Shopkeepers Insurance - Quotation Request

Proposer's Name

E-mail address

Trading as

Address to be insured

Postcode

Telephone No

Fax No (optional)

About the building

What cover do you require

select >>> buildings only contents only buildings and contents  

if buildings cover is required, what sum insured?

Is the building...  (please complete even if only insuring contents)

Constructed of brick, stone or concrete and roofed with slates, tiles, concrete, metal or asbestos sheeting?

Yes No

Maintained in a good state of repair?

Yes No

Occupied by you in connection with your business and as a private dwelling?

Yes No

Heated by low pressure hot water apparatus, fixed gas appliances or fixed electrical appliances?

Yes No

If you have answered no to any of the above, please give details here  

About the contents

Please give the sum insured required for each category 

Category

Sum insured (£)

Business Equipment

Stock (excuding items below)

Tobacco, Cigarettes, Cigars

Wines & Spirits

Jewellery, precious metals or stones

Video equipment, cassettes, discs, computer or video games

Do you require cover for deteration of stock?

Yes No

if yes, insert sum insured

About the insured

Has the Insured or any director or partner incurred any loss, destruction or damage or had any claim made against them in the last 5 years?

Yes No

Insurance required from

Renewal date of present insurance (if applicable)