business
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Now, please give details of the following
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Products manufactured
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Products sold or supplied
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Other work or services
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Will any of your products be supplied directly or indirectly
to the USA or Canada?
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Yes
No
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if 'yes' please give details below
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Optional
Covers
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Buildings
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Do you require cover for the Buildings of your home?
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Yes
No
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if 'no' please click here,
if 'yes' please complete the following;
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Do you require
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Sum Insured
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Please state your desired excess
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Is the home a listed building?
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Yes
No
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if 'yes' to the above please give details
including the listed grade
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Personal & Business Possessions
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Do you require this cover?
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Yes
No
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if 'no' please click here,
if 'yes' please complete the following;
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Unspecified Items - Personal Possessions Only
The amount to be insured for clothing, baggage, other items
of personal use normally worn or carried (including gold
and silver items), jewellery, watches, musical instruments,
photographic equipment, binoculars, telescopes, furs, sports
equipment, tools, contact lenses, telephones (but excluding
hands free accessories and airtime) and pedal cycles not
exceeding £400 each. Please note any one item may not exceed
£1,000
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Sum insured
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Please detail below any other items you wish to insure
e.g. pedal cycles over £400. Please state item and value
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Business Interruption
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| Do you require this cover |
Yes
No |
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Please insert the gross profit figure you require
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Additional Question for Hairdressers
Only
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Are all dyes, bleaches and tints used of proprietary brands
only
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Yes
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No
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Claims History
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Has any incident occured in the last five years which has
or could have given rise to a claim in relation to the risks
proposed?
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Yes
No
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if 'yes' please give details below, if 'no' please click
here
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Cause
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£ Amount
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Date
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Renewal Date of present insurance
(if applicable)
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Insurance required from
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Preferred Payment Method
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Business
at Home Insurance
