Business Category* Select... Clothing & Textiles (inc hire shops) Stationery, Business Supplies & Arts Jewelry Hair & Beauty Medical Related Food & Drink General Store Household & Domestic Goods Furniture Shop Electrical Goods Locksmiths Pharmacy Pub, Bar, Restaurant or Cafe News & Confectionery Building/Construction related Professional Services Sports, Health & Fitness Computers, Toys & Games Charity/Non-Profit Music & Film (inc Rental Shops Other
Do you have a secondary Trade/Business?* No Yes
Is your Business a* Select... Sole Proprietor Partnership Limited COmpany
Turnover Band* Select... < 20,000 20,000 - 50,000 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 - 3,000,000 3,000,000 - 4,000,000 4,000,000 - 5,000,000 5,000,000 +
Do you have employees (Including subcontractors)?* Yes No
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 Front of Premises.* No Yes Not Sure
Sum Insured* £
Is buildings cover required?* No Yes Not Sure
Buildings sum insured required? (Cost to rebuild in the event of total loss)* £
Is Contents cover required?* No Yes Not Sure
Cover Required? (excl Stock)* £
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*
