Have you read, understood and agree to our terms and conditions? *
Yes
No
Full Name * When is your renewal date? * Company Name or Trading Name? * Business Address * Postcode * Main Contact Phone Number * Secondary Phone Email Address * Company Type? * Soletrader Partnership Limited Company Company Turnover * Your Current Insurer Current Premium Is theft cover required *
Yes
No
Is Accidental Cover Required *
Yes
No
Is Terrorism Cover Required *
Yes
No
Contents, trade fixtures and fittings, machinery, plant £ General Stock £ Buildings, fixtures and fittings £ Loss of Rent £ Is Subsidence, Heave or Landslip Cover Required
Yes
No
Indemnity Period 12 months 24 months All Risks to Business Machines Offsite £ Neon signs, facia boards and canopies £ Business Interuption £ Indemnity Period Business Interuption 12 months 24 months Goods In Transit £ Breakage of Glass Includes all external and internal glass £ Loss Of Money whilst in transit or on the premises £ Whilst in a safe outside business hours £ Whilst in a till, or outside a safe, outside business hours £ Whilst at principles private residence £ Loss or damages to safes £ Personal Assault extension death or permanant total disablement £ Temporary total disablement £ Public and Products Liability Amount £ 1,000,000 2,000,000 5,000,000 10,000,000 Employers Liability £10,000,000 Cover
Yes
No
Wages Clerical £ Wages Manual Workers £ Wages Directors Manual £ Wages Directors Non Manual £ Payments made to Bonafide Sub-Contractors £ Payments made to Labour Only Sub Contractors £ Percentage of turnover is work carried out offsite Are all external doors secured with at least one key operated Yale lock
Yes
No
Are all external doors secured with at least 1, 5 lever mortice deadlock
Yes
No
Are all external windows secured with key operated window locks
Yes
No
Are all accessible windows protected by solid steel bars or grilles
Yes
No
Are all shop front windows protected by metal roller shutters
Yes
No
Is there an annually maintained intruder alarm
Yes
No
If yes is the alarm Redcare Bells Only NACOSS Approved Connected to station control Is there any other security protection Is there a health and safety policy in place *
Yes
No
Are regular risk assessments carried out *
Yes
No
Is there any heat work away from your premises *
Yes
No
Is Personal protective equipment handedout to all staff and a signed record kept *
Yes
No
Does the manufacture involve any Plastic Moulding *
Yes
No
Does the manufacture involve assembly only * Work Away from the Premises Wages figure 
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