Business Category* Select... Advertising & Marketing Architects & Engineers Bed & Breakfast, Guest House, Hotel Computer & IT Construction / Building Consultancy Occupations Entertainment, Leisure & Arts General Tradesman Health / Beauty Legal & Financial Shop, Pub & Restaurant Surveyors & Property Services Medical & Dental Professions other

Do you have a secondary Trade/Business?* No Yes

Is your Business a* Select... Sole Proprietor Partnership Limited COmpany

Where do you work from* Select... Home Business Premises

Do you have employees (Including subcontractors)?* No Yes

Public / Product Liability.* No Yes Not Sure

Cover Required* Select... £1,000,000 - £2,000,000 £2,000,000 - £5,000,000 £5,000,000 - £10,000,000

Cover for defective advice (Professional Endemnity).* No Yes Not Sure

Cover Required* Select... £50,000 - £100,000 £100,000 - £250,000 £250,000 - £500,000 £500,000 - £1,000,000 £1,000,000 - £2,000,000 £2,000,000 - £5,000,000 £5,000,000 - £10,000,000

Is buildings cover required for your home or place of business?* No Yes Not Sure

Buildings sum insured required? (Cost to rebuild in the event of total loss)* £

Business or Office Equipment.* No Yes Not Sure

Cover Required* Select... £2,500 - £5,000 £5,000 - £7,500 £7,500 - £10,000 £10,000 - £15,000 £15,000 - £20,000 £20,000 - £25,000 £25,000 - £50,000 £50,000 - £100,000 £100,000 - £200,000

Stock Insurance.* No Yes Not Sure

Cover Required* Select... £2,500 - £5,000 £5,000 - £7,500 £7,500 - £10,000 £10,000 - £15,000 £15,000 - £20,000 £20,000 - £25,000 £25,000 - £50,000

Business Interruption   
(Revenue Protection).* No Yes Not Sure

Cover Required* Select... £50,000 - £100,000 £100,000 - £150,000 £150,000 - £200,000 £200,000 - £250,000

Position* Select... Director/Owner Senior Manager Middle Manager Junior Manager Supervisor Assistant Admin Regular Employee Junior Employee Other

Title* Select... Mr Mrs Ms Miss Dr Other

First Name*

Last Name*

Business Address*

Business Postcode*

Telephone*

Mobile*

Email*