Business Insurance Leave this field blank Broker Full Name (optional) Mobile (optional) Email (optional) Applicant Full Name Applicant (DOB) ? Owner Mobile Email What Type of Business? Business Address & Post Code Correspondence Address & Post Code (optional) Trading Name (if different) Business Start Date Eat in % ? (optional) Takeaway % ? (optional) LTD Name ? (optional) LTD Number ? (optional) Current Insurer ? Food and hygiene Rating * Property Description ? Property Type ? Choose Semi Detached Bunglow Terraced Flat Roof Type Choose Gable Flat Shed Roof Maintained By ? Choose Landlord Leaseholder Agent Tenant Property Managing by Choose Landlord Leaseholder Agent Tenant Purchase Price £ Purchase Date ? Rebuilt Cost £ Built Year ? Any tenant Above? Type of Tenant ? Any Relationship with Tenant ? Yearly Rent cover £ (optional) Tenant agreement with ? (optional) Business Managed By Rent paid by ? (optional) Important Information Must fill if cover required Subsidence Cover? (optional) Accidental Damage Cover ? (optional) Terrorism Cover ? (optional) Legal Expenses Cover ? (optional) Type of Alarm? Alarm Company? ATM on the Premises Money Exchange (optional) Alarm Connection Type Choose Central Station Red Care Direct Police Private Mobile/GSM Bells Only Alarm N/A Alarm provider Approved By Choose NSI SSAIB NACOSS N/A Multi Tenant Choose Yes No Total Staffs Choose 1-5 5-10 10-20 20-30 Insured Item in £ Your premium is calculated based on your individual circumstances and the amount of cover you choose to take out to protect your business. Underinsurance occurs when you’ve not taken out the right amount of insurance cover for your needs. There will be a variety of factors to take into account when you assess how much insurance you need. If you’re not sure about this you should get advice from a broker or valuation expert because if that amount is wrong, it’s likely to impact the amount you’re paid for any claim you need to make. Buildings £ Tenant`s Improvements £ Loss of Rent £ Fixtures and Fittings £ Floor Type? Shutters type ? Shutters Cover £ Front Glass £ External Signs £ (optional) Computer Equipment £ (optional) General Stock £ (optional) Wines/Spirits £ (optional) Cigarettes/Tobacco £ (optional) Goods in Transit £ (optional) Do you have locker? Money In Locked Safe £ (optional) Money in Transit £ Till Money £ (optional) Bank Night Safe £ How Many Tills ? CCTV ? Working Hour Public Liabilities Insurance Employers Liabilities Insurance Claim Information including NCB ** Policy Start Date (optional) Policy End Date (optional) Renewal offered Target Amount Additional Information to support the application (optional) Consent By ticking this box, I confirm that the client(s) have confirmed that they want to receive emailed information / advice about relevant relevant services and have given their consent to do so. By ticking this box, I confirm that the client(s) have confirmed that they have authorised me to pass their personal information to Businessxbridge for advice about relevant services and have given their consent to do so. By ticking this box,I confirm that the client(s) have confirmed no Bankruptcy proceedings? IVA? CVA? Assignment for the benefit of a creditor? Any pending or recently filed claims or judgments (including CCJs)? If yes, please also provide details in Additionally. IMPORTANT NOTICE: Failure to disclose material facts could result in your contract being invalidated/cancelled, a claim not being paid or difficulty in obtaining insurance in the future. If you are in doubt as to whether a fact is material you should disclose it. A copy of this proposal form is available on written request within three months from the date of this proposal. Full details of the cover provided appears in the policy document, a copy of which is available on request. Telephone calls may be recorded for security and training purposes Submit