Proposer's Name
Address		Postcode
Telephone		Email Address
Business Description	Property Owners	Other Occupation		No of Years In Business

Details of the Let Property

Address

Postcode

Occupancy One		Occupancy Two		Occupancy Three
- Walls - Standard Non Standard - Roof - Standard Non Standard - Floors - Timber Concrete Timber & Concrete Other - Stairs - Metal Other Concrete Timber Timber & Concrete Are the premises self contained? Yes No Is any part unoocupied? No Yes
Fire Alarm None Class A Class B Class C Unknown Sprinkler Systems None 28th Edition Class I 28th Edition Class III 28th Edition Ordinary 28th Edition Standard A 28th Edition Stamdard B 29th Edition Grade I 29th Edition Grade II 29th Edition Grade III 28th Edition Class II Subsidence Cover Required Not Required

Year Built		Minimum Letting Period	months
Buildings Sum Insured		Outbuildings		Loss Of Rent	£	Months
Fixtures and Fittings		Special Glass		Shop Front
Communal Contents		Property Owners Liability	Limit of Indemnity £1Million £2Million £5Million	Do you require Employers Liability Insurance?	Yes No

Claims	Date	Cause	Amount