Quote4Insurance
Shop & Office Insurance
Section 1 - Personal Details
Title
Mr.
Mrs.
Miss
Dr.
Rev.
First Names
Surname
Address
Town
City
Postcode
Telephone
Email
Target Premium
Requested By
Section 2 - Claims History ( 5 years )
Date
Cause of Loss
Amount £
Section 3 - Trade / Profession
Type
Premises solely occupied by Proposer as Offices/Sales Shop ?
Yes
No
Select
If NO then give details
When was the Business Established?
How Long in business at these premises?
Standard Construction?
Yes
No
Select
If No then give details
Security Alarms?
Yes
No
Select
NACOSS Approved?
Yes
No
Select
If YES - Type of signalling (i.e. Bells only, Digi Comm, Redcare etc.)
Will Proposer fit/upgrade security
Yes
No
Select
Section 4 - Sums Insured Office
Buildings
Contents
Portable Electrical Equipment
Tenant's Improvements
Trade Samples
What do these comprise?
Legal Expenses ?
Inc. Contract Disputes
Increase Costs of Working Only?
Loss of income and ICOW
Book Debts
Section 3 - Sums Insured Shop
Buildings
Stock
Wines & Spirits
Tobacco
Fixtures & Fittings
Videos
Frozen & Chilled Food
Goods in Transit
Accidental Damage
Yes
No
-- Select--
Legal Expenses?
Yes
No
-- Select--
How did you hear of
Quote4insurance
?
e.g. Name of magazine/newspaper you saw our advert in, T.V., radio, Teletext,diverted from other site = please name site / search engine, internet advert etc.