Proposer's Details

  Your Name

 Address

 Town / City

County

  Postcode

Full Business Description

Risk Details - Sums Insured & Limits Required 

 Buildings Sum Insured

  Machinery / Plant,

All other Contents sum Insured

Stock Sum Insured

 £

Rent Sum Insured

£

Rental Indemnity Period Required

Estimated Gross Annual Profit

 Indemnity Period Required

 Book Debts Sum Insured

 Frozen Foods Sum Insured

Money & Cash

Money in the business when closed for business stored in a locked safe or strongroom.

 Money in the business when closed for business NOT stored in a locked safe or strongroom.

  Money stored at the Private residence of the Assured.

Limit for any other loss.

Estimated Annual Carryings

£

Goods In Transit

Limit to any one Package.

Limit to any One Consignment

  Limit to any One Vehicle

Limit to any One Loss

(Excluding Road Carriers)

£

 Limit Any One Road Carrier

 Total Annual Sendings

Liability Section

Clerical & Non-Manual

 Machinists

Warehousemen

 £

 All Others

 Public Liability Limit required

any one accident, unlimited during currency

 Estimated annual turnover

 Product Liability limit required

any one accident, and in the aggregate

 Percentage of turnover exports to the USA/Canda

 Percentage of Exports to the rest of the World

General Information

Details of any claims in the last 5 years, including outstanding claims

 Underwriting information, details to include fire and theft protections, and all information which might be considered as material information

Target Premium

  £

  Renewal Date

(In "dd / mm / yyyy" format eg. Xmas is 25 /12 /1998)

Thank you for taking the time to complete this insurance quotation form. Any additional information, such as insurance claims against you or special terms applied, can be E-mailed or faxed to us. The more information you can provide the better the terms you will obtain.

To submit the details and receive an Insurance Quotation, please click the "Submit" button below.

Please be assured that your details will only be stored for the express purpose of providing an insurance quotation, and these details will not be passed to any third party, as in accordance with the Data Protection Act.