Proposer's Name
Contact Name
Address		Postcode	A value is required.
Telephone	A value is required.	Email	A value is required.Invalid format.
Business Description
No of Years In Business		Number of Employees
Renewal Date		Renewal Premium

Property Details

-Walls - Brick Brick/Steel Steel Wood Concrete Other - Floors - Concrete Stone Wood Other - Roof - Slate Steel Concrete Timber/Felt Other - Heating - Gas CH Electric Oil Portable Heaters None - Electrics Checked - Less than 12 months Less than 3 years Less than 5 Years Other - Intruder Alarm - BT Redcare Digital Commmunicator Bells Only None - Alarm Maintained - Yes No

-Fire Protections- None Fire Alarm Sprinlkers Alarm and Sprinklers -Window Security Window Locks Grilles/Shutters None -Lockdown Devices- None Fitted Some Fitted All Fitted

- Other Occupants - Yes No
Address of Property if different

Sums Insured / Estimates
Installation Type	Mainframe Mainframe and others PC Network PC only
Sum Insured	£
Portables	£
Software	£
Cover Required	All Risks - Premises Only All Risks - UK only All Risks - Worldwide
Reinstatement of Data	Yes No Sum Insured £
Increased Cost of Working	Yes No Sum Insured £

Claims	Date	Cause	Amount