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Proposer's name: |
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Trading name (If Applicable): |
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Address of premises to be insured: |
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Risk postcode: |
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Type of shop: |
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How many years have you been in
business (at this address): |
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How many years have you been in
business (in this trade): |
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What are the shop opening
hours?: |
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About The
Property |
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What cover do you require: |
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If buildings cover is required, What Sum Insured?: |
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Do you require cover for
subsidence, heave & landslip: |
Yes
No
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Is The
Building.... (Please Complete
Even If Only Insuring Contents) |
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Constructed of brick, stone or
concrete & roofed with slates or tiles with no flat roof?: |
Yes
No |
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Maintained in a good state of
repair?: |
Yes
No |
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Occupied by you in connection with
your business?: |
Yes
No |
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Heated by low pressure hot water
apparatus,
fixed gas appliances or fixed electrical appliances?: |
Yes
No |
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Alarmed?: |
Yes
No |
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If YES, Is
it a NACOSS approved alarm?: |
Yes
No |
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If the answer is 'NO' to any
of
the above, please give details here:
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About
The Contents
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Please Give The Sum Insured
Required For Each Category. |
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Category |
Sum insured (£)
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Fixtures, fittings & all
contents excluding items listed below: |
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Electronic & computer equipment: |
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Stock (excluding items below): |
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Refrigerated stock: |
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Tobacco, cigarettes, cigars &
lighters: |
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Wines & spirits: |
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Clothing: |
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Jewellery, precious metals or stones: |
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Video equipment, cassettes, discs,
computer or video games: |
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Goods in transit: |
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Glass (Shop front): |
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Business interruption
(Estimated 'Net Takings' for next 12 months): |
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Business money: |
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Is legal expenses cover
required?: |
Yes
No |
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More About The Insured And
Premises |
| Has
the insured or any director or partner
incurred any loss, destruction or damage, or had any claim made against
them in the last 5 years?: |
Yes
No |
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Has the Insured or any director
or partner been declared bankrupt, insolvent, been convicted of or has any
prosecution pending for arson or any offence involving dishonesty of any
kind?: |
Yes
No |
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Has any previous insurer
declined a proposal, refused to renew a policy or imposed any special
terms or conditions?: |
Yes
No |
| Does
the insured undertake to work away from
the premises?: |
Yes
No |
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Are the premises in an area
which is exposed to damage by storm, flood, subsidence, heave or landslip,
or near a river, sea, watercourse, cliff or quarry?: |
Yes
No |
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Is there a safe at the
premises?: |
Yes
No |
| Does
any other business occupy or operate from
these premises?: |
Yes
No |
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If the answer is 'YES' to any of
the above, please provide full details in this box: |
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Current insurers (If
applicable): |
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Renewal/Start date: |
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Renewal/Target premium: |
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Email address:
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Telephone number:
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Preferred choice of contact:
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Preferred payment method:
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