Discount code (if any)
How did you hear about us? Walk In Word of Mouth Leaflet Existing customer Friend or Family Email/Newsletter T.V Advertisement
Title -------- Mr Mrs Ms Miss Dr (Male) Dr (Female)
Date of Birth DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / MM 1 2 3 4 5 6 7 8 9 10 11 12 / YYYY 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Employment Status ------- Employed Unemployed Self-Employed House Person Education Retired Not employed due to illness/disability
What is your occupation?
What type of business?
Mobile / Telephone Number
Email *
House Number
House 1st line of Address:
Postcode
Year established at this address since MM 1 2 3 4 5 6 7 8 9 10 11 12 / DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / YYYY 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
House Number
House 1st line of Address
Postcode
Current/Previous Insurer --------- No Previous Insurance ACE Ageas Insurance Allianz Cornhill Insurance Plc AmTrust Europe Limited Arista Aviva Insurance Limited AXA Insurance Company Limited Brit Insurance Canopius Underwriting Ltd Chartis Insurance Chaucer Insurance Chubb Insurance Company of Europe SA CNA International Insurance Company, Birmingham Co-operative Insurance Society Limited Congregational & General Insurance PLC Covea Insurance Direct Line Insurance Limited Ecclesiastical Insurance Office Plc Groupama Insurance Company Ltd Hiscox HRKS Private Limited HSB EIL Engineering HSBC Legal & General Insurance Limited Liverpool Victoria Lloyds TSB General Insurance Markel (UK) Ltd Markerstudy Ltd MMA Insurance plc Nat West New India Assurance Company Limited NIG Novae QBE International Insurance Limited Quinn Direct Royal & Sun Alliance Royal Bank of Scotland PLC Towergate Insurance Unknown Unlisted Insurer Vasek Insurance Zurich Insurance Company
Company status --------- Individual Trading as Limited Partnership Public Limited
Business, Company or Partnership Name
Business Description? --- Adult Bookstore Amusements Antique Furniture Retailing Antique/Rare Book Retailing Antiques Retailing Aquarium Supplier Art Gallery Art Restoration Artist Materials Retailing Arts & Crafts Retailing Audio / Visual Media Retailing Baby Goods Retailing Babywear Retailing Baker Bakers Produce Retailing (excluding Baking) Bakery Basket And/Or Brushware Retailer Bathroom Equipment Retailing Beautician including Hairdressing Beauty Products Beauty Salon Bed Retailing Bedding Retailing Belts / Scarves / Gloves Retailing Bingo Hall Boat Hiring Boat Retailing Bookmaking - Off Course Bookselling Bookselling - Secondhand Boutique Bridal Wear Retailing Builders Merchant Burger Bar Butcher Café Café (ex Deep Fat Frying) Cake Making & Decorating Camping and Outdoor Retailing Candle Dealing Car Accessory Shop Car Radio Dealers inc fitting Carpet (Oriental/Persian) Retailing Carpet Retailing Cash & Carry Catering Equipment Supplying Ceramics And Pottery Chandlery Charity Shop Chauffeur Services Cheese Retailer Chemist - Dispensing Chemist - Non Dispensing Children's Clothing Retailing Children’s Play Centre China And/Or Glassware Retailing Christmas Goods Supplier Clock & Watch Repair Clock & Watch Retailing Clothing Hire - Fancy Dress Clothing Hiring Clothing Retailing Coffee And Tea Retailing Coffee Shop Coin & Medal Dealing Computer Games Retailing Computer Retailing - Business Computer Retailing - General Computer Retailing - Home & Games Computer Supplies Confectionery Retailer Consulting Optician Cosmetics Curios Retailing Cutlery Retailing Cycle Hiring Cycle Repairing Cycle Shop Dairy Products Retailing Decorators Merchant Delicatessen Department Store DIY - Including Timber DIY Store Dog Beautician Dolls/Dolls House Retailing Double Glazing & Replacement Window Showroom Draper Dress Agency Drug Store Dry Cleaning Dry Cleaning (Receiving Service) Dry Cleaning and Laundry (Receiving Service) Electric Tool Retailer Electrical Goods (Domestic) Repair Electrical Goods Hiring - Domestic Appliance Electrical Goods Retailing Electrical Goods Retailing - Domestic Appliance Electrical Goods Retailing - HI FI Audio TV etc. Electrical Goods Retailing - White Goods Engraving Fabric Retailing Fancy Goods Retailing Farm Produce Retailing Fashion Accessories Retailing Fashion Boutique Fashion Retailing Fast Food Retailing Filling Station Film Processing Financial Market Trading Fireplace Retailing Fish & Chip Shop Fishing Tackle Retailing Fishmonger Florist Food Store Footwear Retailing Forklift Driving Training Freezer Centre Frozen Food Retailing Funeral Director Fur Retailing Furniture (Flat Pack) Retailing Furniture Repairing Furniture Restoration Furniture Retailing Furniture Retailing - Fitted Furniture Retailing - Nursery Furniture Retailing - Second-hand Furrier Garden Centre Garden Equipment Retailing Garden Supplies Shop General Store Gift Shop Glass Merchant Glass or Glass Goods Decorator/ Engraver Glassware Retailer Glazier Goldsmith Golf Equipment Retailing Golf Professionals Shop Gown Trade Greengrocer Greeting Card Retailing Grocer Grocer - Licensed Guest House Gun Retailing Gunsmith Haberdashery Hairdressing Hairpiece And Wig Retailing Handicraft Retailing Hardware Retailing Hatter Health Food Retailer Herbs and Spices Retailing Hobby Shop Home Brew Materials Retailing Horticultural Goods Retailing Hosiery Hotel Household Goods Retailing Ice Cream Parlour In Car Entertainment Retailing Industrial Safetywear Retailing Interior Designer including fitting Internet Cafe Intruder Alarm Retailing Ironing Service Ironmonger Jewellery Retailer Key Cutter Kitchen Accessories Retailing Kitchen/Bathroom Unit Showroom Knitting Machine Shop Knitwear Retailing Lamp Shop Launderette (attended) Launderette (unattended) Leather and Travel Goods Leather Clothing Retailing Leather Goods Retailing - Excluding Clothes Leather Goods Retailing -Including Clothes Leisurewear Retailing Light Fitting Retailing Lighting Retailing Linen Hire Linen Retailing Lingerie Retailing Locksmith Lottery Agent Luggage and Handbag Retailing Marine Stores Maternity Wear Retailing Meat Market Menswear Retailer Millinery Mini Cab Operator Mobile Phone Retailing Mobile Shop Model Shop Motor Accessories Retailing Motor Accessories Retailing (excl In-Car Entertainment) Motorcycle Accessories Retailing Music Retailing Musical Instrument Retailing Nail Technician Newsagent Novelty/Carnival Goods Retailing Nursery Goods Shop Off Licence Office Equipment Supplier (excluding Electrical) Office Equipment Supplier (including Electrical) Office Furniture Retailing Office Supplies Retailing Optician Organic Foods Retailing Orthopaedic Equipment Retailer Paint And/Or Wallpaper Retailing Pawnbroking Pens Retailing Perambulator Retailing Perfume Retailing Pet Accessory/Food Store Pet Parlour Pet Shop Petrol Station Pharmaceutical Wholesaler Pharmacy Photo Engraving Photo Processing And Printing Photocopying Photographic Equipment Retailing Photographic Studio Piano Retailing Piano Retailing And Repair Picture Framing Picture Shop Pine And Cane Furniture Retailing Pizza Delivery Plumbers Merchant Pool and Snooker Table Retailing Post Office Post Office - Sub Post Office Services Pottery Poultry And Game Retailing Print Shop Public House Record CD Cassette & Video/DVD Retailing Record Shop Restaurant - Licensed Restaurant - unlicensed Rope Merchant Saddlery And Tack Retailing Safety Equipment Supplier Sailing Equipment Supplier Sandwich Bar Scientific Instrument Retailing Scrap Metal Merchant Second-hand Dealing Sewing Machine Shop Sex Shop Sharpening Service Shirt Retailing Shoe Repairing Shoe Retailing Silversmith Silverware Retailing Sofa Bed Retailing Soft Furnishings Retailing Souvenir Retailing Sports Goods Retailing Sportswear Supplier Stamp Collecting Retailer Stationer Street/Market Trading Supermarket Surgical Equipment Retailer Sweet Shop Tableware Retailer Tailor And Outfitter Take Away Food Retailer Takeaways Tea Room Telecommunication Equipment Supplier Telephone Sales Retailing Television Hiring Television Repairing Television Retailing Textile Retailing Tile Retailer Tobacconist Toiletries Retailing Tool Hire Tool Hire - Hand Tool Hire - Power Driven Tool Retailer Toy And Game Retailing Trophy Retailing Turf Accountant TV & Video Repairing TV And Radio TV And Video Rental Tyre Battery & Exhaust Retailing/Fitter Undertaker Upholstery Venetian Blind Supplier Video/DVD Hire Wallpaper Shop Watch And Clock Retailing Wine Retailer Wool And Needlework Shop Woollen Goods Shop Yacht Chandlery Others
Please specify the business type
What date was your business established? MM 1 2 3 4 5 6 7 8 9 10 11 12 / DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / YYYY 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Total number of employees including partners, principals and directors
What is your Estimated Annual Turnover?
What is your Estimated Annual Wages?
If your business is a restaurant or takeaway, what is your food hygiene rating?
Where is your premises located? ----------- Arcade Business Park Covered Shopping centre Domestic Premises High Street In Building Otherwise Occupied As Dwellings Industrial Estate Industrial Unit Market Hall On Office Premises Parade Precinct Warehouse
What are the opening hours for your business?
Any CCTV camera inside this premises Yes No
Is this premises entitled as a listed building? Yes No
The roof of this premises, is it flat or slope?
The floor, is it made of concrete or wood?
The walls, are they made of bricks or wood?
Does anyone live upstairs and if yes who are they?
The back door, is it secured enough, any shutters or grilled
When is the premises occupied? ---- 24 Hours Business Hours Unoccupied
Does the property have a roller shutter which covers all ground floor exposed glazing? Please select Yes No
Does the property have grilles fitted which cover all ground floor exposed glazing? Please select Yes No
Do you have any sort of alarm in the premises? Please select Yes No
If yes, Type or name/brand of the alarm?(Please specify in the box)
Does the alarm notify you along with police or only you?
Is the alarm being checked regularly by any organization? Please select Yes No
Do you have use of kitchen in the premises for commercial use? Please select Yes No
Percentage of collection: (Please specify in the box)
How many persons could be dined at a time?
Is your fryer a standing fryer or just a small basket fryer?
Maximum how many liters of oil the fryer can occupy?
Is the Premises’ Owned / Leased / Rented by you?
What’s the maximum cash amount to be covered during the business hours?
Wines, Fortified Wines and Spirits sum insured amount
Cigarettes, Cigars and tabacco sum insured amount
Other Stock (other than target stock shown above) to be insured
Frozen items to be insured
Contents (If any Till, Computers & other electrical Equipment’s) sum insured amount
Contents (Fixtures & Furniture’s) sum insured amount
Please provide your Employer Reference Number
When would you like your policy to start MM 1 2 3 4 5 6 7 8 9 10 11 12 / DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / YYYY 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Name of your last insurer
Renewal quote from your insurer
Additional comments:
