General:
| |
| Company Name: | |
| Address 1: | |
| Address 2: | |
| Post Code: | |
| Telephone: | |
| E-mail: | |
| Business description: | |
Type of Firm:
| |
| | Limited Company |
| | Partnership |
| | Sole Trader |
| | Other |
| If 'Other' please specify: | |
| When established: | |
| Annual Turnover: | £ |
| Have you had any claims in the last 5 years: | Yes
No |
| If Yes, please give details: | |
Premises:
| |
| Are the above your only business premises? | Yes
No |
If No, how many premises do you use?
(Please submit a seperate form for each of your premises) | |
| Are your premises detached? | Yes
No |
| Non combustible construction? | Yes
No |
| Combustible roof % | |
| Combustible Linings % | |
| Are fire extinguishers regularly serviced? | Yes
No |
| Do you have a fire alarm? | Yes
No |
| Do you have an intruder alarm? | Yes
No |
| Type of signalling - | Redcare
Other Monitored
Dialler
Bells only |
|
Do you have portable heaters | |
| In office areas only | Yes
No |
| Elsewhere | Yes
No |
| Do your premises have an IEE Certificate? | Yes
No |
Sums Insured:
| |
| Buildings | £ |
Stock of High Risk Items
(Cigarettes, tobacco, wines, spirits, precious metals and stones, non-ferrous metals & portable hand tools) | £ |
| Other Stock | £ |
| Computers & Electrical Office Equipment | £ |
| Portable Hand Tools | £ |
| Other Business Equipment | £ |
| 12 Months Gross Profit | £ |
| Buildings | £ |
| Do you require a longer indemnity period? |
|
| Maximum amount of outstanding debit balances | £ |
| Annual amount of cash in transit | £ |
| Maximum amount on premises or in transit | £ |
| Maximum amount in safe | £ |
| Maximum amount on any one vehicle | £ |
| Number of vehicles operated by you | |
| Public Liability limit of indemnity required |
|
Activities:
| |
| Clerical, Admin & Sales only |
No of employees
Annual wage roll £ |
| Employees working at your premises |
No of employees
Annual wage roll £ |
| Employees working away from your premises |
No of employees
Annual wage roll £ |
| N.B. if you use labour only subcontractors these must be treated as employees. |
| Percentage of Turnover from E.C. | % |
| Percentage of Turnover from USA/Canada | % |
| Percentage of Turnover from Rest of World | % |
| Do you use fixed woodworking machinery? | Yes
No |
| Annual wage roll for such employees | £ |
| Do you use heat equipment away from your own premises? | Yes
No |
| Annual wage roll for such employees | £ |
Are your products used or do you work in manufacturing premises for the following industries:
Petrochemical, Pharmaceutical, Aviation, Marine, Automotive, Oil, Gas or Nuclear? | Yes
No |
Your name: |
Position:
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