Name of Company      

Address of Company

Post Code                     

Nature of business     Sole Trader Partnership Limited Company Other      

Trade or Occupation 

How many years have you operated from your current address?  0 1 2 3 More than 3

Section 1 Trade Contents
Fixtures and fittings *               
Tobacco / Cigarettes           Wines / Spirits          
All other stock                        Computers             
Tenants Improvements          Shopfronts              
*(Machinery, plant, furniture, telephones, signs, grilles etc.)

Section 2  Fixed Glass - Required? 
External and Internal Fixed Glass      Plate Glass Shop Front 
(excluding plate glass)

Section 3 Loss of Money  -  Required? 

Section 4 Deterioration of Frozen Foods -  Required?      
Max £750 per cabinet 

Section 5  Business Interruption   -  Required?   

Sections 6 & 7 Employer's / Public / Products Liability
Employer's Liability £10,000,000         
Public / Products Liability £2,000,000 

Section 8 Buildings  -  Required? 
Rebuilding Cost                
Loss of Rent (12 months)   

General Information
Do you have a deep frying range?  Yes No

If so, are your extractor fans, vents and ducts regularly cleaned?  Yes No

Is your alarm system NACOSS approved and No alarm fitted Bells only Monitored by Redcare or similar

Do you require Personal Accident cover? 
Click here for details of our group and individual personal accident policies

Has your business been involved in any incidents in the last 5 years which did or could have given rise to a claim of a type which this insurance is intended to cover?           Yes No    

Date from which you need cover to start (dd/mm/yyyy)

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Copyright © 2005 Harvington Underwriting Ltd]. All rights reserved.
Revised: December 20, 2006 .