Lloyd Manley Associates - Office and Surgery Enquiries

Please complete the following Office and Surgery Enquiry form

General:
Company Name:
Address 1:
Address 2:
Post Code:
Telephone:
E-mail:
Business description:
Type of Firm:	Limited Company
	Partnership
	Sole Trader
When established:
Annual Turnover:	£
Have you had any claims in the last 5 years:	Yes No
If Yes, please give details:
Premises:
Are your premises detached?	Yes No
Are you the only occupant?	Yes No
Non combustible construction?	Yes No
Do you have an intruder alarm under your sole control?	Yes No
Sums Insured:
Buildings:	£
Deeds, documents, photographs and computer software:	£
Stock of samples:	£
Computers & Electrical Office Equipment:	£
Other Business Equipment:	£
Trade Specific Questions:
Do you require cover for work away from your premises other than non manual visits?	Yes No
Loss of Revenue:
Do you need an indemnity period longer than 12 months?	Yes No
If 'Yes', how long:
Your name:	Position:

Authorised and Regulated by the Financial Services Authority for General Insurance Business No. 302600