Proposer's Name
Contact Name
Address
		Postcode
Telephone		Email

Business Description

No of Years In Business

Number of Employees

Renewal Date

Renewal Premium

Address of Property if different
-Walls - Brick Brick/Steel Steel Wood Concrete Other - Roof - Slate Steel Concrete Timber/Felt Other - Floors - Concrete Stone Wood 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

- Other Occupants - Yes No

Buildings	£
Loss of rent	£
Stock (exc Wines and Spirits and Tobacco)	£
Stock of Wines and Spirits	£
Stock of Cigarettes and Tobacco	£
Business Contents (ex Computers)	£
Computer Equipment	£
Tenants Improvements	£
Deterioration of Frozen Stock	£
Business Interruption / Loss of Profits	£ Estimated Gross Profit
Business Interruption Indemnity Period	Months
Book Debts	£
Cash during business hours	£	Cash in Safe	£
Turnover	£
Clerical and Sales Wages	£
All Other Employee Wages	£
Goods in Transit	£	Number of Vehicles
Legal Expenses	No Yes
Contract Cover	No Yes

Claims Last 5 Years	Date	Cause	Amount

Please use this space to tell us about any other factors that you may feel are important or may affect the opinion of underwriters in assessing the risks associated with the insurance proposed.