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 *          High Value Stock **        
All other stock                        Computers             
Tenants Improvements          Shop fronts             

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

Section 3 Loss of Money  -  Required? 

Section 5  Business Interruption   -  Required?   
The profit you would lose if unable to trade for up to 24 months

Sections 6 & 7 Employer's / Public / Products Liability
How many hairdressers work on the premises? 

Employer's Liability £10,000,000         
Public / Products Liability £2,000,000 

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

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 © 2004 [Harvington Underwriting Ltd]. All rights reserved.
Revised: December 20, 2006 .